Alexithymia and cognitive dysfunctions in patients with panic disorder

BACKGROUND

In patients with panic disorder (PD), the difficulty to identify and manage emotional experience might contribute to the enduring vulnerability to panic attacks. Such a difficulty might reflect a dysfunction of fronto-temporo-limbic circuits. The present study was designed to test the hypothesis that drug-free patients with PD, as compared with healthy subjects (HS), show a higher prevalence of alexithymia, greater difficulty in emotional stimuli processing and poorer performance on neuropsychological tests exploring the activity of fronto-temporo-limbic circuits.

METHODS

Alexithymia, general cognitive abilities, focused and sustained attention, working memory, secondary memory, incidental learning, susceptibility to interference from both cognitive and emotional stimuli, and ability to recognize facial emotional expressions were assessed in 32 drug-free patients with PD and 32 HS.

RESULTS

Alexithymia was more frequent in patients with PD than in HS. Patients with PD, as compared to HS, had lower verbal cognitive abilities and more difficulty to inhibit interference from nonverbal stimuli and from panic-related words; they performed better than HS on the test assessing spatial incidental learning. Anxiety, panic symptomatology and verbal cognitive abilities (VIQ) were associated with alexithymia.

CONCLUSIONS

Findings are compatible with a dysfunction of frontolimbic circuits, in particular orbitofrontal and cingulate cortices. A reduction in verbal cognitive abilities was also observed, which might suggest reduced abstraction and symbolization in these patients.

Factorial validity and measurement invariance of the 20-item Toronto Alexithymia Scale in clinical and nonclinical samples

The most widely used instrument to measure alexithymia is the 20-item Toronto Alexithymia Scale (TAS-20). However, different factor structures have been found in different languages. This study tests six published factor models and metric invariance across clinical and nonclinical samples. It also investigated whether there is a method effect of the negatively keyed items. Second-order models with alexithymia as a higher order factor are tested. Confirmatory factor analyses showed that the original factor model with three factors-difficulty identifying feelings (DIF); difficulty describing feelings (DDF) and externally oriented thinking (EOT)-is the best fitting model. Partial measurement invariance across samples was illustrated but requires further study. A weakness of the model is the low internal consistency of the third factor. Because models with a method factor had a better fit, future reconsideration of the negatively formulated items seems necessary. No evidence was found for the second-order models.

Alexithymia in the German general population

The Toronto-Alexithymia-Scale (TAS-20) is used worldwide as a valid measurement of alexithymia. Until now, population-based standardization and cut-off values of the German TAS-20 version have not been available. This study provides these by means of a representative German sample and by investigating the factorial structure of the TAS-20. Data were generated from a representative random sample of the German general population (1,859 subjects aged between 20 and 69). The TAS-20 sum score was normally distributed. The mean value was 49.5 (SD=9.3) in men and 48.2 (SD=9.2) in women. Divorce, single and low social status were associated with enhanced sum scores. Ten percent of the population exceeded the TAS-20 sum score threshold of >or=61. The 66th percentile reached 53 for men and 52 for women. Factor analysis identified three factors that match the scales of the English original version. An additional fourth factor ("importance of emotional introspection") was extracted. Total explanation of variance by these four factors was 52.27%. The sum score of the German TAS-20 version is suited for the standardized measure of alexithymia. For selecting alexithymic individuals in experimental studies, the cut-off >or=61 is possibly too restrictive. Therefore, we propose the 66th percentile for the identification of high alexithymics. The TAS-20 sum score is associated with important socio-demographic variables. The factorial structure is reliable; the fourth factor ("importance of emotional introspection") provides differentiation of content and allows for enhanced explanation of variance.

Cortical augmenting in alexithymic subjects after unpleasant acoustic stimulation

OBJECTIVE

Alexithymia has a high prevalence in patients with chronic or somatoform pain disorders. Various investigations demonstrated a hypersensitivity and low tolerance of alexithymics to touch and painful stimulation. It was argued that alexithymic characteristics may lead an individual to augment stimuli in order to prevent ignoring stimuli that might be dangerous. Therefore, there may be a relation to the reducer-augmenter construct. To test this hypothesis, cortical reactivity in response to unpleasant acoustical stimulation was measured.

METHODS

Nineteen high alexithymics and 18 low alexithymics were stimulated with five series of acoustic stimuli (white noise) of different intensity levels. Evoked potentials were recorded at electroencephalogram electrodes Fz, Cz, and Pz.

RESULTS

With ascending stimulus intensities, both groups showed increasing P1-N1 and N1-P2 peak-to-peak amplitudes. High alexithymics had higher P1-N1 amplitudes and a stronger intensity-dependent slope of P1-N1 amplitude. In contrast to that, N1-P2 amplitude of low alexithymics tended to decrease in response to the highest stimulus intensity level.

CONCLUSION

High alexithymic subjects seem to behave like cortical augmenters. This may be due to a disturbed transmarginal inhibition, which may normally serve as a protective physiological mechanism.

Cross-cultural validation of a Chinese translation of the 20-item Toronto Alexithymia Scale

BACKGROUND

The purpose of the present study was to develop a Chinese translation of the 20-item Toronto Alexithymia Scale (TAS-20-C) and examine its reliability and factorial validity.

METHODS

The original English version of the TAS-20 was first translated into Chinese and then backtranslated and modified until cross-language equivalence was established. This version was then completed by 870 undergraduate students and 179 clinical patients in China. Internal reliability, retest reliability, and factorial validity were evaluated.

RESULTS

The TAS-20-C showed adequate internal and retest reliability in both samples. Average TAS-20-C scores in Chinese samples were slightly higher than, but comparable to, TAS-20 scores in English-speaking Canadian samples; as well, scores were higher in the clinical sample than in the student sample. Finally, confirmatory factor analysis supported the 3-factor structure of the TAS-20 in both samples.

CONCLUSIONS

The TAS-20-C is a promising instrument for reliable and valid measurement of alexithymia in China.

Dysregulation of Emotions and Premature Ejaculation (PE): Alexithymia in 100 Outpatients

INTRODUCTION

There is still a lack of agreement on etiology, definition, and mechanisms that underlie premature ejaculation (PE) as well as on the different role and interaction between psychological and biological factors. Alexithymia is a deficit in identifying and communicating emotions that is presumed to play an important role in psychosomatic diseases. The influences of alexithymic features on sexuality are still understudied.

AIM

Following a previous report on the relationship between alexithymia and erectile dysfunction, the objective of this study was the investigation of alexithymic features in patients with lifelong PE compared with controls, and the relationship between alexithymia level and PE severity.

METHODS

We assessed 100 consecutive outpatients with lifelong PE (age range 20-60). A control group of 100 male volunteers was recruited for the control group. The two groups were comparable in age, marital status, and socioeconomic characteristics.

MAIN OUTCOME MEASURES

The Toronto Alexithymia Scale (TAS-20) was employed for the assessment of alexithymia. The premature ejaculation severity index was used as self-report measure of PE severity on a multidimensional perspective.

RESULTS

Our data show significantly higher scores of alexithymia in patients with PE than in the control group (P < 0.001), and a positive correlation between alexithymia level and PE severity (P < 0.002). With regard to TAS-20 subfactors, an externally oriented cognitive style shows the highest correlation with PE severity (P < 0.001) and the most significant difference in the comparison between PE and control group (P < 0.001).

CONCLUSION

These findings suggest that alexithymic features, and in particular, an externally oriented cognitive style, can be seen as possible risk and/or maintenance factors for PE, and may contribute to a more serious manifestation of this condition. Alexithymia could represent an important variable for an integrated diagnosis and treatment of PE in a modern somatopsychic and holistic viewpoint.

The role of emotional intelligence and negative affect in bulimic symptomatology

Emotions, particularly emotion dysregulation, play an important role in the development and maintenance of eating disorders as evidenced by the emphasis given to addressing emotions in a number of psychotherapeutic approaches that have been adapted for the treatment of women with disordered eating. The purpose of this study was to assess the role of emotional intelligence and other emotion regulation variables in the relationship between negative affect and bulimic symptomatology. One hundred fifty undergraduate females were assessed via a packet of self-report questionnaires that included measures of emotion regulation, including emotional intelligence (BarOn Emotional Quotient Inventory -- Short Form), alexithymia (Twenty-Item Toronto Alexithymia Scale), and coping (Brief COPE Inventory), negative affect (Positive and Negative Affect Schedule -- Expanded Form and Affect Intensity Measure), and bulimic symptomatology (Bulimia Test -- Revised). Results of multiple regression analyses indicated that each conceptual area of interest contributed to the prediction of bulimic symptomatology. In addition, the measures of emotion regulation accounted for significant variance in bulimic symptomatology even after controlling for negative affect. Emotional intelligence and other emotion regulation variables did not moderate the relationship between negative affect and bulimic symptomatology. However, results highlight the role of emotion in disordered eating behaviors and support the negative affect and emotion dysregulation theories of eating disorders.

Development of an emotional processing scale

OBJECTIVE

The objective of this study was to report on the development and preliminary psychometric evaluation of an emotional processing scale, a 38-item self-report questionnaire designed to identify emotional processing styles and deficits.

METHODS

An initial item pool derived from a conceptual model and clinical observations was piloted on clinical and community samples (n=150). The resulting 45-item scale was administered to patients with psychological problems, psychosomatic disorders, and physical disease, and to healthy individuals (n=460). Exploratory factor analysis was used to explore the underlying factor structure.

RESULTS

Maximum likelihood factor analysis yielded an eight-factor solution relating to styles of emotional experience (Lack of Attunement, Discordant, and Externalized), mechanisms controlling the experience and expression of emotions (Suppression, Dissociation, Avoidance, and Uncontrolled), and signs of inadequate processing (Intrusion). Internal reliability was moderate to high for six of eight factors. Preliminary findings suggested satisfactory convergent validity.

DISCUSSION

Overall, the psychometric properties of this scale appear promising. Work is in progress to refine the scale by incorporating additional items and by conducting further psychometric evaluations on new samples.

The relationships of antisocial behavior with attachment styles, autonomy-connectedness, and alexithymia

The present study was aimed at investigating the relationships among attachment styles, autonomy-connectedness (self-awareness, sensitivity to others, and capacity for managing new situations), alexithymia, and antisocial behavior among 202 college students (67 men and 135 women). We were particularly interested in sex differences in the levels of these variables as well as their associations. Sex differences were expected in types of insecure attachment styles, patterns of autonomy-connectedness, and levels of self-reported antisocial and passive-aggressive behavior. All expected sex differences were indeed found. Furthermore, the model that we hypothesized was partly confirmed: For men, anxious attachment had a stronger direct and positive effect on antisocial behavior than for women, and the positive effect of anxious attachment on passive-aggressive behavior was smaller for women than for men. Interestingly, capacity for managing new situations had a main and mediating effect on antisocial behavior. Sensitivity to others appeared as a mediator between anxious attachment style and passive-aggressive behavior. Contrary to expectations, fantasizing (a component of alexithymia) had a strong, negative association with antisocial behavior. The results are discussed against the background of other recent findings concerning alexithymia and autonomy- connectedeness.

A prospective long-term follow-up study of alexithymia in obsessive-compulsive disorder

BACKGROUND

Studies evaluating the stability of alexithymia over long follow-up periods are rare. We examined the temporal stability of alexithymia in patients with obsessive-compulsive disorder (OCD) over 6 years and the association of alexithymia with the long-term outcome of OCD.

SAMPLING AND METHODS

Of 42 patients with OCD, 34 (81%) could be reassessed 6 years after inpatient treatment. The 20-item Toronto Alexithymia Scale, Yale-Brown Obsessive-Compulsive Scale, and Hamilton Depression Rating Scale were used at pretreatment, posttreatment, and follow-up.

RESULTS

The 20-item Toronto Alexithymia Scale total scores and its factors 1 and 2 decreased significantly during follow-up, whereas factor 3 remained stable. High correlations of the 20-item Toronto Alexithymia Scale total scores (r = 0.84, P < .001) and its 3 factors emerged between posttreatment and follow-up, suggesting relative stability over several years. Regression analyses (with and without controlling for depressive symptoms) showed that higher alexithymia scores did not predict a worse long-term outcome of OCD.

CONCLUSIONS

Relative stability over such a very long follow-up period strongly supports the view that alexithymia is a stable psychologic characteristic in patients with OCD. The result that higher alexithymia scores were not associated with poorer long-term outcome of OCD might be explained with the decrease of alexithymia during treatment and follow-up. However, our sample size was small, and further research is clearly required to evaluate the impact of changes in alexithymia and its association with the course of OCD.

Alexithymia and PTSD symptoms in urban police officers: cross-sectional and prospective findings

The relationship of alexithymia to posttraumatic stress disorder (PTSD) symptomatology was examined cross-sectionally in 166 urban police officers surveyed between 1998 and 1999 and prospectively in 54 of these officers who participated in a follow-up survey after the September 11, 2001 (9/11) terrorist attacks. In cross-sectional analyses, alexithymia scores were positively associated with PTSD symptom levels and self-reported childhood emotional abuse--neglect, but not with cumulative level of critical incident exposure. Alexithymia scores accounted for 11.2% of the variance in PTSD symptoms prior to accounting for additional predictors, but did not retain significance in the final model. In prospective analyses, alexithymia scores significantly predicted 9/11-related PTSD symptom severity over and above pre-9/11 PTSD symptoms.

A new conceptualization of alexithymia in the general adult population: implications for research involving older adults

OBJECTIVE

The purpose of this study is to test the validity of existing conceptualizations of the alexithymia concept, with particular reference to aging.

METHODS

Two hundred and forty-eight healthy adults completed measures of alexithymia and psychosocial functioning; younger and older adults (n=121) also completed a measure of emotional responsiveness.

RESULTS

Older adults engaged in less introspective thought traditionally thought to denote increased alexithymia. However, reduced introspection was associated with improved mental wellbeing, and, thus, could not be construed as a deficit. Difficulty identifying and describing emotions did not differentiate older and younger adults, but were both associated with heightened depression, anxiety, and poor perceived quality of life.

CONCLUSIONS

In clinical practice and research, the Toronto Alexithymia Scale (TAS) is almost exclusively used, with "total" score typically used to index alexithymia. As one of the subscales of the TAS measures reduced introspection, calculating total scores may not be appropriate and may particularly overestimate levels of alexithymia in older adulthood.

The 20-item Toronto Alexithymia Scale: validation of factor solutions using confirmatory factor analysis on physiotherapy out-patients

OBJECTIVE

Whilst the 20-item Toronto Alexithymia Scale (TAS-20) was developed to measure three intercorrelated dimensions, there is some debate as to whether the scale is best served by a two- or three-factor construct. In particular, there is some doubt as to whether clinical data exhibit the third factor. This study uses data from a sample of physiotherapy (physical therapy) out-patients in the UK to validate the factorial structure of a set of models postulated in the literature, including the three-factor model hypothesized by Bagby et al. (1994).

METHOD

Data were collected from a sample of physiotherapy out-patients (N=242). Specialist factor analysis software (LISREL 8.54) was used to perform confirmatory factor analyses on a range of models proposed in the literature.

RESULTS

The analysis supports the three-factor model assumed by Bagby et al. (1994), as well as most of the two-factor models suggested in the literature.

CONCLUSIONS

This new set of clinical data supports most of the two- and three-factor models postulated in the recent literature, including the three-factor model advocated by Bagby et al. (1994).

Gender differences in the association between alexithymia and emotional eating in obese individuals

OBJECTIVE

Women have been reported to use more emotion-regulation strategies than do men and to have more abilities to regulate their emotions in a different way. The aim of the present study was to examine gender differences in the relationships of alexithymia, negative mood, and the combination of alexithymia and negative mood with emotional eating in obese persons.

METHODS

Four hundred thirteen obese individuals [343 females and 70 males, aged 18-60 years, mean=43.6 years, body mass index (BMI)=38.4+/-6.6 kg/m2] completed self-report questionnaires, including the Symptom Checklist-90 (SCL-90) questionnaire, the Dutch Eating Behavior Questionnaire (DEBQ), and the Toronto Alexithymia Scale (TAS).

RESULTS

Hierarchical regression analysis showed a significant interaction between gender and alexithymia. More difficulty in identifying or describing feelings was specifically associated with more emotional eating in men.

CONCLUSION

These findings suggest that alexithymia is more strongly involved in emotional eating of obese men than women. This offers indications for designing gender-specific treatments for emotional eating among obese persons.

The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity

BACKGROUND

Assessments of personality constructs increasingly use self-report and structured interview instruments, which allow for a multimethod measurement approach and decrease specific measurement method bias. The aim of this study was to develop a valid and reliable structured interview for assessing the alexithymia construct.

METHODS

Sixty interview questions were written initially, each with a set of scoring criteria and prompts and probes to elicit information assisting in the scoring of the respondents' answers.

RESULTS

After pilot testing, the number of questions was reduced to 43, which were administered to 136 community participants and 97 psychiatric outpatients. A series of item and scale analyses further reduced the item pool to 24 items. Principal component analysis and confirmatory factor analysis of these 24 items revealed preliminary evidence of a hierarchical, four-factor structure, with four lower factors nested within two higher-order latent factors. This structural configuration resulted in the Toronto Structured Interview for Alexithymia (TSIA) with two domain scales and four facet scales. The TSIA and its six scales demonstrated acceptable levels of interrater, internal, and retest reliability. The TSIA and its scales correlated modestly but significantly with the 20-item Toronto Alexithymia Scale and its three factor scales, providing some support for the concurrent validity of this interview.

CONCLUSION

The TSIA appears to be a promising structured interview for assessing alexithymia.

The relationship between childhood sexual abuse, complex post-traumatic stress disorder and alexithymia in two outpatient samples: examination of women treated in community and institutional clinics

Relationships between trauma variables, complex post-traumatic stress disorder (complex PTSD), affect dysregulation, dissociation, somatization, and alexithymia were studied in 70 women with early-onset sexual abuse treated in community-based private (n = 25) or clinic outpatient settings (n = 45). Measures were the Toronto Alexithymia Scale-20 and the Psychological Trauma Assessment Program. Compared with the community sample, the clinic sample (1) met diagnostic criteria for both lifetime and current complex PTSD; (2) showed correlations between current affect dysregulation, dissociation, and somatization with alexithymia; and (3) higher levels of alexithymia. Results suggest the clinic sample continued to experience current forms of suffering, risk, and vulnerability associated with early-onset sexual trauma. The findings may have implications regarding types of treatment available in community versus clinic settings.

Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)

Alexithymia is a multidimensional construct that describes a constellation of personality features characterised by difficulties in differentiating, identifying and communicating emotions. The purpose of the present study was to investigate prevalence of alexithymia in outpatients with erectile dysfunction (ED), both in the psychogenic lifelong type (PLED) and in the acquired one (PAED). ED severity was evaluated with the International Index of Erectile Function (IIEF) and alexithymia was measured using the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20). The results suggest a high incidence of alexithymic characteristics in patients with psychogenic ED, a positive correlation between the alexithymia level and ED severity in patients with PAED and statistically significant differences in the alexithymia level between the two subgroups PLED and PAED. We assumed that alexithymia contributes to the origin of the PLED, and to a more severe manifestation of ED, once it appears in the acquired form.

Processing of Facial Expressions of Negative Emotion in Alexithymia: The Influence of Temporal Constraint

Alexithymia, a characteristic involving a limited affective vocabulary appears to involve three components: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. There is evidence that alexithymic characteristics are associated with differences in emotion information-processing. We examined the role of temporal factors in alexithymic emotion-processing deficits, taking into account the confound between alexithymic characteristics and positive and negative affectivity. One hundred forty-six participants completed the 20-item Toronto Alexithymia Scale and the Positive and Negative Affect Schedule. In a signal-detection paradigm, participants judged facial expressions depicting neutral or negative emotions under slow and rapid presentation conditions. The alexithymia component of difficulty in describing feelings was inversely related to the ability to detect expressions of negative emotion in the speeded condition. This relationship was independent of positive and negative affectivity. Alexithymic components positive and negative affectivity were unrelated to response bias. The results emphasize the influence of difficulty describing feelings within the alexithymia construct and its difference from positive and negative affectivity. They suggest that an alexithymic deficit in describing feelings is associated with a deficit in processing negative emotions that is most apparent when processing capacity is challenged. Theoretical and methodological implications are discussed.

Alexithymia in young adulthood: a risk factor for pathological gambling

BACKGROUND

Pathological gambling is more prevalent among postsecondary students than among the general adult population. While the prevalence of pathological gambling in this group has risen over the past decade, factors underlying the development of problem gambling among university students remain largely unexplored. One early study found alexithymia to be associated with pathological gambling. The aim of the present study was to further examine the relationship between alexithymia and gambling among postsecondary students.

METHODS

The relationship between alexithymia and pathological gambling was examined in 562 postsecondary students who completed the South Oaks Gambling Screen (SOGS) and the 20-item Toronto Alexithymia Scale (TAS-20).

RESULTS

Approximately 12% of the sample was classified as alexithymic according to the TAS-20. These individuals were found to have significantly more gambling problems, as measured by the SOGS, than nonalexithymic individuals. Approximately 9% of the sample was classified as pathological gamblers according to the SOGS. These individuals were found to have significantly higher levels of alexithymia, as measured by the TAS-20, than nonproblem gamblers.

CONCLUSIONS

Alexithymia is associated with pathological gambling and may be a risk factor among postsecondary students for developing severe gambling problems.

Psychometric properties of the Toronto Alexithymia Scale (TAS-20) for substance users

OBJECTIVE

To determine the psychometric properties of the Toronto Alexithymia Scale (TAS-20), an established self-report measure of alexithymia, for a substance user sample participating in a clinical trial of outpatient cognitive-behavioral therapies (N=230).

METHODS

Confirmatory and exploratory factor analyses were used to determine the number and nature of the factors underlying the TAS-20 in a sample of substance users. Structural equation modeling was used to determine the predictive validity of the TAS-20.

RESULTS

A factor structure comparable, but not identical, with TAS-20 psychometric results with other populations was found; alpha coefficients were .88 for the feelings factor, .62 for the external thinking factor, and .87 for the total score. Although, on average, the substance users did not appear to have elevated alexithymia scores compared with the undergraduate students, alexithymia predicted less treatment engagement, i.e., fewer sessions attended and weaker helping alliance. Alexithymia also predicted alcohol use outcomes but not drug use outcomes. The relation between alexithymia and drinking outcome was conditional on whether the patient was using solely alcohol at baseline.

CONCLUSION

The TAS-20 has reasonably good psychometric properties in this sample, which might be improved by dropping several marginal questionnaire items. Alexithymia appears to attenuate substance abuse treatment engagement. More clinical and research experience with this construct and specific instrument in substance user samples is needed.

Alexithymia Assessment and Relations with Dimensions of Personality

Abstract. This study examines the relationship between alexithymia, impulsiveness, locus of control, irrational beliefs, and both the domain and the facet levels of the Five-Factor Model (FFM) of personality in a sample of 136 undergraduate students by using the 26-Item and the 20-Item Toronto Alexithymia Scales (TAS-26; TAS-20), the Impulsiveness Questionnaire (I7), the Internal, Powerful others, and Chance Scales (IPC), the Malouff and Schutte Belief Scale and the NEO Personality Inventory Revised. The aim of this study is to compare the TAS-26 and the TAS-20, and to explore relations between alexithymia and personality especially regarding aspects that have not been taken into account so far, like impulsiveness and irrational beliefs. As expected, alexithymia overlaps with various dimensions of the FFM, as well as other dimensions like external locus of control and irrational beliefs. Surprisingly, there is no association between alexithymia and impulsiveness. Our results suggest that alexithymia is a cognitive state of externally oriented thinking with an emotional instability associated to the inability to cope with stressful situations.

Different traumatic experiences are associated with different pathologies

We tested the hypothesis that different traumatic experiences will contribute in variable degree to different mental pathologies. A total of 223 young adult non-patients were assessed with the help of self-reports. The role of six different trauma experiences (broken home, dysfunctional family, family violence, child sexual abuse, child severe sexual abuse and adult sexual abuse) in six different conditions/pathologies (alexithymia, depression, somatization, borderline, overall physical health and overall mental health) was tested in a series of multivariate analyses of variance and of Roy-Bargmann stepdown analyses. The hypothesis was confirmed: Individual traumatic experiences were indeed associated with different pathologies. Specifically, sexual abuse predicted borderline pathology, severe child sexual abuse somatization, and dysfunctional or broken family depression. Family violence was associated with worse overall mental health and alexithymia, whereas no trauma variable could be identified to be associated with overall physical health. Most of these individual relationships were reported in the literature, based on results obtained in different clinical samples. Our results were won in a sample of young non-patients controlling for overlap between pathologies.

Validité du questionnaire d’alexithymie de Bermond et Vorst : étude chez des sujets présentant des troubles du comportement alimentaire et chez des témoins

Alexithymia core features are the difficulties in identifying and describing feelings; the difficulties in distinguishing feelings from the bodily sensations of emotional arousal; an impaired symbolization, as evidenced by a paucity of fantasies and other imaginative activity; and a tendency to focus on external events rather than inner experience. Several measures of alexithymia have been developed, including interviewer-rated questionnaires and self-report questionnaires. Among the self-report questionnaires, the 20-item Toronto Alexithymia scale (TAS-20) is the most commonly used, but it fails to measure all the core features of alexithymia. A recently developed instrument, the Bermond-Vorst Alexithymia Questionnaire (BVAQ), allows the measurement of the alexithymia core features, as well as an additional one. It appeared to present good psychometric properties, notably the abbreviated BVAQ-form B. The results of recent studies comparing the psychometric properties of the TAS-20 and the BVAQ have recommended the BVAQ over the TAS-20. However, this questionnaire needed further validation.

OBJECTIVES

Thus, the aim of the present study was to determine the convergent, discriminant and concurrent validity of the Bermond-Vorst Alexithymia Questionnaire -- form B (BVAQ-B) in a clinical sample of 59 eating disorder patients, as well as in 191 controls. The TAS-20 constituted the gold standard for the assessment of the BVAQ-B' convergent validity. To compare the concurrent validity of the BVAQ-B and the TAS-20, participants also completed several self-reports investigating different dimensions of emotion regulation capacities: the 13-item Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI-form Y), as well as the Chapman and Chapman Physical and Social Anhedonia Scales (PAS and SAS). One way analyses of variance were used for mean scores comparisons. Convergent validity was determined using Pearson coefficients of correlation.

RESULTS

Results of the analyses suggested the BVAQ-B has a satisfying convergent and discriminant validity. This was observed in both the clinical and control samples. Moreover, the comparison of the convergent validity of the BVAQ-B and the TAS-20 revealed several differences between these two alexithymia self-report questionnaires. The BVAQ-B appeared less sensitive to the subjective emotional state of the participants than the TAS-20. Whereas it was argued the TAS-20 overlaps with other emotional state scores, the BVAQ-B would allow to measure alexithymia more specifically. In addition, the present results allowed to further determine the relations between alexithymia and other dimensions of emotion regulation capacities. The analyses confirmed that alexithymia is linked to other emotion regulation dimensions such as depression and anxiety. Moreover, alexithymia was associated with physical and social anhedonia, two dimensions that received less interest in the alexithymia literature to date. This study also showed that control and clinical sample have different emotion regulation capacities. Eating disorder patients were not only more alexithymic and more depressed, but also more anxious and more anhedonic than the controls. Finally, this study revealed that alexithymia differs whether the alexithymic individuals are patients or controls. Healthy alexithymic individuals (ie, individuals categorized as alexithymic in the control group) seemed characterised by a selective deficit of emotional cognition, with sparing of emotional experience (Bermond's type II alexithymia). Alexithymics individuals of the eating -disorder group seemed particularly unabled to experience affect. This pattern could correspond to Bermond's type I alexithymia, which is characterised by the absence of emotional experience and, consequently, by the absence of the cognition accompanying the emotion. In summary, results of the present study add to the literature debating on whether alexithymia is similar in different types of population.

Temporal stability and differential relationships with neuroticism and extraversion of the three subscales of the 20-item Toronto Alexithymia Scale in clinical and nonclinical samples

OBJECTIVES

To examine the cross-sample and temporal stability of the three subscales of the 20-item Toronto Alexithymia Scale (TAS-20) and to study the pattern of associations between the TAS-20 scales, neuroticism, and alexithymia.

METHODS

Two clinical and three nonclinical samples were included in the cross-sectional part of the study. One clinical and one nonclinical sample also participated in the 6-month follow-up study. To test the replicability of the three-factor structure of the TAS-20 across samples, a principal component analysis was conducted, followed by a Procrustes rotation. Linear regression analyses were conducted to examine temporal stability and to determine the specificity of the associations among the TAS-20 scales, neuroticism, and extraversion.

RESULTS

The three-factor structure of the TAS-20 was confirmed across all five samples. With a few exceptions, neuroticism and extraversion attained a higher level of temporal stability than the alexithymia scales. The TAS-subscale measuring difficulty identifying feelings (DIF) was less stable in the clinical than in the nonclinical sample. Neuroticism was most strongly associated with DIF, whereas extraversion was mainly related to externally oriented thinking (EOT). A combination of both neuroticism and extraversion was the best predictor of difficulty describing feelings (DDF).

CONCLUSIONS

Future studies on the psychometric properties and the clinical value of the TAS-20 should pay more attention to its subscales. Especially the EOT facet needs further examination.

Alexithymia in parents of daughters with eating disorders: its relationships with psychopathological and personality variables

OBJECTIVES

The purpose of this research was to investigate alexithymia among parents of a daughter with eating disorders (EDs) and to relate alexithymia to personality and psychopathology characteristics.

METHODS

Parents of 73 women with ED (20 with anorexia nervosa, restrictive subtype (ANR), 23 with anorexia nervosa, bulimic subtype (ANB) and 30 with bulimia nervosa (BN)) and parents of 72 normal women were evaluated with the Toronto Alexithymia Scale (TAS-20), the Eysenck Personality Questionnaire, the Beck Depression Inventory and the Self-Rating Anxiety Scale.

RESULTS

The parents of daughters with ED show higher scores in the TAS-20 and its factors than the controls. TAS-20 scores of parents are associated with neuroticism, anxiety and depression.

CONCLUSIONS

Alexithymia in parents of daughters with an ED could be a trait of personality, but it could also be a state due to distress. Alexithymia should be taken into account in order to help these parents express emotions.

Is there a reliable factorial structure in the 20-item Toronto Alexithymia Scale? A comparison of factor models in clinical and normal adult samples

OBJECTIVES

The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for measuring alexithymia. However, different studies did not always yield identical factor structures of this scale. The present study aims at clarifying some discrepant results.

METHODS

Maximum likelihood confirmatory factor analyses of a German version of the TAS-20 were conducted on data from a clinical sample (N=204) and a sample of normal adults (N=224). Five different models with one to four factors were compared.

RESULTS

A four-factor model with factors (F1) "Difficulty identifying feelings" (F2), "Difficulty describing feelings" (F3), "Low importance of emotion" and (F4) "Pragmatic thinking" and a three-factor model with the combined factor "Difficulties in identifying and describing feelings" described the data best. Factors related to "externally oriented thinking" provided no acceptable level of reliability.

CONCLUSIONS

Results from the present and other studies indicate that the factorial structure of the TAS-20 may vary across samples. Whether factor structures different from the common three-factor structure are an exception in some mainly clinical populations or a common phenomenon outside student populations has still to be determined. For a further exploration of the factor structure of the TAS-20 in different populations, it would be important not only to test the fit of the common three-factor model, but also to consider other competing solutions like the models of the present study.

[A critique of the construct "alexithymia" and its measurement--the weakness of self-report and the opportunities of an objective assessment approach]

Approximately thirty years ago the term alexithymia was coined but it is still open which characteristics have to be considered core symptoms of alexithymia. A selective review of recent expert definitions reveals dynamism in defining the alexithymia construct. At present, the self-report Toronto-Alexithymia-Scales (TAS) are the most frequently used measures of alexithymia. Empirical findings regarding various aspects of validity (factorial, concurrent, and experimental construct validity data) question the validity of the Toronto-Alexithymia-Scales. Alexithymia as measured by the TAS appears not to be consistently related to physiological, affect decoding or affective vigilance characteristics. The heterogeneity of the results could be due to the fact that non-alexithymic persons such as depressed or socially anxious individuals yield high scores on the TAS; on the other hand self-report appears to be in principle a methodologically inadequate approach for the assessment of alexithymia. Objective or direct measures of alexithymic characteristics as the Levels of Emotional Awareness Scale or the prototypicity analysis of mood diaries based on adjective checklists seem to be promising assessment methods for future research.

The 20-Item Toronto Alexithymia Scale. IV. Reliability and factorial validity in different languages and cultures

OBJECTIVE

The aim of this paper was to review findings from studies that have evaluated the reliability and factorial validity of the 20-item Toronto Alexithymia Scale (TAS-20) in different languages and cultures.

METHOD

Data from published articles as well as unpublished data from various countries were reviewed to determine whether the three-factor structure of the TAS-20 is replicable in different cultures by the method of confirmatory factor analysis (CFA), and whether the scale and its three-factor scales show internal reliability in these cultures.

RESULTS

The TAS-20 has been translated adequately into 18 different languages and evaluated by CFA in 19 different countries. There is strong support for the generalizability of the three-factor structure of the scale across languages and cultures. In addition, the full-scale TAS-20 and the first two factors show adequate to good internal reliability for most of the translations. In most cultures where English is not the primary language, however, the third factor lacks internal reliability; this might be due to cultural differences or a response bias to the several negatively keyed items on this factor.

CONCLUSION

The findings support the use of the TAS-20 in cross-cultural research, and suggest that alexithymia may be a universal trait that transcends cultural differences.

The 20-Item Toronto Alexithymia Scale. III. Reliability and factorial validity in a community population

OBJECTIVE

Some researchers have questioned the stability of the three-factor structure of the 20-Item Toronto Alexithymia Scale (TAS-20) or the reliability of one or more factors of the scale. The aim of this study was to assess the replicability of the factor structure of the TAS-20 in a large community sample and to determine also whether the same three-factor structure can be recovered in men and women. The study also assessed the reliability of the scale and the influence of gender, age, and education on TAS-20 scores.

METHOD

The TAS-20 was administered to 1933 adults (880 men and 1053 women) residing in several small cities and towns in Ontario, Canada. The factor structure of the scale was assessed using confirmatory factor analysis (CFA).

RESULTS

The three-factor structure of the TAS-20 was replicable in the entire community sample and also separately in men and women. The TAS-20 and its three factors demonstrated internal reliability, and the variables of gender, age, and education accounted for relatively small or modest amounts of variability in total TAS-20 and factor scale scores.

CONCLUSION

The results provide strong support for the reliability and factorial validity of the TAS-20 and indicate the importance of using CFA when assessing the replicability and theoretical integrity of the factor structure of the scale.

Social situation of expectant mothers and alexithymia 31 years later in their offspring: a prospective study

OBJECTIVE

We studied the association between alexithymia in adulthood and social situation of the child's family at the time of the child's birth.

METHODS

The study forms part of the prospective Northern Finland 1966 Birth Cohort Project. The original material consisted of all 12,058 live-born children in the provinces of Lapland and Oulu in Finland with an expected delivery date during 1966. The material represents 96% of all births in the region. In 1997 a 31-year follow-up study was made on part of the initial sample. The 20-item version of the Toronto Alexithymia Scale (TAS-20) was given to 5983 participants of the field study. Of them, 85% returned the questionnaire properly completed. Factors indicative of the social situation of the child's family were already gathered during pregnancy and the time of birth from the mothers, thus eliminating recall bias.

RESULTS

Alexithymia was more common in subjects from rural than urban dwelling areas. Unwanted children or subjects born into families with many children also exhibited an association with alexithymia in adulthood.

CONCLUSIONS

Maternal social situation and environment predict alexithymia in the offspring.

Psychophysiological Response Patterns of High and Low Alexithymics Under Mental and Emotional Load Conditions

Abstract Compared to normals or low alexithymics, high alexithymic subjects show a modified psychophysiological reactivity under experimental stress. This study aims to differentiate these effects under different load conditions (mental vs. emotional load, 5min each). High (N = 33) and low (N = 33) alexithymic subjects were identified by the German version of the Toronto-Alexithymia-Scale (TAS-20). Subjects were exposed to two tasks of the continuous performance test as a mental load condition and two unpleasant movie sequences as an emotional load condition. Heart rate and electrodermal activity (nonspecific skin conductance reactions) were continuously recorded during stimuli presentation. High alexithymic subjects showed a decreased number of nonspecific skin conductance reactions under all load conditions compared to low alexithymics. Initial heart rate acceleration of high alexithymic subjects under mental load was stronger, whereas under emotional load high alexithymic subjects showed a stronger initial heart rate deceleration. Results are discussed with respect to a modified processing of emotionally qualified information in alexithymics.

Exposure to trauma: the long-term effects of suppressing emotional reactions

A cross-sectional study of 437 ambulance officers in a large state of Australia examined the long-term effects of suppressing emotion reactions to exposure to trauma. Results indicate that the use of emotion-suppressing defenses (e.g., withdrawal or acting out) have a highly significant positive relationship with physical and psychological stress symptoms. Alexithymia scores were also positively associated with stress symptoms. In addition, there was a positive association between years of ambulance service and stress symptoms. Implications of the findings are discussed for recovery from exposure to trauma of emergency services personnel and more generally to the experience of survivors of trauma.

The assessment of alexithymia: a critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20

OBJECTIVE

The objectives were to give an overview of studies on the validity of the Toronto Alexithymia Scale (TAS-20) and to present data regarding the validity of the TAS-20.

METHODS

The literature on the psychometric properties of the TAS-20 was reviewed and a study was conducted of its psychometric properties in a sample of students and a sample of psychiatric outpatients using a statistical method allowing identification of a stable factor structure.

RESULTS

The review revealed that the majority of studies on the TAS-20 were conducted with nonpatient samples. The factorial validity and reliability of the dimensions 'identifying feelings' (DIF) and 'describing feelings' (DDF) could be replicated in many of these studies. However, in practically all studies the dimension 'externally oriented thinking' (EOT) appears to be unreliable. In addition, the presupposed fantasy aspect of the alexithymia construct is not included in the TAS-20. Although many studies were conducted on the construct validity of the TAS-20, no studies have been published on its criterion validity. Some studies show a different factor structure to exist in patient samples. This was confirmed in our own study in which the dimensions 'identifying feelings' and 'describing feelings' collapsed into one single subscale. As in other studies, the reliability of the dimension 'EOT' was low.

CONCLUSION

The TAS-20 has some important shortcomings with respect to validity and reliability. For the assessment of alexithymia in empirical research, it is recommended to use the TAS-20 in combination with other instruments. We do not recommend the TAS-20 to be used in clinical practice.

Culture and alexithymia: mean levels, correlates, and the role of parental socialization of emotions

Two studies examined the relationship between culture and alexithymia. In Study 1, mean levels and correlates of alexithymia were examined in 3 cultures: European American (EA), Asian American (AA), and Malaysian college students. Both Asian groups had higher alexithymia levels than the EA group. Somatization was more strongly associated with alexithymia in the Asian groups than in the EA group. Mood and life satisfaction were associated with alexithymia in similar ways across groups. In Study 2, the relations among culture, gender, retrospective reports of parental socialization of emotions, and alexithymia were examined among EA and AA college students. Cultural and gender differences were found in alexithymia and emotion socialization levels. Most important, parental emotion socialization mediated the relations among culture, gender, and alexithymia.

Binge-eating disorder in Brazilian women on a weight-loss program

OBJECTIVE

To examine binge-eating disorder (BED) and its association with obesity, weight patterns, and psychopathology in a Brazilian sample of female participants of a weight-loss program in São Paulo, Brazil.

RESEARCH METHODS AND PROCEDURES

Two hundred and seventeen overweight (body mass index >/= 25 kg/m(2)) women, ages 15 to 59 years, enrolled in the Weight Watchers Program were recruited for the study at a program branch meeting after completing the Questionnaire on Eating and Weight Patterns-Revised, Beck Depression Inventory, and the Toronto Alexithymia Scale-20. Participants were categorized into four groups: those who met questionnaire criteria for BED, those who met questionnaire criteria for bulimia nervosa (BN), those that reported binge eating but did not meet all the criteria for any eating disorder (BE), and those with no eating disorder symptoms (No ED). Groups were compared on measures of weight, depressive symptoms, and alexithymia.

RESULTS

Binge eating was frequently reported by women in this study (BED, 16.1%; BN, 4.6%; BE, 22.6%). BED women had significantly higher body mass index, greater highest weight ever, and more frequent weight cycling than the No ED group. BED women also reported more depressive symptoms than BE and No ED women, and were more alexithymic than the No ED group. BE women presented more frequent weigh cycling and were also more depressed and alexithymic than the No ED group.

DISCUSSION

BED is not uncommon in overweight Brazilian women, and similar to North American and European samples, it is associated with overweight and higher levels of psychopathology in this population.

Construct validity of rorschach variables for alexithymia

The construct validity of Rorschach Comprehensive System (CS) variables theoretically linked to alexithymia was evaluated in 92 outpatients with inflammatory bowel disease, 32 of whom were categorized as alexithymic, 15 as indeterminate-alexithymic, and 45 as nonalexithymic, on the basis of Toronto Alexithymia Scale scores. Six sets of Rorschach CS marker variables were selected for analysis: fantasy, affect, adaptive resources, cognition, social adaptation, and projection. Most variables significantly differentiated the three groups. Compared with the other groups, alexithymic subjects were more likely to show an impoverished fantasy life, poorly adapted emotional expression, poor coping resources, concrete and stereotypical thinking, and social conformity with compromised relationships.

Alexithymie: Kompetenzdefizit oder (motivierte) Hemmung?

Zusammenfassung. Theoretischer Hintergrund: Alexithymie bezeichnet eine eingeschränkte Fähigkeit, Affekte zu identifizieren und zu beschreiben. Auf konstruktheoretischer Ebene ist ungeklärt, ob alexithyme Phänomene auf einer defizitären oder auf einer gehemmten Affektregulation beruhen. Fragestellung: Um eine Entscheidung zu ermöglichen, wurden aus jeder der beiden theoretischen Perspektiven Hypothesen formuliert und überprüft. (1) Alexithyme Patienten verfügen über einen weniger differenzierten semantischen Raum für die Unterscheidung von Emotionen. (2) Alexithyme Patienten akzeptieren ihre eigene Emotionalität in geringerem Maße als nichtalexithyme Patienten und/oder erwarten in stärkerem Ausmaß, daß ihre Emotionalität von anderen abgelehnt wird. Methode: Bei 39 Patienten mit DSM-III-R Angststörungen wurde der Differenzierungsgrad der Emotionswahrnehmung individuell für jeden Patienten mit einer Variante der Repertory-Grid-Technik, dem “Emotions-Grid“, bestimmt. Die Emotionsakzeptanz wurde mittels Ratings für diverse Grundemotionen bestimmt. Mit der Toronto Alexithymia Scale (TAS-20) wurden alexithyme Merkmale psychometrisch erfasst. Ergebnisse: Eine emotionale Differenzierungsschwäche alexithymer Patienten kann belegt werden. Schlussfolgerungen: Die Befunde stützen ein “Defizitkonzept“ der Alexithymie.

[Testing and validation of the 26-Item Toronto Alexithymia Scale in a representative population sample]

This paper presents the authorized German version of the 26-item Toronto alexithymia scale (TAS-26). Due to the fact, that the revised version of this questionnaire (TAS-20) displays low reliability concerning the scale "external oriented thinking" in the German version, we decided to reinvestigate all TAS-26 items. In a representative sample of the German population (N=2047), the four factor structure of the original version could be reproduced and reliabilities for the four scales as well as for a pooled 5th scale (scales 1 to 3) varied satisfyingly between r=.67 to r=.84. TAS-scale no. 4 "reduced daydreaming" correlated negatively with other TAS scales in this German version also, so we can not recommend to use this construct for the study of alexithymia. Scale values proved to be independent from age and sex, whereas a clear relation with education could be detected: persons with low education scored high on alexithymia scales. To validate the German version of the TAS-26, a mood questionnaire and a body experience questionnaire were used. It could be shown that high alexithymia scores were associated with negative body image and undesirable emotions. It is discussed whether the latter correlation is due to a methodological artefact, since persons with high alexithymia scores tend to prefer middle categories of the mood questionnaire.

Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic

To examine the relationship between somatosensory amplification and three factors of alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), 48 outpatients attending a Japanese psychosomatic clinic and 33 comparative outpatients completed the Somatosensory Amplification Scale (SSAS), 20-item Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), and other self-rating questionnaires. The scores on the SSAS and the first and second TAS-20 factors were higher (all P<0.001) in the psychosomatic group than in the comparison group. The SSAS was positively associated (both P<0.01) with these two TAS-20 factors, controlling for the effects of age, sex, group, and POMS tension-anxiety and depression. Somatosensory amplification appears to be associated with difficulties identifying and describing feelings, not externally oriented thinking, in Japanese patients.

Compulsive checking behaviors in generalized anxiety disorder

Recent evidence suggests that a relationship exists between worry, the central feature of generalized anxiety disorder (GAD), and compulsive behaviors, particularly compulsive checking. In this article we report the results from two studies. The first study assessed the frequency of obsessions and compulsions in 107 principally diagnosed GAD clients. The second study examined levels of alexithymia in analogue samples of GAD checkers (n = 31), GAD noncheckers (n = 30), and non-GAD nonchecking controls (n = 27) using the Toronto Alexithymia Scale-20 (Bagby, Parker, & Taylor, 1994). The results from these studies suggest that compulsive behaviors in the form of compulsive checking is more common in GAD than previously expected and that such behaviors in GAD may act as an additional mechanism by which affective experiences are avoided.

Factorial structure of the 20-item Toronto Alexithymia Scale: confirmatory factorial analyses in nonclinical and clinical samples

OBJECTIVE

The 20-item Toronto Alexithymia Scale (TAS-20) measures three intercorrelated dimensions of alexithymia: (1) difficulties identifying feelings (DIF), (2) difficulties describing feelings (DDF), and (3) externally oriented thinking (EOT). The aim of the study was to test the three-factor model of the TAS-20 using confirmatory factorial analyses (CFA).

METHOD

769 healthy subjects and 659 patients meeting the DSM-IV criteria for substance use disorders or eating disorders completed the TAS-20. The correlation matrices for each of the samples were analyzed with LISREL 7.16.

RESULTS

In each sample, the three-factor model was found to be replicable.

CONCLUSION

The three TAS-20 subcales can be used to explore the distinct facets of the alexithymia construct.

Alexithymia in DSM-IV Disorder: Comparative Evaluation of Somatoform Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Depression

The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.