Comparison of 26-item and 20-item versions of the Toronto Alexithymia Scale for psychiatric outpatients

This study compared the 20-item revised Toronto Alexithymia Scale with the 26-item version for 257 psychiatric outpatients. Scores on the 20-item version significantly correlated with those on the 26-item inventory even when controlled for depressed mood. Furthermore, the 20-item scale showed greater internal consistency. Factor analysis for both versions indicated three subfactors but the factors in the TAS-20 accounted for greater common variance (92%) than for the factors in the TAS-26 (78%). The total variance accounted for by these factors on the TAS-20 (45%) was also greater than for the TAS-26 (38%).     

Reliability and factorial validity of a Farsi version of the 20-item Toronto Alexithymia Scale with a sample of Iranian students

This study investigated the psychometric properties of the Farsi version of the 20-item Toronto Alexithymia Scale for 587 undergraduate students (349 women and 238 men) at the University of Tehran. All participants were asked to complete the Farsi version of the TAS-20, the Emotional Intelligence Scale, and the Mental Health Inventory. Findings supported the internal consistency, test-retest reliability, concurrent validity, and three-factor structure of the Farsi version of the 20-item Toronto Alexithymia Scale. The factors found in the Farsi version of this scale are similar to the three factors found previously and were accordingly labeled as Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking. The results provide evidence for applicability of the TAS-20 and its cross-cultural validity.     

Criterion validity of Bermond-Vorst Alexithymia Questionnaire-20 Form B: a study of 63 alcoholic subjects

The aim of the study was to set alexithymia cutoff scores on the 20-item Bermond-Vorst Alexithymia Questionnaire-20 Form B. Alexithymia is a clinical construct describing individuals who have difficulty identifying and reporting their specific emotions. 63 subjects meeting the DSM-IV criteria for alcohol dependence completed the questionnaire and the 20-item Toronto Alexithymia Scale. Using cutoff scores for the latter, subjects were divided into alexithymic and nonalexithymic subgroups. Taking into account the sensitivity, specificity, and predictive positive value, several potential Bermond-Vorst questionnaire scores were tested. Using the Younden formula (Sensitivity+ Specificity-1), score of 52 was the most appropriate cutoff score for the Bermond-Vorst-20 to indicate the presence of alexithymia in these male alcoholics.     

Alexithymia and Cardiovascular Risk in Older Adults: Psychosocial,Psychophysiological, and Biomedical Correlates

Psychosocial correlates of alexithymia were examined in 102 healthy, older adults (ages 53-83; 76% male). Alexithymic ( n = 26) and non-alexithymic ( n = 30) groups, defined by top ( S 70) and bottom ( h 54) quartiles of the distribution of Toronto Alexithymia Scale (26-item) scores, were compared with respect to psychosocial, psychophysiological, and biomedical risk factors for cardiovascular disease. Both categorical ratings and continuous scores of alexithymia were associated with significantly greater levels of trait anxiety, anger-in, neuroticism, hostility, perceived stress, depression, and lower levels of social support. Compared to non-alexithymics, alexithymics displayed significantly greater blood pressure responses to anger provocation and tended to have a greater percent body fat. The groups did not differ in resting cardiovascular parameters, heart rate reactivity, fasting glucose and lipoprotein lipids, body mass index, waist-to-hip ratio, social desirability, or trait anger. These findings suggest several psychosocial and psychophysiological pathways by which alexithymia may confer risk for cardiovascular disease among older adults.     

Factorial validity of the 20-item Toronto Alexithymia Scale

The 20-item Toronto Alexithymia Scale (TAS-20) was developed in previous research to measure a general dimension of alexithymia with three inter correlated factors. These three factors reflect distinct facets of the alexithymia construct: (1) difficulty identifying feelings and distinguishing them from the bodily sensations of emotion, (2) difficulty describing feelings to others, and (3) an externally orientated style of thinking. This study tested the three-factor model for the TAS-20, using confirmatory factor analysis, in separate samples of young adults from Germany, Canada, and the United States. The previously established three-factor model was found to be replicable in all three samples. In addition, the full TAS-20 and its three factors demonstrated adequate internal reliability in all three samples. Although evaluation of the convergent, discriminant, and criterion validity of the TAS-20 is required in diverse cultural groups, the present results provide evidence for the factorial validity and internal reliability of the TAS-20.     

Associations among alexithymia, positive and negative emotions, and self-defeating personality

This study examined the associations among 210 college students' alexithymia scores and three emotional orientation scores. Students completed the following three self-report instruments: 20-item Toronto Alexithymia Scale, 20-item Positive and Negative Affect Scale, and 24-item Self-defeating Personality Scale. As predicted, a linear regression model indicated that alexithymia was associated with negative emotional activation, self-defeating personality, and inversely associated with positive emotional activation. These three affect orientations accounted for 27% of the variance associated with subjects' cognitive-affective communication difficulties expressing their emotions. A second linear regression model indicated that negative emotion activation was significantly associated with self-defeating personality, and positive emotion activation was significantly inversely associated with self-defeating personality.     

Different subgroups of high-scorers on the TAS-20 based on the big five personality traits

We investigated whether it was possible to obtain a consistent representation of the alexithymia trait by using the twenty-item Toronto Alexithymia Scale (TAS-20). TAS-20 and the NEO-Five Factor Inventory were administered to nonclinical participants (N = 2188). The results of hierarchical cluster analysis and a two-way analysis of variance indicated two subgroups with high scores on the TAS-20. One group had difficulty identifying feelings and high neuroticism; the other had a high externally oriented cognitive style and low openness to experience. These results suggest that the total score on the TAS-20 should not be considered a uni-dimensional measure of alexithymia.     

The Toronto Alexithymia Scale (TAS-20): A measure of general psychological distress

The Toronto Alexithymia Scale (Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.) is the most commonly used measure of Alexithymia (= difficulties identifying and describing one’s own feelings). Sixty-three persons (34 psychiatric inpatients, 29 healthy controls) first filled in the TAS-20 and were then interviewed about their interpersonal relationships. Two raters coded the emotional experiences that the participants reported during these interviews. Contrary to expectations, participants with higher TAS-20 scores reported more emotions (particularly negative ones), and more different emotions, questioning the validity of the TAS-20 as a measure of Alexithymia. Based on correlation patterns and a joint factor analysis with two well-established measures of psychopathology, it is concluded that the TAS-20 assesses a general psychological distress factor.     

Processing of facial expressions of negative emotion in alexithymia: the influence of temporal constraint

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

Analyzing the aesthetic impressions of alexithymic Japanese students

We investigated the association between alexithymic tendencies as measured by the 20-item Toronto Alexithymia Scale and the characteristics of aesthetic impressions for words and drawings. Impressions were measured using the semantic differential technique in three groups of Japanese students (High scores n = 31, Moderate scores n = 40, and a Control group n = 182) who were presented only words (Word condition), only drawings (Drawing condition), or pairs comprising one word plus one drawing that represented the same emotional categories (Drawing/Word condition). In a factor analysis on the data from participants, three factors (Evaluation, Activity, and Potency) were extracted. Based on the factor scores, the distances among the three conditions were calculated for each of the groups. For Potency, significant group differences were found between the Drawing/Word and other conditions. In the High-scoring alexithymia group, in particular, the Potency impressions based on tactile sensation, e.g., soft-hard, blunt-sharp, were amplified regardless of stimulus condition. These results are discussed in the context of somatosensory amplification associated with alexithymia and the difficulty of distinguishing between emotion and somatic sensations.     

Fonctionnement psychoaffectif d’adultes atteints de dermatite atopique

This study aims to evaluate the existence of explanatory factors associated with the maintenance of atopic dermatitis (DA) during adulthood by analyzing several psychological dimensions in patients.MethodsThe Toronto Alexithymia Scale (TAS-20) was administered to 25 subjects with DA (mean age: 27 years, [20–60]; 72% women and 28% men). Among these patients, ten accepted a projective psychological assessment (Rorschach).ResultsA prevalence of 44% of alexithimic subjects was observed among patients with DA (against 20.7% observed in the general population). Concerning their psycho-affective functioning, several common characteristics were observed using the Rorschach: difficulties with aggressiveness management, presence of narcissistic features, as well as depressive elements in particular among subjects who do not present alexthymia.ConclusionPatients with DA would present frequent difficulties in describing and verbalizing their feelings. This would be associated to elements of personality that may participate in the maintenance of the DA and facilitate a somatic discharge of the emotional tension.     

Validation of the Empathy Quotient in Mainland China

This research aimed to validate a simplified Chinese version of the Empathy Quotient (EQ; 60 items) for use with Mainland Chinese people. The original English version of the EQ was translated into simplified Chinese. Through an online survey, 588 Mainland Chinese participants completed the EQ and 3 other questionnaires: the Interpersonal Reactivity Index (IRI), the Autism-Spectrum Quotient (AQ), and the 20-item Toronto Alexithymia Scale (TAS–20). Thirty-five participants completed retesting of the EQ 3 to 4 weeks later. Sex differences on the EQ scores and psychometric properties of the EQ items were examined. Confirmatory factor analysis suggested that an EQ 15-item structural model fitted the data quite well. Self-report empathy, as assessed by the current simplified Chinese version of the EQ, appeared to relate to participants' autistic and alexithymic traits but not sex.     

Observation of couple interactions: Alexithymia and communication behaviors

Alexithymia is conceptualized as a deficit of the cognitive aspect of an emotional response. Alexithymia has been associated with various relational difficulties, but few studies have investigated couple relationships. The present study addresses the imperative need for the advancement of knowledge regarding the impact of alexithymia on couple relationships and, more specifically, on communication behaviors. One hundred and fifty participants (75 couples) completed the Toronto Alexithymia Scale (TAS-20) and their interactions in the laboratory were coded using the Interactional Dimensions Coding System (IDCS). Actor–partner effects were investigated using Multi-level analyses. For women, no relationship was found between self-alexithymia and communication behaviors for self or partner. For men, alexithymia was found to be associated with their own hostility, but also with their partner’s hostility, withdrawal and communication skills. The results are discussed through a social learning perspective.     

Alexithymia in patients with major depressive disorder and comorbid cluster C personality disorders: a 6-month follow-up study.

The authors examined the association between alexithymia, cluster C personality disorders (CPD), and severity of depression among 121 outpatients with major depressive disorder (MDD) in a 6-month, follow-up study. Diagnosis of depression and CPD was confirmed by means of the Structured Clinical Interviews for DSM-III-R (SCID I and SCID II). Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale and severity of depression was assessed using the 21-item Beck Depression Inventory. Results indicated that alexithymic features are common in patients with MDD but often alleviated during recovery from depression. Moreover, comorbid CPD and severity of depression seemed to be associated with poorer recovery from alexithymia. The implications of these findings are discussed.     

Alexithymia and interpersonal problems: A study of natural language use

The concept of alexithymia refers to difficulties in experiencing, verbalizing and regulating emotions. The relationship between alexithymia and interpersonal style is investigated by means of lexical content analysis. It is hypothesized that alexithymia is related to less frequent and less varied use of communication words and references to others. Alexithymia was measured with the 20-item Toronto Alexithymia Scale and the Toronto Structured Interview for Alexithymia. The Clinical Diagnostic Interview was administered to 50 psychiatric inpatients, transcribed verbatim, and computer-analysed with the Linguistic Inquiry and Word Count-dictionary. Results showed that alexithymia is related to a less complex vocabulary for communication words. Contradictory results for some subscales of the TAS-20 and the TSIA however compromise their construct validity.     

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

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

20‐Item Toronto Alexithymia Scale: Do difficulties describing feelings assess proneness to shame instead of difficulties symbolizing emotions?

A hallmark of alexithymia is the difficulty putting emotional states into words which has to be differentiated from problems to communicate emotion to others. Shame proneness is a personality trait that is expected to be closely related to a reduced emotional self-disclosure in social interactions. The present investigation was conducted to examine construct validity of the Difficulties Describing Feelings scale of the 20-Item Toronto Alexithymia Scale (TAS-20). The TAS-20 was administered to 68 subjects (30 psychiatric inpatients and 38 normals) along with the Levels of Emotional Awareness Scale (LEAS), a direct measure of the ability to express feelings verbally, and the Shame-Guilt-Scale. Difficulties Describing Feelings was associated with shame assessing scales but not with guilt assessing scales or the LEAS. Thus, in view of our data one should be cautious in interpreting scores from the TAS-20 scale Difficulties Describing Feelings as indices of a difficulty to symbolize one's emotions. Instead, this TAS-20 scale seems to evaluate aspects of social shame.     

TAS-20 alexithymia in obesity, and its links to personality

We studied the association between alexithymia (20-item Toronto Alexithymia Scale, TAS-20) and obesity, and also assessed the construct validity of the TAS-20 in terms of personality dimensions in obese patients. The TAS-20 and its subscales were analysed for their correlations with the NEO Personality Inventory - Revised (NEO PI-R) in an obese sample of 259 patients. Obesity was associated with higher scores on the TAS-20 than a Swedish reference sample. Obese men furthermore scored higher on Externally Oriented Thinking than the obese women. TAS-20 scores correlated with elevated Neuroticism and lower levels of Extraversion and Openness, in agreement with most previous research, but also somewhat unexpectedly with lower Conscientiousness and for women also with lower Agreeableness. The TAS-20 subscales showed divergent associations with personality variables, largely in accordance with previous findings. The associations were more prominent for the women, and some gender-specific patterns not previously reported were also revealed.     

Association between alexithymia, neuroticism, and social desirability scores among Italian graduate students

An inverse correlation between social desirability and alexithymia has been observed in undergraduate students in Japan and Australia. It is not clear how this association is influenced by the personality dimension of neuroticism. This study examined the association of scores on social desirability with those on alexithymia controlled for neuroticism, in a sample of 111 Italian graduate students, with age range of 24 to 58 years. Students completed the Eysenck Personality Questionnaire (short form) and the Toronto Alexithymia Scale-20 (TAS-20). Social desirability scores inversely correlated with TAS-20 total scores, neuroticism scores, and the TAS-20 subscale, Difficulty identifying feelings. Neuroticism directly correlated with TAS-20 total score, Difficulty identifying feelings, and Difficulty describing feelings. Students with higher alexithymia and neuroticism scores seem to present themselves in less socially desirable ways. The correlation of social desirability with alexithymia was moderated by higher neuroticism scores.     

Alexithymia and its measurement: confirmatory factor analyses of the 20‐item Toronto Alexithymia Scale and the Bermond–Vorst Alexithymia Questionnaire

Alexithymia refers to the difficulties an individual has in experiencing and expressing feelings. The 20‐item Toronto Alexithymia Scale (TAS‐20) and the Bermond–Vorst Alexithymia Questionnaire (BVAQ) with two parallel versions of 20 items have been constructed to measure it. The present study compared the psychometric properties of these two self‐report questionnaires in English (N=290) and French (N=322) language versions. Confirmatory factor analysis was used to examine the fit between the hypothesized factors and the data. Results revealed a better fit to the data for the second version of the BVAQ (BVAQ‐20B) for both language versions as compared to the TAS‐20, the whole BVAQ, or the first version of the BVAQ (BVAQ‐20A). Additionally, the factor comparison of both language versions indicated that only the factorial structure of the BVAQ‐20B was replicable across languages. Concurrent validity of the questionnaires is discussed. Copyright © 1999 John Wiley & Sons, Ltd.