Validity and reliability of the Toronto Alexithymia Scale (TAS) in a population study

Unveiling sex difference in factors associated with suicide attempt among Chinese adolescents with depression: a machine learning-based study

BACKGROUND

Adolescents with depression are at heightened risk of suicide, with a distinct sex difference in suicidal behaviour observed. This study explores the sex-specific factors influencing suicide attempts among Chinese adolescents with depression.

METHODS

Data were collected from 2343 depressed adolescents across 14 hospitals in 9 provinces through self-report questionnaires. The survey was conducted between December 2020 and December 2023. Thirty-six potential risk factors were selected from validated measures of psychological, sociodemographic, and social stress domains. The dataset was split by sex, and SMOTE was applied to address class imbalance. Logistic regression, elastic net regression, random forest, XGBoost, and neural networks were used to model the data, evaluated by accuracy, precision, recall, and F1 score. The optimal model was employed for SHapley Additive exPlanations (SHAP) analysis to identify key factors influencing suicide attempts.

RESULTS

The Random Forest model exhibited the best performance for both sexes (AUC: females 0.720, males 0.736). Non-suicidal self-injury and depression were significant predictors for both sexes. Among females, factors like difficulty identifying emotions and physical abuse had a stronger impact, while resilience and hopelessness were more predictive for males.

CONCLUSIONS

The study highlights sex differences in suicide attempt predictors, emphasizing the need for sex-specific prevention strategies.

Do Individuals with Internet Gaming Disorder Share Personality Traits with Substance-Dependent Individuals?

(1) Background: Internet gaming disorder (IGD) shares many similarities with substance use disorder (SUD), contributing to its recognition as an addictive disorder. Nevertheless, no study has compared IGD to other addictive disorders in terms of personality traits established as highly co-occurring with SUDs. (2) Methods: We recruited a sample of gamers (massively multiplayer online role-playing games) (MMORPGs) via online in-game forums. We compared 83 individuals with IGD (MMORPG-IGD group) to 47 former heroin addicts under methadone maintenance treatment (MMT; MMT group) with regard to alexithymia, impulsivity, sensation seeking and aggressiveness assessed through self-administered scales, being TAS-20, BIS-10, Z-SSS and BDHI, respectively. (3) Results: Our results draw a relatively similar personality profile between groups but indicate that the subject traits are generally more pronounced in the MMT cohort. The overall lesser intensity of these traits in the MMORPG-IGD group might reflect the greater variability in the severity of the IGD. (4) Conclusions: IGD shares personality traits with MMT, and intensity may be influenced by the severity of the addiction or by certain direct environmental factors, and might also influence the propensity towards one behavior rather than another.

Can emerging technologies be effective in improving alexithymia due to brain lesion?: Lessons from a case report

INTRODUCTION

About 66% of stroke survivors present with cognitive or physical consequences, which are often complicated by emotional instability. Alexithymia is defined as "a difficulty in identifying and describing feelings", although there is no consensus on the exact diagnosis and treatment.

PATIENT CONCERNS

A 36-year-old right-handed man, affected by ischemic stroke (which occurred about 3 months before admission) involving the right hemisphere (ie, the fronto-parieto-temporal region) with left hemiparesis and behavioral abnormalities, came to our observation for intensive rehabilitation. He was treated unsuccessfully with a traditional and behavioral training.

DIAGNOSIS

Alexithymia due to ischemic stroke.

INTERVENTIONS

Then, a specific combined protocol using computerized emotional and virtual emotional training was applied in a semi-immersive virtual reality environment using the BTS-Nirvana device.

OUTCOMES

At the end of this novel rehabilitation approach, the patient showed a significant improvement in emotional skills, cognitive performances, and coping strategies.

CONCLUSIONS

Virtual reality, in addition to standard therapy, may be a valuable tool in improving emotional abnormalities due to brain lesions, such as alexithymia.

A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research

The term "alexithymia" was introduced in the lexicon of psychiatry in the early '70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the '80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.

Alexithymia, emotional dysregulation, and recovery from alcoholism: therapeutic response to assessment of mood

This study is a secondary analysis of a randomized controlled trial that tested the effects of a gratitude intervention on well-being in a sample of individuals in outpatient treatment for alcohol use disorder (AUD). Follow-up qualitative interviews unexpectedly revealed that participants found the Positive and Negative Affect Schedule (PANAS) to be helpful to their recovery in the ways that it asked them to identify and rate their emotions. Participant statements were purposively sampled and analyzed using grounded theory methods to produce a conceptual framework illustrating the process of mood identification and its sequelae. Evidence of existing alexithymia and emotional dysregulation, dominance of negative mood, and increasing ability to identify, accept, and regulate mood as part of recovery was found. Findings suggest that emotion regulation is a compelling topic for those in recovery from AUD, and may deserve a more prominent role in treatment.

Regional cortical thinning may be a biological marker for borderline personality disorder

OBJECTIVE

We investigated cerebral cortical thickness and its relation to measurements of difficulties with identifying and describing emotions in patients with borderline personality disorder (BPD).

METHOD

Eighteen SCID-II-diagnosed female patients with BPD and 21 healthy female controls underwent magnetic resonance imaging and completed the Toronto Alexithymia Scale (TAS). First, regional cortical thickness across the cerebral surface was compared between patients and healthy controls. Then, analyses of the association between cortical thickness and TAS subscales were performed in patients.

RESULTS

Compared with controls, patients exhibited clusters of significantly reduced cortical thickness in the left medial and lateral prefrontal cortex, left temporoparietal junction, bilateral temporal poles, and bilateral paracentral lobules. Significant negative associations were observed between cortical thickness and the 'Difficulties Describing Feelings' TAS subscale (DDF) scores in patients. The anatomical distribution of these associations was highly overlapping with the group differences in cortical thickness.

CONCLUSION

The pattern of regions exhibiting cortical thinning in patients resembles a network of cortical structures repeatedly shown to be involved in social cognition. The results of the DDF analyses suggest that the thinning may partly be related to interpersonal dysfunction in patients with BPD. The pattern of thinning may represent a potential biological marker for BPD.

The Role of Relationships in Understanding the Alexithymia–Depression Link

Alexithymia is associated with increased depressive symptoms in both clinical and community samples. One way that alexithymia may lead to depression is through its impact on interpersonal relationships. Individuals with alexithymia report lower perceived social support, intimacy, and relationship satisfaction. Furthermore, poor relationship functioning is a clear risk factor for depressive symptoms. Given the established alexithymia–depression link and marital dysfunction–depression link, a logical next step is to examine whether relationship dysfunction (low social support, intimacy, negative relationship behaviours, and relationship dissatisfaction) mediates the association between alexithymia and depressive symptoms. The hypothesized mediation model was assessed in a sample of 104 community couples with two analytical approaches—first with cross–sectional measures using path analysis and second with daily diary measures collected over a seven–day period using a multilevel modelling approach. Poor relationship functioning mediated the association between alexithymia and depressed mood in the daily diary data and partially mediated that association with the cross–sectional measures. These results identify alexithymia as an important variable in understanding the marital functioning–depression association, and this finding has implications for treatment. Copyright © 2012 European Association of Personality Psychology

Temporal stability of alexithymia in cancer patients following a psychological intervention

OBJECTIVE

The state-trait nature of alexithymia is not fully resolved. The aim of this article was to evaluate the temporal stability of alexithymia in cancer patients after psychological intervention.

DESIGN

Absolute and relative stability of alexithymia was evaluated in 104 cancer patients who received multicomponent psychological treatment or usual medical care.

RESULTS

Alexithymia scores significantly decreased in treated patients and increased in the control group, thus showing that the lack of absolute stability (i.e., the change of personality scores over time) likely was because of the effect of the treatment versus the control condition. The relative stability (i.e., the extent to which the inter-individual differences remain the same over time) of alexithymia after 6 months was, however, demonstrated with multiple regressions, after controlling for anxiety, depression, and cancer-related pain.

CONCLUSIONS

This study confirms the relative stability of alexithymia and that the lack of absolute stability of the construct is influenced by psychological intervention in cancer patients.

Stability of alexithymia in the general population: an 11-year follow-up

OBJECTIVES

There is an ongoing debate concerning the temporal stability of alexithymia. Most previous studies have been conducted on clinical populations of psychiatric and somatic patients. However, psychiatric and somatic morbidity have been found to confound the findings so that in their presence, alexithymia appears to be less stable. Nevertheless, few general population studies have been published, and there have been no follow-ups longer than 5 years.

METHOD

In a population-based sample of middle-aged Finnish men, 755 participants completed the Toronto Alexithymia Scale (TAS)-26 at baseline and on 11-year follow-up. Absolute or mean stability refers to the extent to which scores change over time, and it was measured with group comparisons of paired samples. Relative stability refers to the consistency of relative differences in alexithymia levels among the study subjects, and it was measured with test-retest correlations.

RESULTS

Changes in the total scores and the subscales of the TAS-26 were all statistically significant but had low effect sizes (0.09-0.20) for the change-suggested absolute stability. The correlations between baseline and follow-up scores were high (ρ = 0.51-0.63), indicating relative stability. The exclusion of depressive symptoms, a history of mental illnesses, and cancer or cardiovascular diseases at baseline and at the 4- and 11-year follow-ups did not essentially alter these findings. Of the background variables, a higher age independently associated with the increase in the TAS-26 scores. Those with alexithymia at baseline were more likely to have elevated depressive symptoms at the 4- and 11-year follow-ups.

CONCLUSIONS

Both the absolute and relative stabilities of alexithymia in the general population are high, even for a long follow-up period. These results may support the assumption that alexithymia represents a stable personality trait in general. Alexithymia may increase vulnerability to depressive symptoms.

Alexithymia is associated with increased cardiovascular mortality in middle-aged Finnish men

OBJECTIVE

To explore the associations between alexithymia and increased somatic morbidity. The mechanisms underlying these associations, however, are still unclear. Furthermore, data on the association between alexithymia and mortality are scarce.

METHODS

A total of 2321 Finnish men, aged 46 to 61 years, were followed up for an average of 20 years. Mortality rates were obtained from the national register. The associations between baseline alexithymia and cardiovascular disease (CVD), all-cause, injury, and cancer deaths were examined with adjustments for age and several behavioral (smoking, alcohol consumption, physical activity), physiological (low- and high-density lipoprotein cholesterol, body mass index, systolic blood pressure, history of CVD), and psychosocial (marital status, education, depression) factors.

RESULTS

After all adjustments, the risk of CVD death was increased by 1.2% for each 1-point increase in Toronto Alexithymia Scale-26 scores.

CONCLUSIONS

Alexithymia is associated with increased cardiovascular mortality.

Alexithymia in infertile women

OBJECTIVE

Alexithymia was compared in women with fertility disorders and fertile women who have never been confronted with fertility problems.

METHOD

Self-report instruments (TAS-20 and BVAQ) were used to measure alexithymia in a group of 73 infertile women and in a comparison group of 32 fertile women. Semi-structured interviews were used to assess medical history, current and lifetime diagnosis of psychiatric disorders.

RESULTS

Infertile women showed significantly higher rates of alexithymia than fertile women. The degree of alexithymia does not constitute a discriminating variable between unexplained infertile women and women with an organic aetiology of infertility. The prevalence of psychiatric diagnosis did not differ between the two groups of patients. Lifetime prevalence of depression, obsessive-compulsive disorders, post-traumatic stress disorder were statistically comparable.

CONCLUSION

This result raises the question of secondary alexithymia as a coping strategy in women with fertility troubles. Given the lack of published data on alexithymia in infertile women, there is a need to replicate our results and evaluate other aspects of affect regulation in infertile patients.

Stability of neuroticism and alexithymia in somatization

The personality traits neuroticism and alexithymia have been hypothesized as predisposing factors for somatization. Stability over time is a basic assumption underlying any trait construct. Although there are considerable (and sometimes conflicting) data relevant to this issue, the stability of neuroticism and alexithymia has not been assessed in somatization. The main purpose of this study was to examine the temporal stability of neuroticism and alexithymia in patients presenting to their primary care physician with medically unexplained symptoms, and compare this to the stability of negative and positive affect, anxiety, and depression. A total number of 318 patients were assessed at baseline and at 6-months follow-up. Whereas the affective state dimensions changed significantly over the follow-up period, neuroticism and alexithymia were substantially stable.

Alexithymia and body weight in obese patients

The authors evaluated severely obese patients to determine whether being far different in body shape from the accepted standard may cause obese people to develop alexithymic personality traits. They evaluated the food- and weight-related attitudes in obesity surgery patients and in long-term follow-up of those who had previously had biliopancreatic diversion (BPD) for obesity. One quarter of the obese patients had alexithymic characteristics without any modification following stable weight loss, a rate of alexithymia similar to that observed in the nonclinical population. Furthermore, the frequency of alexithymia and the patients' scores on the Toronto Alexithymia Scale were similar in obese and post-BPD individuals. The authors concluded that being obese by itself does not influence the presence of alexithymic personality traits. However, they suggest that the improvement in food-related and weight-related attitudes following stable weight loss may be different in alexithymic and in nonalexithymic obese patients.

Why do alexithymic features appear to be stable? A 12-month follow-up study of a general population

BACKGROUND

This 12-month follow-up study investigated the prevalence of alexithymia and its relationship with depression in a sample of the general population from Eastern Finland (n = 1,584).

METHODS

Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI).

RESULTS

The prevalence of alexithymia in each study phase was similar (baseline: 9.7%; follow-up: 10.1%). Mean values of BDI, TAS-20 and subfactors of the TAS-20 also remained unchanged between the study phases. However, by using the original cutoff points, we found that a proportion of the subjects were in a different TAS-20 category on follow-up than at baseline. The mean values of BDI had not changed in those subjects who had similar alexithymia status in both phases, but increased or decreased in parallel with the change in TAS-20 score among all other subjects.

CONCLUSIONS

Our findings indicate that it is important to use a variety of viewpoints when studying changes in alexithymia status. Alexithymia appears to be a stable trait based on the similarity of the mean TAS-20 scores in separate study phases. However, when focusing on the changes in alexithymia status at the individual level, alexithymic features also appear to be state dependent and strongly related to depressive symptoms.

Zur Konstruktvalidität einer deutschen Fassung der Toronto Alexithymia Scale

Zusammenfassung: Eine deutsche Übersetzung der Toronto Alexithymie Skala (TAS) wurde an einer Studentenstichprobe (N = 228) auf ihre Faktorenstruktur und ihre psychometrischen Kennwerte hin überprüft. Anhand einer zweiten Stichprobe (N = 170) wurden die Zusammenhänge der Unterskalen der TAS mit Absorption untersucht, sowie mit Fragebogenskalen zu Beschwerdenäußerung, habitueller Gestimmtheit, Kontrollüberzeugung zu Krankheit und Gesundheit, Ärgerausdruck und defensiver Bewältigung. Die konfirmatorischen Faktorenanalysen (FA) sprachen für eine Mehrdimensionalität der TAS, mit einem Faktor zum Identifizieren, Differenzieren und Beschreiben von Gefühlen (TAS-ID), sowie zwei Faktoren des external orientierten Denkens. Die korrelierten TAS-Unterskalen zum external orientierten Denken, «Mangelnde Wichtigkeit von Emotionen» (TAS-WI) und «pragmatische Haltung» (TAS-PR), zeigten deutlich geringere Konsistenz als die von beiden relativ unabhängige Unterskala zu TAS-ID. Eine hierarchisch-oblique FA ergab keinen Sekundärfaktor im Sinne eines übergreifenden Alexithymiekonstrukts. Es ergaben sich widersprüchliche Zusammenhänge der TAS-Unterskalen mit der Absorption-Skala und weiteren Fragebogeninstrumenten. Es wird geschlossen, daß die TAS-Unterskalen kein einheitliches Alexithymiekonstrukt abbilden und daß weitere Untersuchungen zu Alexithymie auf Untermerkmale konzentriert werden sollten.

Factors associated with alexithymia in patients suffering from depression

BACKGROUND

We studied the factors associated with alexithymia in 137 depressed outpatients.

METHODS

Diagnosis of depression was confirmed by means of the Structured Clinical Interview for DSM-III-R. Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale. Severity of depression was assessed using the 21-item Beck Depression Inventory, and other psychiatric symptoms with the help of the Symptoms Checklist (SCL-90). Life satisfaction was also assessed with a structured scale.

RESULTS

Almost half of the patients were considered alexithymic. They were significantly more often male, unmarried and had a lower education than the nonalexithymic patients. Alexithymic patients more often showed psychiatric symptoms (SCL-90) and were also more often severely depressed and dissatisfied with their life than were the other patients. Logistic regression analyses revealed that four factors were independently associated with alexithymia: male gender, a low level of education, low life satisfaction and severe depression. Sleep disturbances were independently associated with alexithymia in men and severe depression in women.

CONCLUSIONS

Alexithymia is very common among patients with depressive disorder. An awareness of these risk factors would be useful in improving the efficacy of treatment.

The influence of alexithymic characteristics on the self-perception and facial expression of a physiological stress state

BACKGROUND

In spite of the connection of alexithymic characteristics to many stress-related disorders, little is known about the effects of these characteristics on the self-perception of stress, which may have functional value in the regulation of daily behavior. The present study assessed the influence of alexithymic characteristics on the self-perception of stress in relation to the corresponding physiological/expressive responses during and while recovering from a phasic stressor.

METHODS

A median split of the scores on the Toronto Alexithymia Scale was used to divide 32 healthy middle-aged men into two groups, a high alexithymia (HA) and a low alexithymia (LA) group. Both groups participated in a 3-min hand-grip task, followed by a 3-min recovery period. During these periods, subjects' heart rate (HR) and facial electromyographical (EMG) activity on the corrugator supercilii and frontalis lateralis areas were measured and perceptions of exertion, unpleasantness and tension were self-rated. The perceptual style was assessed with the discrepancy scores: standardized scores of the physiological measures were subtracted from the corresponding standardized scores of the perceptions. Thus, positive scores indicated that self-reported perceptions exceeded the corresponding physiological or expressive activity (overestimation) and negative scores indicated the opposite (underestimation).

RESULTS

The HA group decreasingly underestimated exertion in relation to HR during the task and increasingly overestimated it during the recovery period. The HA group also overestimated unpleasantness in relation to the corrugator EMG response during the recovery period.

CONCLUSIONS

High alexithymic characteristics seem to predispose to the delayed self-perception of physiological stress state so that the beginning of this state may remain subjectively unnoticed and the subjective recovery from it prolonged relative to the physical recovery. During this prolonged subjective recovery the feelings of unpleasantness are not facially expressed. The consequences of this style for health-related behavior are discussed.

Alexithymia: a facet of essential hypertension

Two hundred thirty-seven newly diagnosed yet untreated hypertensive men and women, 35 to 54 years of age, were compared with an age- and gender-stratified random population sample of 146 normotensive men and women to find out whether psychological distress symptoms, anger expression, and alexithymia are associated with elevated blood pressure and whether the possible associations are independent of sodium and alcohol intake, body mass index, and physical fitness. The independent attributes of mean arterial pressure were studied by multivariate regression analyses after combining the subjects in the hypertensive and control groups. Three questionnaires were used: the Brief Symptom Inventory (BSI-37), a 31-item version of the Spielberger State-Trait Anger Expression Inventory (STAXI), and the Toronto Alexithymia Scale (TAS-26). Total scores of the TAS-26 were higher (P<0.001) in hypertensive men and women than in their normotensive control subjects (75.6+/-7.8 vs 64.1+/-9.8 in men and 72.9+/-7.1 vs 57.5+/-11.5 in women). There were no differences between the study and control groups in psychological distress symptoms, including anxiety, depression, and hostility, or in anger expression. In multivariate regression analyses, higher age, male gender, higher sodium intake, lower physical fitness, and alexithymia were independently and highly significantly (P<0.01 for male gender, P<0.0001 for other variables) associated with increased blood pressure, explaining altogether 39.5% of the cross-sectional variation in mean arterial pressure. We conclude that alexithymia, that is, poor ability to experience and express emotions, is associated with elevated blood pressure independent of sodium and alcohol intake, body mass index, and physical fitness.

Alexithymia and the interpretation of hostile-provoking situations

BACKGROUND

To examine the relationship between alexithymia and the interpretation of hostility-provoking situations.

METHODS

Sixty-two college students completed the TAS-20 and the Test for the Interpretation of Provoking Situations (TIPS). The TIPS measures how accurately participants can select the most likely explanation for the occurrence of a hypothetical, potentially provoking situation; it also measures how accurately participants judge whether explanations for events are innocent or noninnocent.

RESULTS

Higher levels of alexithymia were associated with greater degrees of accuracy in interpreting the innocence of interpersonal information. The facets of alexithymia that were most strongly associated with interpretation accuracy varied by gender.

CONCLUSIONS

Alexithymia is not associated with a general affect recognition deficit. The results are consistent with social factors playing a central role in alexithymia.

Alexithymic features do not predict compliance with psychotherapy in consultation-liaison patients

A 1-year follow-up study on 54 general hospital psychiatric consultation outpatients was carried out in order to determine whether alexithymic features, measured by the Toronto Alexithymia Scale (TAS) are predictive of psychotherapy recommendations and whether alexithymia is associated with patients' compliance with these recommendations. Contrary to what we expected, the presence of alexithymic features predicted neither treatment recommendations nor compliance. Psychological distress as measured by the Brief Symptom Inventory (BSI) proved to be a better predictor.

Alexithymia and risk of death in middle-aged men

We prospectively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men (N = 2297) participating in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Alexithymia, impairment in identification, processing, and verbal expression of inner feelings, was assessed by the validated Toronto Alexithymia Scale (TAS) In age-adjusted survival analyses, men in the highest alexithymia quintile had a twofold greater risk of all-cause death (p < 0.001) and a threefold greater risk of death from accidents, injury, or violence (p < 0.02) relative to the men in the three lowest alexithymia quintiles. There was little evidence for confounding by behavioral factors (smoking, alcohol consumption, physical activity). physiological risk factors (LDL, HDL, body mass index, hypertension), socioeconomic status, marital status, perceived health, prior diseases and diagnoses, depressive symptoms or social connections. Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup (N = 1650). Why difficulties in dealing with emotions associate with increased mortality remains unclear. Our findings suggest that the association is independent from the effect of well-known behavioral, biological, and psychosocial risk factors.

Ethnolinguistic correlates of alexithymia: toward a cultural perspective

Gender and ethnolinguistic correlates of alexithymia were explored by having a large, ethnically heterogeneous sample of university students in Toronto, Canada, complete the 20-item Toronto Alexithymia Scale (TAS-20). Men scored higher in the externally oriented thinking factor than women. Non-native English speakers scored higher on the overall TAS-20, as well as on the difficulty identifying feelings factor, than native English speakers. Further analyses showed that native Chinese language speakers scored consistently higher than native English and native European language speakers on the overall TAS-20 and its three underlying factors. These ethnolinguistic differences may reflect sociocultural influences making ethnic Chinese individuals likely to be less psychologically minded and more somatically oriented vis-à-vis their emotions than those from Western, ethnocultural traditions. Whether alexithymia should be construed as an "etic" construct (i.e., widely applicable across many different cultures) or an "emic" one (i.e., applicable to only one or two cultures) is discussed.

Introducing alexithymia: a concept within the psychosomatic process

Alexithymia (Greek, a = lack, lexis = word, thymos = emotion) is a new concept which, whilst being based upon longstanding clinical observation, remains unproven clinically. The lack of definite criteria for inclusion, and the absence of reliable and valid assessment tools, ensures that past data collection has been flawed and that no real inter-study comparisons can be made. However, the theoretical concept employed at clinical level provides a personality trait that is of great interest to the therapist. Alexithymic individuals lack the ability to transfer the emotional (biological) arousal of experience into feelings and fantasy that symbolize and express the emotion. Literally, they have no words for feeling, and express their arousal in physical (somatic) ways. This paper reviews the clinical components of this trait and the somatic symptomatology associated with it. It also reviews the present 'tools' for 'measuring' alexithymia, and relates these to suggested aetiology. It recommends that all rehabilitation personnel should be aware of this phenomenon, as the somatized symptom may be the presenting complaint of a client. It also encourages therapists to begin screening for alexithymia so that more comprehensive epidemiology information can be gathered, particularly relating to the influences on treatment and physical manifestation.

Emotional disturbances in trauma patients during the rehabilitation phase: studies of posttraumatic stress disorder and alexithymia

Recent studies have shown a partial similarity between posttraumatic stress disorder (PTSD) and alexithymia. In this study, the authors examined the relationship between PTSD and alexithymia in two samples of 26 patients with burn injury and 27 patients with digit amputation during rehabilitation. The prevalence rates of DSM-III-R PTSD and alexithymia assessed by the Toronto Alexithymia Scale (TAS) were significantly higher for injury patients than for healthy volunteers. The rate of PTSD symptoms of avoidance and emotional numbing was significantly and positively correlated with the TAS scores in injury patients. The PTSD symptoms of avoidance and emotional numbing had a significant relationship with function after digit replantation. Alexithymia also had a similar relationship with physical conditions. These results suggest that 1) in some cases, alexithymia may be evident when PTSD emotional symptoms appear in injury patients, and 2) emotional disturbances (i.e., PTSD symptoms of avoidance and emotional numbing and alexithymia) may be influenced by the level of functional recovery after digit replantation.

Alexithymia in primary health care patients

Although many studies have been published about the relationship between alexithymia and different somatic diseases, little is known about the occurrence of alexithymia in primary health care patients. The aim of the present study was to shed light on this problem. The study forms part of a larger project dealing with psychiatric morbidity in primary health care patients. The original material consisted of 1,000 randomly selected adult patients in Turku in 1989-90. As part of a follow-up study (N = 748) three years later, alexithymia was measured using the Toronto Alexithymia Scale (TAS). Primary care patients seemed to have commonly alexithymic features: The mean of the TAS-score was 64.41 +/- 11.71 for male and 63.51 +/- 11.86 for female patients. The results indicated that alexithymia was associated with psychological distress, age, educational level, and socioeconomic status. The nature of alexithymia is discussed.

Alexithymia--state or trait? One-year follow-up study of general hospital psychiatric consultation out-patients

We carried out a 1-year follow-up study on 54 out of 80 general hospital psychiatric consultation out-patients. Alexithymic features were measured by the Toronto Alexithymia Scale (TAS), and self-reported psychological distress with the Brief Symptom Inventory (BSI). Men were more alexithymic and distressed than women both at the baseline and at the follow-up evaluations. The degree of alexithymia in both genders remained consistent, whereas psychological distress decreased significantly in both genders during the follow-up period. Therefore we conclude that alexithymia presents a constant trait in psychiatric consultation out-patients.

The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure

Addressing shortcomings of the self-report Toronto Alexithymia Scale (TAS), two studies were conducted to reconstruct the item domain of the scale. The first study resulted in the development of a new twenty-item version of the scale--the TAS-20. The TAS-20 demonstrated good internal consistency and test-retest reliability, and a three-factor structure theoretically congruent with the alexithymia construct. The stability and replicability of this three-factor structure were demonstrated in the second study with both clinical and nonclinical populations by the use of confirmatory factor analysis.

The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity

A previous paper described the development of the twenty-item Toronto Alexithymia Scale (TAS-20) and reported preliminary evidence of reliability and factorial validity of the scale. This paper describes a study that further evaluated the construct validity of the TAS-20 by examining its relationship with measures of personality traits theoretically related or unrelated to the alexithymia construct, as well as its relationship with an observer-rated measure of alexithymia. Evidence of convergent and discriminant validity of the TAS-20 was demonstrated in samples of university students by a pattern of correlations with the scales of the NEO Personality Inventory and separate measures of psychological mindedness and need-for-cognition that was consistent with theoretical predictions. The concurrent validity of the scale was demonstrated by positive correlations with observer-ratings of alexithymia in a sample of behavioural medicine out-patients.

Social factors in alexithymia

Social characteristics of alexithymic individuals were examined in a population-based study of 2,682 middle-aged men from Eastern Finland. Alexithymia, referring to difficulties in identifying and verbally describing inner feelings, was assessed using the Toronto Alexithymia Scale (TAS). Men whose high TAS score suggested reduced ability in verbal emotional expression were more often unmarried and had low levels of social contacts and acquaintances. Education, income, and occupational status were inversely related to the TAS score. These associations remained statistically significant after adjustment for confounding factors. The results suggest that alexithymia could be viewed not only as a psychological phenomenon, but also partly as a socially determined one.