Beyond the Stressor: Vulnerability and Difficulties in Stress Regulation in Takotsubo Syndrome: A Retrospective Cross-Sectional Study

Objective: Takotsubo syndrome (TTS) is a condition frequently triggered by physical or emotional stressors that predominantly affects postmenopausal women. The aim of this study was to investigate whether the psychological profiles of patients with TTS differ from those of healthy individuals and patients with acute myocardial infarction (AMI). Methods: This retrospective, multicenter cross-sectional comparative study was conducted in four hospitals in Spain. A total of 119 participants were included: 46 patients with TTS, 34 patients with AMI, and 39 healthy controls. The mean age of the sample was 67.5 years (standard deviation [SD] = 10.15). Participants in both control groups were recruited using a sex and age (± 3 years) matching strategy with the TTS group as the reference. Qualitative variables were analysed using Chi-square tests, and quantitative variables were examined using analyses of variance (ANOVA) and complementary analyses of covariance (ANCOVA) adjusting for educational level. Assessments were conducted between June 2018 and December 2024. Results: There were no differences in most psychological variables. Patients with TTS showed higher overall emotional dysregulation, particularly in emotional lack of control, anger-in and vulnerability-related personality traits compared with healthy controls and presented significant differences in social inhibition compared with AMI participants in unadjusted analyses. After adjustment for educational level, vulnerability remained the most consistent psychological variable associated with TTS, whereas several emotion-related differences were attenuated. Conclusion: TTS showed a psychological profile characterized by emotional vulnerability and difficulties in emotion regulation. These findings support the potential relevance of integrating psychological assessment and emotion regulation strategies into the clinical management of TTS.