Validity of the M Test: simulation-design and natural-group approaches

The utility of the M Test (Beaber, Marston, Michelli, & Mills, (1985) as a screening measure for malingering was assessed using simulation-design (subjects asked to fake mental illness) and natural-group (forensic assessment cases suspected of malingering) approaches. A total of 318 subjects from community, clinical, and correctional settings completed the M Test under instructions to respond honestly or to simulate a major mental disorder. A factor analysis of the M Test items supported the original rationally based scale assignment, and the scales were found to have adequate internal reliability. To examine the predictive validity of the M Test, results revealed that sensitivity using the cutting scores suggested by Beaber et al. (1985) was much higher for simulating subjects (79.8%) than for the suspected malingerers (40.0%). The findings emphasize the danger of exclusive reliance on simulation studies for validating measures of malingering. It was concluded that, in its present form, the M Test does not constitute a good screening measure for assessing malingering.

Multidimensionality of state and trait anxiety: factor structure of the Endler Multidimensional Anxiety Scales

The Endler Multidimensional Anxiety Scales (EMAS) are derived from an interactional model of personality that proposes that anxiety is a function of the interaction of person and situation variables. The EMAS distinguish between state and trait anxiety and assume that both are multidimensional constructs. The EMAS were administered to 2,009 students in a neutral situation. Three factor analyses were performed to clarify the empirical relation between state and trait anxiety and the variables within the 2 domains. Results support the distinction between state and trait anxiety. Factor analysis of the state items provided support for the separate dimensions of cognitive and autonomic state anxiety. Factor analysis of the trait items provided support for trait anxiety multidimensionality. Four congruent factors were associated with increases in state anxiety in 4 general situations: Social Evaluation, Physical Danger, Ambiguous, and Daily Routines.

Problems with measuring alexithymia

Research evaluating the relationship of alexithymia to medical and psychiatric disorders has been compromised by the poor psychometric properties of the instruments that have been used to measure alexithymia. This study evaluated the psychometric properties of a recently introduced measure of alexithymia--the revised Schalling-Sifneos Personality Scale (SSPS-R). While the factor structure of the SSPS-R was found to be reasonably congruent with the theoretical domains of the alexithymia construct, the scale lacked homogeneity and internal reliability. These results are compared with the reliability and validity of other available measures of alexithymia. Recommendations are offered for the improved assessment of alexithymia in future research studies.

The alexithymia construct. A potential paradigm for psychosomatic medicine

During the past decade, the alexithymia construct has undergone theoretical refinement and empirical testing and has evolved into a potential new paradigm for understanding the influence of emotions and personality on physical illness and health. Like the traditional psychosomatic medicine paradigm, the alexithymia construct links susceptibility to disease with prolonged states of emotional arousal. But whereas the traditional paradigm emphasizes intrapsychic conflicts that are presumed to generate such emotional states, the alexithymia construct focuses attention on deficits in the cognitive processing of emotions, which remain undifferentiated and poorly regulated. This paper reviews the development and validation of the construct and discusses its clinical implications for psychosomatic medicine.

Reassessing the validity and reliability of the MMPI Alexithymia Scale

In the past decade, alexithymia has emerged as a heuristically useful personality construct used to explain the pathogenesis of a variety of physical illnesses, including classical psychosomatic diseases, somatization disorders, hypochondriasis, and somatoform pain disorders. Unfortunately, research evaluating the alexithymia construct has been conducted with little attention to assessing the psychometric properties of various scales used to measure it. In two separate studies, we examined various scale and item properties as well as the factor structure and validity of the Minnesota Multiphasic Personality Inventory Alexithymia Scale (MMPI-A), one of the most commonly used scales to assess alexithymia. In Study 1, the 22 items that comprise the MMPI-A were extracted from a computerized MMPI data bank which included separate samples of psychiatric inpatients and outpatients. Poor item-to-scale characteristics and only moderate levels of internal reliability were found for both samples. Factor analysis produced factors that were poorly related to the theoretical domains of the alexithymia construct. In Study 2, we found little support for validity of the scale as those patients identified as alexithymic and nonalexithymic by the MMPI-A did not differ on several theoretically relevant scales. These results question seriously the value of the MMPI-A in investigating the alexithymia construct.

Dimensional analysis of the MMPI Alexithymia scale

Recently, the alexithymia construct has emerged as a heuristically useful personality construct in the explanation of the pathogenesis of a variety of physical illnesses. Research that has evaluated the alexithymia construct, however, has been conducted with little attention to the psychometric properties of the various scales constructed to measure it. This study investigated the underlying dimensions and factor structure stability of the MMPI Alexithymia scale (MMPI-A). The MMPI-A was administered to 552 undergraduates, and the data then were split randomly into two samples. Factor analysis of both samples produced a three-factor solution with little theoretical relevancy to the alexithymia construct. Comparisons of the factor structures from the two samples revealed only moderate congruence, which indicates an unstable factor structure.

Decision making in psychiatric civil commitment: an experimental analysis

OBJECTIVE

Legislation in Canada and the United States that was intended to decrease the use of civil commitment has resulted in a paradoxical increase in involuntary hospital admissions. To elucidate the reasons for this increase, this study was designed to assess the relative importance of various factors involved in the decision to commit a patient.

METHOD

All psychiatrists in Ontario were sent a questionnaire asking them to make commitment decisions based on hypothetical case vignettes. Four factors were systematically varied in the vignettes: the patients' legal commitability, clinical treatability, alternative resources, and psychotic symptoms. Completed questionnaires, with three vignettes each, were returned by 495 respondents.

RESULTS

All four variables were statistically significant in the expected direction; legal commitability (i.e., dangerousness to self and/or others, inability to care for self) and presence of psychotic symptoms accounted for the majority of the variance in the final decision to commit.

CONCLUSIONS

These results suggest that psychiatrists in Ontario rely primarily on legally mandated factors (i.e., psychosis and dangerousness) in making their decisions to commit, although a considerable amount of individual variation is also evident.

Multidimensionality of state and trait anxiety: Factor structure of the Endler Multidimensional Anxiety Scales

The Endler Multidimensional Anxiety Scales (EMAS) are derived from an interactional model of personality that proposes that anxiety is a function of the interaction of person and situation variables. The EMAS distinguish between state and trait anxiety and assume that both are multidimensional constructs. The EMAS were administered to 2,009 students in a neutral situation. Three factor analyses were performed to clarify the empirical relation between state and trait anxiety and the variables within the 2 domains. Results support the distinction between state and trait anxiety. Factor analysis of the state items provided support for the separate dimensions of cognitive and autonomic state anxiety. Factor analysis of the trait items provided support for trait anxiety multidimensionality. Four congruent factors were associated with increases in state anxiety in 4 general situations: Social Evaluation, Physical Danger, Ambiguous, and Daily Routines.

A preliminary investigation of alexithymia in men with psychoactive substance dependence

The prevalence of alexithymia in a group of newly abstinent male substance abusers (N = 44) was 50%. The alexithymic patients had significantly less ego strength and repressive defensive behavior and significantly higher levels of somatic complaints and general dysphoria.

Validation of the alexithymia construct: a measurement-based approach

Alexithymia is a hypothetical personality construct that has been associated with a variety of medical and psychiatric disorders. This article reviews a program of research evaluating the validity of the construct using a measurement-based, construct validation approach. For this purpose the Toronto Alexithymia Scale (TAS) was developed. In a series of studies the TAS demonstrated internal consistency, good test-retest reliability, and a stable factor structure theoretically congruent with the alexithymia construct. In separate tests of construct validity, the TAS correlated in a theoretically meaningful fashion with measures of other constructs. Criterion validity was supported by a study in which the TAS was able to discriminate between behavioural medicine outpatients designated as alexithymic and those designated as nonalexithymic on the basis of objectively rated structured interviews. In a normal adult sample, TAS scores were not related to sociodemographic variables or intelligence. These results provide considerable empirical support for the validity of the alexithymia construct. In addition, the TAS appears to be a psychometrically sound measure of alexithymia that may prove useful in testing the construct with psychiatric and medical patient populations.

Cross-validation of the factor structure of the Toronto Alexithymia Scale

The Toronto Alexithymia Scale (TAS) is a self-report measure of the alexithymia construct. In previous studies with college students, the TAS demonstrated excellent psychometric properties including a 4-factor structure theoretically congruent with the alexithymia construct. The present study attempted to cross-validate the factor structure of the TAS with samples of normal adults, psychiatric outpatients and college students. Congruence coefficients comparing the similarity of the factor structures for these three samples indicated good congruence for all four factors. The results provide further support for the validity of both the TAS and the alexithymia construct. In addition, the results provide evidence of the applicability of the scale to normal adult and clinical samples.

Diagnostic legitimacy of factitious disorder with psychological symptoms

The authors question the clinical status of factitious disorder with psychological symptoms as a mental disorder. In particular, they argue that unresolved issues regarding the motivational basis of this disorder and the lack of clearly delineated inclusion, exclusion, and outcome criteria seriously compromise its diagnostic legitimacy. Two case reports are presented to illustrate these difficulties. Future studies should consider these empirical and conceptual difficulties in refining the diagnosis of factitious disorder with psychological symptoms for DSM-IV.

The alexithymia construct: relationship with sociodemographic variables and intelligence

Conflicting results have been reported in studies examining the relationships between alexithymia and the variables of age, gender, social class, and intelligence. Moreover, these results are of dubious validity and generalizability because many of the studies used psychometrically poor scales to measure the alexithymia construct. The present study reexamined the relationships between alexithymia and sociodemographic variables and intelligence in a sample of normal adults using the Toronto Alexithymia Scale (TAS), a recently developed self-report measure with evidence of reliability and validity. The results indicate that alexithymia, as measured by the TAS, is not associated with age, gender, educational level, socioeconomic status, and intelligence.

Measurement of alexithymia. Recommendations for clinical practice and future research

The clinical assessment of alexithymia and research investigating its neurobiologic correlates require standardized assessment instruments. Observer-rated questionnaires, self-report scales, and projective techniques are currently available for measuring alexithymia, but most of these lack adequate reliability and validity. The Toronto Alexithymia Scale appears to have excellent psychometric properties, but a multimethod, multimeasure approach will enhance both measurement and further evaluation of the alexithymia construct.

Criterion validity of the Toronto Alexithymia Scale

The criterion validity of the Toronto Alexithymia Scale (TAS) was assessed by administering the scale to 46 patients referred to a behavioral medicine outpatient clinic. Clinical ratings derived from observed interviews served as the criterion. TAS scores were significantly higher for the group of patients identified by two out of three raters as "alexithymic" than for the group identified as "nonalexithymic." On the basis of these findings, preliminary TAS cutoff scores were suggested. The results from this study and from previous investigations assessing the reliability and construct validity of the TAS indicate that it is currently the psychometrically best-validated measure of alexithymia. Further refinement and cross-validation with other clinical samples are recommended.

Construct validity of the Toronto Alexithymia Scale

Previous reports have documented the development of the Toronto Alexithymia Scale (TAS) in addition to evaluating its reliability and validity. The present paper describes two studies designed to further evaluate the construct validity of the TAS. In Study I 117 university students completed the TAS and the three subscales of the Short Imaginal Processes Inventory. In Study II 74 students completed the TAS and measures of ego strength, anger expression, and physical symptoms. In both studies the pattern of correlations between the TAS and the various psychological measures converged and diverged in a theoretically meaningful fashion, providing further evidence for the validity of the TAS and of the alexithymia construct.

Alexithymia: a comparative study of three self-report measures

This study evaluates and compares the psychometric properties of the three self-report measures of alexithymia - a hypothetical personality construct thought to be associated with hypochondriasis, somatization disorder and a variety of other medical and psychiatric disorders. Two hundred and nine college students were administered the Schalling-Sifneos Personality Scale (SSPS), MMPI alexithymia scale (MMPI-A), Toronto Alexithymia Scale (TAS), and two measures of functional somatic symptoms. Results indicated that the TAS is internally consistent and sensitive to reports of somatic symptoms. In contrast, the SSPS and MMPI-A were found to have response and/or gender biases, poor internal reliabilities, and no systematic relationship with somatic symptoms. In addition, factor analysis showed the TAS to have a stable, replicable factor structure, while the SSPS demonstrated little factor stability. These findings suggest that the TAS is the most psychometrically sound measure of the alexithymia construct.