Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples

Alexithymia profiles and depression, anxiety, and stress

BACKGROUND

Alexithymia is a multidimensional trait comprised of difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is regarded as an important risk factor for emotional disorders, but there are presently limited data on each specific facet of alexithymia, or the extent to which deficits in processing negative emotions, positive emotions, or both, are important. In this study, we address these gaps by using the Perth Alexithymia Questionnaire (PAQ) to comprehensively examine the relationships between alexithymia and depression, anxiety, and stress symptoms.

METHODS

University students (N = 1250) completed the PAQ and the Depression Anxiety Stress Scales-21. Pearson correlations, hierarchical regressions, and latent profile analysis were conducted.

RESULTS

All facets of alexithymia, across both valence domains, were significantly correlated with depression, anxiety, and stress symptoms (r = 0.27-0.40). Regression analyses indicated that the alexithymia facets, together, could account for a significant 14.6 %-16.4 % of the variance in depression, anxiety, and stress. Difficulties identifying negative feelings and difficulties identifying positive feelings were the strongest unique predictors across all symptom categories. Our latent profile analysis extracted eight profiles, comprising different combinations of alexithymia facets and psychopathology symptoms, collectively highlighting the transdiagnostic relevance of alexithymia facets.

LIMITATIONS

Our study involved a student sample, and further work in clinical samples will be beneficial.

CONCLUSIONS

Our data indicate that all facets of alexithymia, across both valence domains, are relevant for understanding depression, anxiety, and stress. These findings demonstrate the value of facet-level and valence-specific alexithymia assessments, informing more comprehensive understanding and more targeted treatments of emotional disorder symptoms.

Alexithymia or general psychological distress? Discriminant validity of the Toronto Alexithymia Scale and the Perth Alexithymia Questionnaire

BACKGROUND

Alexithymia is an important transdiagnostic risk factor for emotion-based psychopathologies. However, it remains unclear whether alexithymia questionnaires actually measure alexithymia, or whether they measure emotional distress. Our aim here was to address this discriminant validity concern via exploratory factor analysis (EFA) of the 20-item Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ).

METHOD

United States general community adults (N = 508) completed the TAS-20, PAQ, and the Depression Anxiety Stress Scales-21 (DASS-21). EFA was used to examine the latent dimensions underlying these measures' scores.

RESULTS

Our EFA extracted two higher-order factors, an "alexithymia" factor and a "general distress" factor (i.e., depression, anxiety, stress). All PAQ scores loaded cleanly on the alexithymia factor, with no cross-loadings on the distress factor. However, for the TAS-20, Difficulty Identifying Feelings (DIF) facet scores cross-loaded highly on the distress factor.

LIMITATIONS

Our sample consisted of general community adults; future work in clinical settings will be useful.

CONCLUSIONS

Our data indicate that the PAQ has good discriminant validity. However, the TAS-20 appears to have significant discriminant validity problems, in that much of the variance in its DIF facet reflects people's current levels of distress, rather than alexithymia. The TAS-20, which has traditionally been the most widely used alexithymia questionnaire, may therefore not be the optimal alexithymia tool. Our findings add to the body of evidence supporting the validity and utility of the PAQ and suggest that, moving forward, it is a superior option to the TAS-20 for alexithymia assessments.

Examining the Incremental Validity of the Perth Alexithymia Questionnaire (PAQ) Relative to the 20-Item Toronto Alexithymia Scale (TAS-20)

The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for assessing alexithymia, with more than 25 years of research supporting its reliability and validity. The items that compose this scale were written to operationalize the components of the construct that are based on clinical observations of patients and thought to reflect deficits in the cognitive processing of emotions. The Perth Alexithymia Questionnaire (PAQ) is a recently introduced measure and is based on a theoretical attention-appraisal model of alexithymia. An important step with any newly developed measure is to evaluate whether it demonstrates incremental validity over existing measures. In this study using a community sample (N = 759), a series of hierarchical regression analyses were conducted that included an array of measures assessing constructs closely associated with alexithymia. Overall, the TAS-20 showed strong associations with these various constructs to which the PAQ was unable to add any meaningful increase in prediction relative to the TAS-20. We conclude that until future studies with clinical samples using several different criterion variables demonstrate incremental validity of the PAQ, the TAS-20 should remain the self-report measure of choice for clinicians and researchers assessing alexithymia, albeit as part of a multi-method approach.

Interactive relationship between alexithymia, psychological distress and posttraumatic stress disorder symptomology across time

Alexithymia, psychological distress, and posttraumatic stress disorder (PTSD) are highly related constructs. The ongoing debate about the nature and relationship between these constructs is perpetuated by an overreliance on cross-sectional research. We examined the longitudinal interactive relationship between alexithymia, psychological distress, and PTSD. We hypothesised that there is an interactive relationship between the three constructs. Military personnel (N = 1871) completed the Toronto Alexithymia Scale, the Kessler 10 and a PTSD Checklist (PCL-C) at pre-deployment, post-deployment, and at 3-4 years following the post-deployment assessment. We initially tested whether psychological distress is either a moderator or mediator in the relationship between alexithymia and PTSD across the time points. General psychological distress was a partial mediator of total PTSD severity and hyperarousal symptomology at all three time points. Psychological distress fully mediated re-experiencing and avoidance symptomology at all three time points. Our results suggest that those with alexithymia are at longitudinal risk of developing more severe PTSD symptomology and experiencing hyperarousal irrespective of temporal proximity to traumatic exposure. Further, vulnerability to the emergence of re-experiencing and avoidance symptomology for those with alexithymia is increased when one experiences greater distress. Our results show that alexithymia is a persistent risk factor for PTSD symptomology.

Improving the Objective Measurement of Alexithymia Using a Computer-Scored Alexithymia Provoked Response Questionnaire with an Online Sample

The study and measurement of alexithymia - a trait marked by difficulty identifying and describing feelings - can be improved by incorporating objective measures to supplement self-report scales. The Alexithymia Provoked Response Questionnaire (APRQ) is an observer-rated alexithymia tool that shows promise yet can be time-consuming to administer. The present study aimed to assess the feasibility of computer administration and scoring of the APRQ. Further, the APRQ's association with verbal IQ and emotional vocabulary use was examined, as was the relationship between the APRQ and the self-report Bermond-Vorst Alexithymia Questionnaire-B (BVAQ-B). Adult participants (n = 366), including a proportion gathered through purposive sampling, participated in an online study. Inter-rater reliability measures indicated that computerized scoring of the APRQ is as reliable as human scoring, making the measure scalable for use with large samples. Alexithymia levels were independent of two measures of verbal IQ. Correlational analyses indicated overlap in alexithymia as measured by the APRQ and most of the subscales of the BVAQ-B. The APRQ, as an objective measure, may capture deficits in emotional awareness independent of self-insight.

Soreness Reminds Me of Grief: Patients With Chronic Pain Show Less Differentiated Representations of Emotional Feelings and Bodily States

People experience similarities between emotional feelings and bodily states on a daily basis, but both the magnitude and pervasiveness of this experiential similarity vary across individuals. Inspired by previous findings that chronic pain (CP) is characterized by strengthened pain-affect coupling and reduced interoceptive accuracy, we conducted 2 cross-sectional studies to examine whether patients with CP would exhibit less differentiated perception and mental representation of emotional feelings and bodily states. In study 1 (N = 500), patients with CP and healthy controls (HCs) completed a self-report questionnaire that asked explicitly about the perceived similarity between 5 basic emotion categories and a series of bodily states. In study 2 (N = 73), a specially designed false memory test was administered to examine whether patients with CP would have reduced differentiation of concepts of negative emotion and somatic distress. We found that patients with CP perceived greater and more pervasive similarities between emotional feelings and bodily states, as indicated by higher questionnaire scores and denser, less specialized bipartite emotion-body networks, both associated with lower subjective interoceptive accuracy. Furthermore, patients with CP formed false memories of negative emotion words (eg, grief) more readily than HCs after memorizing somatic distress words (eg, soreness), as if they represented negative emotion and somatic distress as a single, enmeshed semantic category. Our findings extend previous literature by demonstrating reduced discrimination between emotional and bodily experiences in CP that is not restricted to pain-related emotional and sensory experiences and may be related to a fundamentally less differentiated interoception. PERSPECTIVES: This study shows that patients with chronic pain have a profoundly less differentiated perception and implicit conceptualization of emotional feelings and bodily states, which appears to be associated with altered interoception. These findings may provide new perspectives on why they often experience a stronger pain-affect coupling.

What is the relationship between alexithymia and experiential avoidance? A latent analysis using three alexithymia questionnaires

Alexithymia is a clinically relevant personality trait characterized by poor emotional awareness and associated with several psychological and physical health concerns. Individuals with high alexithymia tend to engage in experiential avoidance and this may mediate psychological distress. However, little is known about what specific processes of experiential avoidance are involved, and the nature of the relation between alexithymia, experiential avoidance, and psychological distress remains unclear at a latent construct level. To examine this relationship at the latent construct level, a representative sample of 693 U.S. adults completed alexithymia (TAS-20, BVAQ, PAQ), general distress (DASS-21), multi-dimensional experiential avoidance (MEAQ), and general health (PROMIS-G-10) questionnaires. Structural equation modeling revealed that alexithymia significantly predicted experiential avoidance (β = 0.966, t = 82.383, p < .01), experiential avoidance significantly predicted general distress (β = 0.810, t = 2.017, p < .05), and experiential avoidance fully mediated the relationship between alexithymia and general distress (βindirect = -0.159, t = -0.398, p > .05). Correlations between alexithymia and experiential avoidance subfactors revealed a strong relationship to the repression and denial subfactor. Experiential avoidance is a promising target for clinical interventions, though longitudinal research is necessary to elucidate how the relationship between alexithymia and experiential avoidance unfolds over time.

The Perth Alexithymia Questionnaire-Short Form (PAQ-S): A 6-item measure of alexithymia

BACKGROUND

Alexithymia is a trait characterized by difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is widely regarded as an important transdiagnostic risk factor for a range of psychopathologies, including depressive and anxiety disorders. Whilst several well-validated psychometric measures of alexithymia exist, these are relatively lengthy, thus limiting their utility in time-pressured settings. In this paper, we address this gap by introducing and validating a brief 6-item version of the Perth Alexithymia Questionnaire, called the Perth Alexithymia Questionnaire-Short Form (PAQ-S).

METHOD

Across two studies with adult samples (Study 1 N = 508 United States community; Study 2 = 378 Australian college students), we examined the psychometric properties of the PAQ-S in terms of its factor structure, reliability, and concurrent/criterion validity.

RESULTS

In exploratory and confirmatory factor analyses, all PAQ-S items loaded well on a single general alexithymia factor. The PAQ-S total score had high reliability, and correlated as expected with the long-form of the PAQ, as well as other established markers of alexithymia, emotion regulation, and affective disorder symptoms.

LIMITATIONS

Our samples were general community or college student samples from two Western countries; future validation work in clinical samples and more diverse cultural groups is thus needed.

CONCLUSIONS

The PAQ-S retains the psychometric strengths of the PAQ. As such, the PAQ-S can be used as a quick, robust measure of overall alexithymia levels. The introduction of the PAQ-S hence enables valid assessments of alexithymia in a more diverse range of settings and research designs.

Alexithymia and emotion regulation

BACKGROUND

Alexithymia is a key transdiagnostic risk factor for emotion-based psychopathologies. Conceptual models specify that this is because alexithymia impairs emotion regulation. However, the extent of these putative emotion regulation impairments remains underexplored. Our aim in this study was to begin to address this gap by examining whether people with high, average, or low levels of alexithymia differ in the types of emotion regulation strategies they typically use.

METHOD

General community adults from the United States (N = 501) completed a battery of alexithymia and emotion regulation measures. Participants were grouped into high, average, and low alexithymia quantiles.

RESULTS

After controlling for demographics and current levels of distress, the high, average, and low alexithymia groups differed in their use of cognitive and behavioral emotion regulation strategies. Compared to the other groups, the high alexithymia group reported lesser use of generally adaptive regulation strategies (cognitive reappraisal, approaching problems, and seeking social support) and greater use of generally maladaptive regulation strategies (expressive suppression, behavioral withdrawal, ignoring).

LIMITATIONS

Our data were cross-sectional and from self-report questionnaires. Future work in other cultural groups would be beneficial.

CONCLUSIONS

Our results support the view that alexithymia is associated with impaired emotion regulation. In particular, people with high alexithymia seem to exhibit a less adaptive profile of emotion regulation strategies. Direct targeting of these emotion regulation patterns in psychotherapy may therefore be a useful pathway for the treatment of emotional disorder symptoms in people with high alexithymia.

Assessing alexithymia in adults with acquired brain injury: Psychometric properties of the Perth Alexithymia Questionnaire

BACKGROUND

Alexithymia is a multidimensional personality trait comprised of difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking. The assessment of alexithymia in people with acquired brain injury (ABI) is of clinical interest because alexithymia is linked to poor psychosocial functioning and community reintegration after ABI. To date, alexithymia measures have not been psychometrically investigated/validated in an ABI sample, restricting confident empirical work in this area. We aimed to fill this gap by assessing the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) in adults with ABI and determining whether the alexithymia construct manifests similarly in ABI samples compared to the general community.

METHODS

The PAQ and Depression Anxiety Stress Scales-21 were administered to an ABI sample (N = 350) and a community sample (N = 1012). Factor structure, measurement invariance, internal consistency reliability, and concurrent/discriminant validity were explored.

RESULTS

Our confirmatory factor analysis of the PAQ supported the intended five-factor correlated model as the best solution, where items loaded well onto the five intended subscales. This factor structure was invariant across ABI and community samples. Good reliability and concurrent and discriminant validity were also established.

LIMITATIONS

The PAQ is a self-report measure and may be impacted by insight deficits known to occur after ABI.

CONCLUSION

Our data suggests that the PAQ has good validity and reliability as a measure of alexithymia. The latent structure of alexithymia manifests similarly in ABI and community samples. This study provides the first psychometric foundation for confident assessment of alexithymia in ABI.

The Effectiveness of Interpersonal Psychotherapy on Alexithymia, Emotion Regulation, and Psychological Capital of Male Substance Abusers Treated by Addiction Treatment Centers in Kerman

Background

Addiction is a psychiatric disorder with biological, psychological, and social aspects. Literatures indicated that alexithymia, emotional dysregulation, and low psychological capital affect substance abuse. This study investigated the effectiveness of interpersonal psychotherapy on alexithymia, emotional regulation, and psychological capital of male substance abusers.

Methods

This quasi-experimental study was conducted in 2021 in Kerman, Iran using a pretest, post-test design with a control group. A single therapy center was randomly selected via the multi-stage cluster method from several substance abuse treatment centers. 50 people were randomly selected and allocated to experimental and control groups. The research instruments were questionnaires for alexithymia, emotional regulation, and psychological capital. After the pretest phase, the experimental group underwent 12 sessions of interpersonal psychotherapy. In the next step, the post-test was conducted and after 6 weeks the follow-up test was performed on the groups. The control group did not receive the treatment. Finally, the data obtained from 40 participants were analyzed using the MANCOVA test by SPSS25 statistical software.

Findings

Our findings indicated significant MANCOVA results for alexithymia (F=65.14 and P<0.05), emotion regulation (F=44.72 and P<0.05) and psychological capital (F=12.05 and P<0.05) showing a significant difference between the scores of dependent variables in the experimental group and control group.

Conclusion

The results showed that interpersonal psychotherapy improves the state of alexithymia, emotional regulation, and psychological capital in substance abusers. It can also be used as an effective intervention in addiction treatment centers.

Assessing alexithymia across negative and positive emotions: Psychometric properties of the Polish version of the Perth Alexithymia Questionnaire

The Perth Alexithymia Questionnaire (PAQ) is a 24-item self-report measure of alexithymia. Originally developed in English, it was designed to try to enable more comprehensive (i.e., facet-level and valence-specific) alexithymia assessments. This study aimed to introduce and validate a Polish version of the PAQ. Our sample were 1,008 people (69.44% females, 30.06% males and 0.50% non-binary) aged 18-78 (M = 29.69, SD = 14.15) from the general community. The PAQ's factor structure was verified with confirmatory factor analysis, and convergent and divergent validity were assessed via relationships with other measures of alexithymia and mental health symptoms. Our results indicated strong factorial validity, conforming to the intended subscale structure. As expected, all PAQ subscales correlated in expected directions with another established alexithymia measure, and markers of depression, anxiety, and stress symptoms. The PAQ showed good discriminant validity in terms of measuring an alexithymia construct that was separable from people's current level of distress. Test-retest and internal consistency reliabilities were also good. Overall, the Polish PAQ therefore appears to have strong psychometric properties. Our findings add to a growing body of literature supporting the validity of the PAQ, and the multidimensional nature of the alexithymia construct, across different nations and languages.

Stability of alexithymia is low from adolescence to young adulthood, and the consistency of alexithymia is associated with symptoms of depression and dissociation

BACKGROUND

The aims of this study were to investigate the stability of alexithymia from adolescence to young adulthood, as well as the association between alexithymia, peer relationships, and symptoms of depression and dissociation.

METHODS

The participants (n = 755, aged 13-18 years) were assessed with self-rated questionnaires and the 20-item Toronto Alexithymia Scale (TAS-20) at baseline in 2005 and on follow-up in 2011.

RESULTS

The changes in the TAS-20 total score (t = -12.26) and the scores for its subscales, difficulty identifying feelings (DIF) (t = -4.04), difficulty describing feelings (DDF) (t = -5.10), and externally oriented thinking (EOT) (t = -18.23), were statistically significant (p < 0.001). Effect sizes (Cohen's d) for the change indicating absolute stability were small for DIF (-0.15) and DDF (-0.19), medium for TAS-20 total (-0.45), and large for EOT (-0.66) scores. Moderate correlations in test-retests with Spearman's ρ (TAS-20 total 0.46, DIF 0.41, DDF 0.39, EOT 0.43) indicated relative stability, whereas low intraclass correlation coefficients (ICCs) (respectively 0.41, 0.39, 0.37, 0.37) indicated poor reliability of test-retests. In regression analyses, poor relationships with peers, loneliness, and symptoms of depression and dissociation at baseline associated with alexithymia at baseline and on follow-up. Unlike EOT, increases in the TAS-20 total, DIF, and DDF scores during the 6-year follow-up associated with baseline symptoms of depression and dissociation.

CONCLUSIONS

Alexithymia in adolescence is not always a reliable predictor of alexithymia in young adulthood. Mental health symptoms appear to affect the consistency of alexithymia during adolescent development.

Psychometric evaluation of the Norwegian Toronto Alexithymia Scale (TAS-20) in a multisite clinical sample of patients with personality disorders and personality problems

OBJECTIVE

Psychometric properties of 20-item Toronto Alexithymia Scale (TAS-20) have been widely analyzed, but the validity and psychometric qualities of the TAS-20 in populations with personality disorders are still poorly understood. The aim of the current study was to analyze the factor structure and validity of TAS-20.

METHOD

Data were extracted from a multisite clinical sample of patients with personality disorders or personality-related problems referred to specialist mental health services in Norway.

RESULTS

With one exception, TAS-20 revealed acceptable psychometric properties. Variations of TAS-20 are associated with other clinical measures of distress and severity. Anxiety disorders, borderline, and avoidant personality disorders were all highly related to levels of TAS-20. The TAS-20 also revealed unique variance not accounted for by subjective distress, symptom disorders, or dysfunctional personality traits.

CONCLUSION

The TAS-20 is a relevant instrument for use in assessment of personality disorders, but one subscale should be improved.

[Common foundation of alexithymia and expressive suppression]

Hintergrund

Internationale Studien konnten bereits einen Zusammenhang zwischen Alexithymie und expressiver Suppression belegen. Im deutschsprachigen Raum wurde dieser Zusammenhang bisher nur sehr selten betrachtet. Übergeordnetes Ziel der vorliegenden Studie war die Untersuchung eines korrelativen und faktoriellen Zusammenhangs von Alexithymie und expressiver Suppression.

Material und Methoden

Insgesamt 317 Personen nahmen einer Onlinebefragung teil. Mithilfe der deutschsprachigen Versionen der Toronto Alexithymia Scale-26 (TAS-26) und des Emotion Regulation Questionnaire (ERQ) wurden Daten zu Alexithymie und expressiver Suppression erfasst.

Ergebnisse

Es bestanden signifikante Korrelationen zwischen der Subskala „Schwierigkeit bei der Identifikation von Gefühlen“ der TAS-26 und der Skala „Unterdrückung“ des ERQ (r = 0,5; p < 0,001) sowie zwischen der Subskala „Schwierigkeit bei der Beschreibung von Gefühlen“ der TAS-26 und der Skala „Unterdrückung“ des ERQ (r = 0,64; p < 0,001). Die Ergebnisse einer explorativen Faktorenanalyse ergaben eine Zwei-Faktoren-Lösung mit einem gemeinsamen Faktor für die TAS-26-Subskalen „Schwierigkeit bei der Identifikation von Gefühlen“ und „Schwierigkeit bei der Beschreibung von Gefühlen“ und der Skala „Unterdrückung“ des ERQ mit einer gemeinsamen Varianz von 38,2 % (χ² = 363,843; p < 0,001; Kaiser-Meyer-Olkin[KMO]-Wert = 0,699).

Schlussfolgerung

Die Ergebnisse legen nahe, dass den Skalen der TAS-26 in den Komponenten „Schwierigkeit bei der Identifikation von Gefühlen“ und „Schwierigkeit bei der Beschreibung von Gefühlen“ sowie der Skala „Unterdrückung“ des ERQ in der Komponente der „expressiven Suppression“ ein gemeinsames Konstrukt zugrunde liegt, das mit dem Begriff der Sprachlosigkeit belegt werden kann.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1-40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a "general alexithymia" factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with "TAS" no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia ).

Differences Between Autistic and Non-Autistic Adults in the Recognition of Anger from Facial Motion Remain after Controlling for Alexithymia

To date, studies have not established whether autistic and non-autistic individuals differ in emotion recognition from facial motion cues when matched in terms of alexithymia. Here, autistic and non-autistic adults (N = 60) matched on age, gender, non-verbal reasoning ability and alexithymia, completed an emotion recognition task, which employed dynamic point light displays of emotional facial expressions manipulated in terms of speed and spatial exaggeration. Autistic participants exhibited significantly lower accuracy for angry, but not happy or sad, facial motion with unmanipulated speed and spatial exaggeration. Autistic, and not alexithymic, traits were predictive of accuracy for angry facial motion with unmanipulated speed and spatial exaggeration. Alexithymic traits, in contrast, were predictive of the magnitude of both correct and incorrect emotion ratings.

Understanding Oneself to Understand Others: The Role of Alexithymia and Anxiety in the Relationships Between Autistic Trait Dimensions and Empathy

People on the autism spectrum may have difficulty inferring others' emotions (cognitive empathy), but may share another's emotions (affective empathy) and exhibit heightened personal distress. The present study examined independent autistic trait dimensions (social difficulties and restricted/repetitive behaviours) and the roles alexithymia and trait anxiety have in explaining this profile of empathy. Results from the general population (n = 301) revealed that pronounced social difficulties and not restricted/repetitive behaviours related to reduced cognitive and affective empathy, and heightened personal distress. However, both dimensions, through alexithymia and anxiety, indirectly influenced empathy. Surprisingly, while the dimensions indirectly improved affective empathy, pronounced social difficulties directly reduced affective empathy. This study motivates a nuanced model of empathy by including autistic trait dimensions, anxiety, and alexithymia.

Further Support for the Psychometric Properties of the Farsi Version of Perth Alexithymia Questionnaire

Alexithymia is defined as the lack of words to describe emotions and is associated with different psychopathologies. Various tools have been developed for measuring alexithymia; each has its limitations. A new questionnaire, Perth Alexithymia Questionnaire (PAQ), was developed to simultaneously assess positive and negative dimensions. Validation of such a tool in different cultures allows cross-cultural health psychology studies and facilitates knowledge transfer in the field. We aimed to examine the psychometric features of the PAQ in the Farsi-speaking population in Iran. Four-hundred-twenty-nine university students were asked to complete the PAQ, the Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and emotion regulation questionnaire (ERQ). Concurrent validity, discriminant validity, internal consistency, and test-retest reliability and factor structure were investigated. Confirmatory factor analysis showed a five-factor model identical to the original questionnaire. The questionnaire indicated good internal consistency (0.82 < α < 0.94). Test-retest reliability was acceptable for all subscales. The correlations between PAQ and its subscales with BDI-II, BAI, and TAS, and expression suppression subscale of ERQ were strong for concurrent validity. Concerning the discriminant validity, PAQ and its subscales were not correlated with reappraisal subscales of ERQ. The present findings suggest that the Farsi version of PAQ has strong psychometric properties and is appropriate for use in the Farsi-speaking population.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting one's own emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies a number of cognitive and emotional differences previously attributed to autism, such as difficulties in facial emotion recognition and reduced empathy. Although questionnaires such as the twenty-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have attempted to determine the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 verbal autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study (the Human Penguin Project). The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to further refine the scale based on local model misfit and I-DIF between the groups. Correlations between alexithymia and other clinical outcomes such as autistic traits, anxiety, and quality-of-life were used to assess the nomological validity of the revised alexithymia scale in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate global model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an eight-item unidimensional scale (TAS-8) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that TAS-8 scores meaningfully predict autistic trait levels, anxiety and depression symptoms, and quality of life, even after controlling for trait neuroticism.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was overwhelmingly female, later-diagnosed, and well-educated; clinical and control groups drawn from different studies with variable measures; and an inability to test several other important psychometric characteristics of the TAS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the TAS-8 as a psychometrically robust tool to measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced TAS-8 latent trait scores in research applications (available at http://asdmeasures.shinyapps.io/TAS8_Score ).

Alexithymia traits outweigh autism traits in the explanation of depression in adults with autism

When contemplating the alarming depression rates in adults with autism spectrum disorder (ASD), there is a need to find factors explaining heightened symptoms of depression. Beyond the impact of autism traits, markedly increased levels of alexithymia traits should be considered as a candidate for explaining why individuals with ASD report higher levels of depressive symptoms. Here, we aim to identify the extent to which autism or alexithymia traits indicate depressive symptoms in ASD and whether the pattern of association are specific to ASD. Data of a large (N = 400) representative clinical population of adults referred to autism diagnostics have been investigated and split by cases with a confirmed ASD diagnosis (N = 281) and cases with a ruled out ASD diagnosis (N = 119). Dominance analysis revealed the alexithymia factor, difficulties in identifying feelings, as the strongest predictor for depressive symptomatology in ASD, outweighing autism traits and other alexithymia factors. This pattern of prediction was not specific to ASD and was shared by clinical controls from the referral population with a ruled out ASD diagnosis. Thus, the association of alexithymia traits with depression is not unique to ASD and may constitute a general psychopathological mechanism in clinical samples.

Assessing Alexithymia: Psychometric Properties of the Perth Alexithymia Questionnaire in a Spanish-Speaking Sample

Alexithymia is a trait composed of difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally orientated thinking (EOT). It is an important transdiagnostic risk factor for psychosomatic disorders and other types of emotion-based psychopathologies, and can reduce the efficacy of some treatment approaches. Alexithymia assessments are therefore important in psychiatric and research settings. The Perth Alexithymia Questionnaire (PAQ) was recently developed to enable more comprehensive alexithymia assessments, however, its psychometric properties need further examination and it is so far only available in English. In this study, we sought to address this by translating the PAQ into Spanish and testing its psychometric properties in an adult sample from Chile (N = 370). Confirmatory factor analyses found the PAQ to have a theoretically congruent factor structure, supporting the contemporary status of alexithymia as a multifaceted construct and the PAQ's capacity to assess the DIF, DDF, and EOT facets of alexithymia across negative and positive emotions. All subscale and composite scores had high internal consistency reliability, and demonstrated good concurrent and discriminant validity. The PAQ therefore appears to provide a robust and detailed alexithymia profile. This Spanish version should help to enable more comprehensive cross-cultural research into alexithymia and its role in and psychological disorders.

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

BACKGROUND

Autistic people are disproportionately vulnerable to anorexia nervosa and other eating disorders (ED), and within the general population, autistic traits correlate with ED psychopathology. A putative mechanism which may underpin this heightened risk is alexithymia, a difficulty identifying and describing emotional states which is observed in both autism and ED. In two experiments with independent non-clinical samples, we explored whether alexithymia might mediate the heightened risk of eating psychopathology in individuals high in autistic traits.

METHODS

Our first experiment used the PROCESS macro for SPSS to examine relationships between alexithymia (measured by the Toronto Alexithymia Scale (TAS-20)), autistic traits (autism quotient (AQ)), and eating psychopathology (Eating Attitudes Test (EAT-26)) in 121 participants. Our second experiment (n = 300) replicated and furthered this analysis by examining moderating effects of sex and controlling for anxiety and depression as covariates. We also included an additional performance-based measure of alexithymia, the Levels of Emotional Awareness Scale (LEAS).

RESULTS

Study 1 suggested that TAS-20 scores mediated the relationship between heightened autistic traits and eating psychopathology. Replication and further scrutiny of this finding, in study 2, revealed that this mediation effect was partial and specific to the female participants in this sample. The mediation effect appeared to be carried by the difficulty identifying feelings subscale of the TAS-20, even when depression and anxiety were controlled for. LEAS scores, however, were not significantly related to autistic traits or eating psychopathology.

LIMITATIONS

Cross-sectional data prevents any conclusions around the direction and causality of relationships between alexithymia, autistic traits, and eating psychopathology (alongside depression and anxiety), necessitating longitudinal research. Our non-clinical sample was predominantly Caucasian undergraduate students, so it remains to be seen if these results would extrapolate to clinical and/or autistic samples. Divergence between the TAS-20 and LEAS raises crucial questions regarding the construct validity of these measures.

CONCLUSIONS

Our findings with respect to autistic traits suggest that alexithymia could partially explain the prevalence of ED in autistic people and may as such be an important consideration in the pathogenesis and treatment of ED in autistic and non-autistic people alike. Further research with clinical samples is critical to explore these ideas. Differences between men and women, furthermore, emphasize the importance of looking for sex-specific as well as generic risk factors in autistic and non-autistic men and women.

Consistent evidence of a link between Alexithymia and general intelligence

Alexithymia is a personality construct characterised most notably by a difficulty in identifying and expressing feelings. Although the emotional difficulties in alexithymia are well established, to date little work has examined its relationship to broader cognitive abilities, such as general intelligence. Across three independent, healthy adult samples (Ns = 389, 318, & 273), we examined whether alexithymia was associated with general intelligence. In all three samples, we observed a significant negative association between alexithymia and general intelligence. In two of the samples, general intelligence was a significant predictor of alexithymia even when accounting for performance on tests of facial emotion recognition ability and supramodal emotion recognition ability (measured with faces, bodies, and voices). From a theoretical perspective, these results suggest that models of alexithymia need to incorporate a role for more generalised cognitive functioning. From a practical perspective, studies examining links between alexithymia and clinical disorders, many of which have known links to general intelligence, should consider including a measure of general intelligence in order to adjust for this potentially confounding factor.

What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity

OBJECTIVE

There is ongoing uncertainty about the structure and definition of alexithymia. Conceptually, alexithymia has traditionally been defined as a multidimensional trait with four components: difficulty identifying feelings, difficulty describing feelings, externally orientated thinking, and difficulty fantasizing. However, some authors suggest that difficulty fantasizing might not be a component, and others suggest low emotional reactivity is a fifth component. In this study, we sought to clarify this issue using factor analysis.

METHOD

In a sample of adults (N = 508), we administered a comprehensive battery of psychometric measures and analyzed their latent structure using exploratory factor analysis.

RESULTS

Subscales assessing difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking all loaded well together on the alexithymia factor. However, none of the subscales assessing aspects of difficulty fantasizing (i.e., daydreaming frequency, vividness, content, or use of daydreams to regulate emotions) loaded on the alexithymia factor. Similarly, no emotional reactivity subscales loaded on the alexithymia factor, and alexithymia was associated with higher (not lower) levels of emotional reactivity for negative emotions.

CONCLUSIONS

Difficulty fantasizing and low emotional reactivity are not components of the latent alexithymia construct. The traditional four-component definition of alexithymia likely warrants refinement to a more parsimonious three-component solution.

Alexithymia, empathy, negative affect and physical symptoms in patients with asthma

Although alexithymia has been found to be associated with physical symptoms in psychosomatic disorders such as asthma, mechanisms linking this association are unknown. However, affective alexithymic features may be associated with physical symptoms in the presence of deficits in affective characteristics such as low empathy and high negative affect. This study aimed to assess direct effects of alexithymic traits on physical symptoms and indirect effects of these subscales through empathy and negative affect (e.g. depressive, anxious and stress symptoms) by controlling for asthma severity in patients with asthma. Three hundred patients with asthma completed the Toronto Alexithymia Scale-20 (TAS-20), the Basic Empathy Scale (BES), the Depression Anxiety Stress Scales-21 (DASS-21) and the Physical Symptoms Inventory (PSI). After controlling for asthma severity, the results showed that alexithymia subscales of the TAS-20 had no direct effects on physical symptoms, but the difficulty in identifying feelings (DIF) subscale of the TAS-20 was associated with affective empathy and negative affect. Affective empathy was significantly related to negative affect. Affective empathy and negative affect were associated with physical symptoms. The affective subscale of alexithymia on the TAS-20, that is DIF, indirectly affected physical symptoms through affective empathy and negative affect. Findings suggest that patients with asthma who have high levels of DIF may show high physical symptoms in the presence of low affective empathy and high negative affect.