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

Emotion Regulation and Psychological Dependence on Pain Medication among Hospital Outpatients with Chronic Spinal Pain: The Influence of Rumination about Pain and Alexithymia

Objective: To examine the extent to which pain acceptance, pain catastrophising and alexithymia moderate associations between pain intensity and psychological pain medication dependence. Methods: Participants (106 hospital outpatients with chronic spinal pain) completed the Leeds Dependence Questionnaire (LDQ) to measure psychological dependence on pain medication, and the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), the Pain Catastrophising Scale (PCS) and the Toronto Alexithymia Scale-20 (TAS-20), plus the Depression, Anxiety and Stress Scale-21 (DASS-21). Results: Multiple linear regression showed that degree of psychological dependence (measured dimensionally across the range of LDQ scores) was associated with TAS subscale difficulty identifying feelings (DIF) (β = 0.249, p = <0.002) and PCS subscale rumination (β = 0.193, p = 0.030), independently of pain intensity and risk behaviors for medication misuse. The effect of pain intensity was moderated by rumination, with pain intensity more strongly associated with dependence when rumination was high (interaction β = 0.192, p = 0.004). Logistic regression showed that the effect of pain intensity on severe dependence (measured categorically as LDQ score ≥ 20) was moderated by alexithymia, so that severe dependence was independently associated with the combination of intense pain and high alexithymia (interaction odds ratio = 7.26, 95% CIs = 1.63-32.42, p = 0.009). Conclusions: Rumination and alexithymia moderated the associations between pain intensity and psychological pain medication dependence, consistent with emotion regulation theory. This raises the possibility that specifically targeting rumination about pain and symptoms of alexithymia could potentially improve the effectiveness of psychological interventions for chronic pain and help people to avoid or reduce their psychological dependence on pain medication.

Psychological profiles of patients with suspected drug allergy

Background

Several studies demonstrate an important association between allergic diseases and patients' psychological characteristics.

Objective

To evaluate any differences in the psychological characteristics of patients studied for suspected drug allergy in comparison with healthy controls. A secondary aim was to assess differences between patients with confirmed versus excluded drug allergy, with respect to the clinical aspects.

Methods

The psychological characteristics of 115 consecutive patients >16 years-old, studied for suspected drug allergy were assessed. They were compared with healthy controls. Four validated questionnaires were used to evaluate anxiety, depression, alexithymia, and personality type.

Results

Eighty-eight patients completed the evaluation: 34 had confirmed drug allergy and 33 excluded. Forty-eight healthy subjects filled the 4 questionnaires. Increased neuroticism was associated with increased odds of belonging to the excluded drug allergy group (odds ratio [OR], 1.374; 95% confidence interval [CI], 1.173–1.609). Increased neuroticism (OR, 1.244; 95% CI, 1.065–1.453) and increased anxiety (OR, 1.210; 95% CI, 1.084–1.351) were associated with increased odds of confirmed drug allergy. However, higher extraversion decreased this likelihood (OR, 0.755; 95% CI, 0.643–0.888). The odds of having confirmed drug allergy was reduced by 79.7% (OR, 0.203; 95% CI, 0.060–0.694) for patients with 2 suspected drugs and by 84.6% (OR, 0.154; 95% CI, 0.029–0.809) for those with ≥3 in comparison to those with only one. Patients with moderate to severe reactions were more likely to have confirmed drug allergy (OR, 4.295; 95% CI, 1.105–16.693) than those with milder manifestations.

Conclusion

Our results highlight that patients with drug allergy have a distinctive psychological profile. Psychological assessment may help to identify patients that would benefit from a targeted intervention.

Association Between Alexithymia and Immature Coping Styles Is Mediated by Self-Inconsistency and Is Correlated to Obsessive-Compulsive Symptoms

This study aimed to investigate whether a multivariate association between alexithymia and coping styles is affected by self-inconsistency and whether the association contributed to obsessive-compulsive symptoms in 34 patients with obsessive-compulsive disorder (OCD) and 53 healthy participants. Alexithymia, coping styles, self-inconsistency, and obsessive-compulsive symptoms were evaluated using the Toronto Alexithymia Scale-20, the Coping Style Questionnaire, the Self-Consistency and Congruence Scale, and the Vancouver Obsessive-Compulsive Inventory, respectively. We found that self-inconsistency partially mediated the association between alexithymia and immature coping styles in the OCD patients but fully mediated the association in the healthy participants. Moreover, in the two groups, the alexithymia-coping coupling was related to contamination, obsession, indecisiveness, and ritualization, but not the checking symptom dimension. The findings suggest that the disturbance in identifying and describing feelings is associated with immature coping styles through disharmony between self-recognition and experience. The mechanism of the checking symptom seems to be distinct from other obsessive-compulsive symptoms.

Investigating alexithymia in autism: A systematic review and meta-analysis

BACKGROUND

New research suggests that, rather than representing a core feature of autism spectrum disorder (ASD), emotional processing difficulties reflect co-occurring alexithymia. Autistic individuals with alexithymia could therefore represent a specific subgroup of autism who may benefit from tailored interventions. The aim of this systematic review and meta-analysis was to explore the nature and prevalence of alexithymia in autism using the Toronto Alexithymia Scale (TAS).

METHODS

Online scientific databases were searched systematically for studies on ASD popu lations using the TAS. Meta-analyses were performed to evaluate differences in scores between the ASD and neurotypical groups, and to determine the prevalence of alexithymia in these populations.

RESULTS

15 articles comparing autistic and neurotypical (NT) groups were identified. Autistic people scored significantly higher on all scores compared to the NT group. There was also a higher prevalence of alexithymia in the ASD group (49.93% compared to 4.89%), with a significantly increased risk of alexithymia in autistic participants.

CONCLUSIONS

This review highlights that alexithymia is common, rather than universal, in ASD, supporting a growing body of evidence that co-occurring autism and alexithymia represents a specific subgroup in the ASD population that may have specific clinical needs. More research is needed to understand the nature and implications of co-occurring ASD and alexithymia.

Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale

OBJECTIVE

The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups.

METHOD

Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs.

RESULTS

Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions.

CONCLUSION

Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.

"Identifying and Describing Emotions": Measuring the Effectiveness of a Brief, Alexithymia-Specific, Intervention for a Sex Offender Population

Certain individuals who sexually offend may have difficulty differentiating, identifying, and articulating emotions. These clients may prove challenging for therapists when engaging with them in treatment. Such clients may suffer from alexithymia. There has been a dearth of research regarding specific psychotherapeutic interventions for alexithymia in both the clinical and forensic fields. The present study provides results from a pilot study on the efficacy of a brief, four-session, alexithymia-specific intervention with adults who have sexually offended. The intervention also aimed to increase emotional awareness and psychological mindedness. The intervention was comprised of both mindfulness and mentalization treatment components. Thirty-two men (Mage = 41.8 years, SD = 11.9) convicted of sexual offences completed the intervention group. When compared with a matched control condition (n = 27; Mage = 39, SD = 10.8), the intervention was effective in decreasing alexithymia characteristics and increasing psychological mindedness. Results suggest that the intervention was an effective means of increasing emotional awareness in this population. These provisional results must be tempered by the limitations of the study. However, the positive findings warrant future investigation. Clinical implications and ideas for future work are also discussed.

Toronto alexithymia scale for patients with eating disorder: [corrected] performance using the non-parametric item response theory

BACKGROUND

The aim of this study was to investigate the performance of the Toronto Alexithymia Scale (TAS-20) in patients with eating disorders. As a secondary objective, we analyzed a subset of items in order to determine whether the total score is a good tool for classifying these patients and whether the items are ordered according to the difficulty of choosing a particular answer depending on the severity of the patient's condition.

SUBJECTS AND METHODS

We administered the TAS-20 to 103 consecutive patients who met DSM-IV-R criteria for anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Mokken scale analysis, nonparametric item response theory (NIRT), and confirmatory factor analysis (CFA) were used to test the psychometric properties of the scale. To improve our understanding of the structure underlying the TAS-20, we used an automated item selection procedure based on the Mokken scale.

RESULTS

We identified a subset of 13 independent and clinically interpretable items that are potentially sufficient to rate patients with alexithymia. This subset was considered a unidimensional reduction of the TAS-20. However, the scale composed of this subset needs to be validated. Thirteen of the 20 items were maximally related to alexithymia because they have a one-dimensional structure. The NIRT and CFA enabled us to identify a maximal subset of items that conform to the requirements for good measurement of alexithymia in patients with eating disorders.

Predictors of painkiller dependence among people with pain in the general population

OBJECTIVES

Self-medication with painkillers is widespread and increasing, and evidence about influences on painkiller dependence is needed to inform efforts to prevent and treat problem painkiller use.

DESIGN

Online questionnaire survey.

PARTICIPANTS

People in the general population who had pain and used painkillers in the last month (N = 112).

MEASUREMENTS

Pain frequency and intensity, use of over-the-counter and prescription painkillers, risk of substance abuse (Screener and Opioid Assessment for Patients with Pain [SOAPP] scale), depression, anxiety, stress, alexithymia, pain catastrophizing, pain anxiety, pain self-efficacy, pain acceptance, mindfulness, self-compassion, and painkiller dependence (Leeds Dependence Questionnaire).

RESULTS

In multiple regression, the independent predictors of painkiller dependence were prescription painkiller use (β 0.21), SOAPP score (β 0.31), and pain acceptance (β -0.29). Prescription painkiller use mediated the influence of pain intensity. Alexithymia, anxiety, and pain acceptance all moderated the influence of pain.

CONCLUSIONS

The people most at risk of developing painkiller dependence are those who use prescription painkillers more frequently, who have a prior history of substance-related problems more generally, and who are less accepting of pain. Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence: 1) pain leading to painkiller use, 2) risk factors for substance-related problems irrespective of pain, and 3) psychological factors related to pain. The model could guide further research among the general population and high-risk groups, and acceptance-based interventions could be adapted and evaluated as methods to prevent and treat painkiller dependence.

A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program

OBJECTIVES

Alexithymia is common among psychiatric outpatients and can complicate treatment. There has been little research into whether alexithymia can be modified by psychological intervention, and whether change in alexithymia is related to other areas of improvement. The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia, and whether such change is related to improvement in interpersonal functioning.

DESIGN AND METHODS

Sixty-eight consecutively admitted psychiatric outpatients to a comprehensive group therapy program were evaluated at baseline, post-therapy, and 3-month follow-up using the Toronto Alexithymia Scale 20, the Beck Depression Inventory, and the Inventory of Interpersonal Problems-28. Associations among variables were evaluated with correlations and among group comparisons with t test, ANOVA, chi-square tests, and logistic regression. Change in alexithymia was examined using repeated measures ANOVA, controlling for change in depressive symptoms.

RESULTS

Alexithymia, particularly difficulty identifying feelings, decreased significantly during the treatment period. Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion. Changes in alexithymia were significantly associated with changes in interpersonal problems, both during therapy and during the follow-up period.

CONCLUSIONS

The results of our study suggest that a comprehensive, integrated group therapy program can affect change in alexithymia, and that such change can be maintained once therapy is completed. Also, modifying alexithymia may contribute to improvement in interpersonal functioning.

Affect, cognition, awareness and behavior in eating disorders. Comparison between obesity and anorexia nervosa

A kontinuummodell szerint az evészavarok elhelyezhetőek egy olyan folyamatos spektrumon, aminek az egyik végén a restriktív anorexia, a másik végén a stabil obesitas kórképe található. Számos vizsgálat bizonyítja továbbá azt, hogy a hangulati (depresszió, kóros szorongás és alexitímia), illetve a kognitív zavarok a testkép észlelésének problémájával együtt jelentkeznek az evészavarokban. Ennek ellenére az obesitast még mindig csupán testsúlykezelési problémaként tartják számon a klinikumban. Célkitűzés: Azon érzelmi, kognitív, illetve testképzavarok feltárása restriktív anorexiában és túlevés okozta stabil obesitasban, amelyek a kontinuummodell érvényességét igazolhatják, továbbá amelyek az evészavarok patológiájának közös alapját képezhetik. Módszerek: Neuropszichológiai tesztekkel vizsgáltuk a kognitív zavarokat, pszichológiai kerdőívekkel a hangulati zavart és az explicit testképértékelést, továbbá affektív priming paradigmát használtunk az implicit attitűdök feltárására. Eredmények: A neuropszichológiai tesztek figyelmi problémát mutattak ki mind anorexiában, mind obesitasban. Mind a gyerek-, mind a felnőttobesitasban megjelent a mentális rigiditás és a stratégiaváltás problémája, ami a frontális lebeny végrehajtórendszerének zavarát igazolta. Az elhízott betegek lassabban kategorizálták a szomorúságot kifejező arcokat, míg az anorexiások a mosolygós arcokat. Az elhízott csoport pozitív implicit attitűdöt, az anorexiás csoport negatív attitűdöt mutatott a túlsúlyos, de nem kövér testkép iránt. Anorexiások nem mutattak preferenciát a nagyon vékony testalak iránt. Következtetések: Az eredményeink szerint a restriktív anorexia több közös tünetet mutat a szorongásos kórképekkel, míg az elhízás a szenvedélybetegségek sajátosságait mutatta. Így a vizsgálatok nem igazolták egyértelműen a modell érvényességét.

Anxiety sensitivity and aspects of alexithymia are independently and uniquely associated with posttraumatic distress

Using a sample of adult survivors of physical trauma requiring hospitalization (N = 677), we examined the relationship of aspects of alexithymia and anxiety sensitivity to symptoms of posttraumatic distress (PTD). At the bivariate level, both aspects of alexithymia and anxiety sensitivity were positively associated with acute PTD symptomatology, but anxiety sensitivity was more strongly related to PTD symptoms. At the multivariate level, both anxiety sensitivity and aspects of alexithymia made unique and independent contributions to both total PTD symptoms and the majority of PTD symptom clusters. At the facet level, anxiety sensitivity-physical concerns and anxiety sensitivity-psychological concerns, and the alexithymic dimension of difficulty identifying feelings, were uniquely associated with acute PTD symptoms. Findings are discussed in terms of potential clinical implications.