Are alexithymia and Type D personality distinct or overlapping constructs? A confirmatory factor analysis of the Toronto alexithymia and Type D scales

Theoretically and conceptually the constructs of alexithymia and Type D personality share many common characteristics. Despite both measures being utilized widely in psychosomatic research, to-date no study has examined the constructs simultaneously. The present study was undertaken to determine if alexithymia and Type D personality are distinct or overlapping constructs. A cross-sectional sample of 1016 healthy participants completed the 20-item version of the Toronto alexithymia scale (TAS-20), and the Type D personality scale (DS14). Confirmatory factor analysis of the 14 items of the DS14, and 20 items of the TAS-20 was conducted. Based on the underlying theoretical structures of the DS14 and TAS-20 a five-factor model was examined (corresponding to the five subscales of the DS14 and TAS-20). The analysis revealed that the five factor model was an acceptable fit for the data (χ²/df = 4.7; CFI = .94, RMSEA = 0.06). These results provide evidence to suggest that alexithymia and Type D are distinct and separate constructs. However, future research should aim to replicate these findings in population and clinical samples.     

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, Irrational Beliefs, and the Rational-Emotive Explanation of Emotional Disturbance

In recent discussions of Rational-Emotive Behavior Therapy (REBT), Ellis has argued that unconscious processes supplement irrational beliefs in explaining psychopathology. The hypothesis of this investigation was that these unconscious processes reflect alexithymia. University students responded to the three factors from the Toronto Alexithymia Scale, the Malouff and Schutte Belief Scale (MSBS), 5 subscales from the Survey of Personal Beliefs, and instruments recording depression, anxiety, and neuroticism. As hypothesized, alexithymia and irrational beliefs predicted greater emotional disturbance while also displaying some small positive correlations with each other. In multiple regressions, both types of variables combined to predict emotional disturbance, with alexithymia explaining the greater amount of variance. Alexithymic difficulties in identifying emotions had uniquely negative mental health implications. The MSBS and the Low Frustration Tolerance subscale were the most noteworthy measures of a pathogenic irrationality. These data supported the claim that the unconscious processes of REBT could be conceptualized in terms of alexithymia.     

Alexithymia, emotion, and somatic complaints

Alexithymia, by definition, involves difficulties in identifying and describing emotions and has been assumed to be associated with somatization (i.e., a tendency to express psychological distress in somatic rather than emotional form). Empirical research so far, however, has produced no convincing evidence that alexithymia is more associated with somatic complaints than with emotional complaints or that alexithymia correlates with somatic complaints when negative affect is controlled for. In the present study, alexithymia, as measured by the TAS-20, showed no association with somatic complaints in a community sample of 137 individuals when trait anxiety and depression were controlled. Alexithymia did correlate negatively with positive affect, and positively with negative affect. The former association, however, was much more robust, whereas the latter association was found mainly on subjective trait measures of negative affect (as distinct from state measures and more objective trait measures derived from daily recordings during an 8-week period). It is suggested that the association between alexithymia and lack of positive affect deserves more attention in future research.     

Apathy in dementia: relations with depression, functional competence, and quality of life

This study set out to clarify the association of apathy and depression in dementia as well as apathy's association with basic (ADLs) and instrumental (IADLs) activities of daily living and quality of life. 68 outpatients with mild dementia were assessed on apathy, depression, global cognition, traditional ADLs/IADLs, complex daily living activities requiring intact executive functioning (DAD: Disability Assessment for Dementia Scale), and quality of life. The sample was stratified into high and low global cognition groups and compared. While no relationship was found between scores on apathy and depression in the high cognition group, there was a significant relationship between apathy and depression in the low cognition group. Further, high and low cognition groups differed in the relationship between apathy and ability to perform basic and complex activities of daily living. Specifically, in the high cognition group, increased apathy was correlated with diminished ability to perform traditional IADLs as well as those activities requiring intact executive functioning (i.e., DAD). In the low cognition group, increased apathy was associated with poor performance on traditional ADLs and IADLs, but was not related to performance on independent daily activities demanding good executive functioning. Finally, increased apathy was significantly associated with worse quality of life, but this held for the high cognition group only, suggesting that dementia patients with better cognition have insight into their deficits and, perhaps, experience poor quality of life as a result.     

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     

Alexithymia,Defenses, and Ego Strength: Cross-Sectional and Longitudinal Relationships with Psychological Well-Being and Depression

Affect regulation is important to mental health. A deficit in one’s ability to identify and express emotions (alexithymia), cognitive styles of regulating emotional conflict (defenses), and the capacity for integrative and complex self-other understanding (ego strength or maturity) need to be studied to understand how they relate to each other as well as to mental health and well-being. A sample of 415 community-dwelling adults from a major metropolitan area in the Midwest U.S., stratified for gender, age, and ethnicity, completed three methodologically different measures of affect regulation along with measures of well-being and depression. Six years later, 49 % of the sample again reported their well-being and depression. At baseline, ego strength and the defenses of principalization and reversal correlated negatively with alexithymia and the other defenses (turning against self, turning against object and projection), even after controlling for negative affect. Cross-sectionally, relationships were largely as hypothesized, with low alexithymia, use of mature defenses, and greater ego strength correlating with less depression and greater well-being, although some of these relationships were attenuated after controlling for negative affect. Prospectively, each of the affect regulation measures predicted hypothesized changes in well-being after 6 years, after controlling for baseline well-being, but affect regulation did not predict changes in depression. These findings illuminate similarities and differences among these affect regulation constructs, suggest the importance of differentiating well-being from depression, and reveal that affect regulation uniquely predicts changes in long-term well-being.     

Attribution of cause by patients with depression, anxiety, and alexithymia

This study evaluated the relationship between the personality construct of alexithymia and the attribution of depression to biological, psychological, sociocultural, and external stress. When alexithymia was considered as a continuous variable, there was a significant correlation between a higher score on the Toronto Alexithymia Scale and a greater belief in psychological causes for their psychiatric disorder. The other factors also had positive but nonsignificant correlations with alexithymia. When alexithymia was categorically partitioned and controlled for depressed mood, alexithymic subjects more frequently endorsed all four factors to be causal for their psychiatric illness. This appears to contradict earlier assumptions that alexithymic patients tend to be less psychologically minded than those without this psychological trait.     

Attitude Toward Own Aging: Age Invariance and Construct Validity Across Middle-Aged,Young-Old,and Old-Old Adults

The Attitude Toward Own Aging (ATOA) Scale assesses an individual’s evaluation of their own aging, and has been widely used in the field of subjective aging literature. The present study examined whether the ATOA scale measures the same construct across middle-aged (40–60), young-old (61–74), and old-old adults (ages 75 or older) and also evaluated the construct validity of the ATOA construct in relation to measures of subjective well-being. Data drawn from the 2008 wave of the German Aging Survey (DEAS; n?=?6091) were used. ATOA was assessed by the ATOA subscale of the Philadelphia Geriatric Center Morale Scale (PGCMS), and subjective well-being was assessed with the Satisfaction with Life Scale (SWLS) and the Positive and Negative Affect Scale (PANAS). Confirmatory factor analysis revealed that the model fit of the one-factor model consisting of four items fits the data well. Multi-group invariance analyses provide evidence for configural and metric invariance of the ATOA scale across the age groups, but not for scalar invariance. Additional analysis assessing construct validity indicated that the ATOA items exhibited convergent validity. The findings support the utility of the 4-item scale when examining age group differences of ATOA across a wide age range and that ATOA is distinct from measures of subjective well-being.     

Depression, alexithymia, and pain prone disorder: a Rorschach study

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p less than .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.     

Depression,Alexithymia, and Pain Prone Disorder: A Rorschach Study

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p < .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.     

Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation

The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait anxiety, alexithymia and global psychiatric symptom severity. A multivariate analysis of covariance demonstrated that subscales of the Liebowitz Social Anxiety Scale (LSAS) were related to alexithymia and trait anxiety. The “difficulty in describing feelings” (DDF) dimension of alexithymia and trait anxiety appear to be important factors in this relationship between social anxiety and alexithymia. Results of this study suggest that patients with dermatological disorder may benefit from both treatment of social anxiety symptoms and learning how to regulate their affects and emotional expression.     

BRIEF REPORT

This study examined the different facets of emotional intelligence, alexithymia, and mood awareness. Undergraduate students (N = 129) completed the Trait Meta-Mood Scale (TMMS), the Toronto Alexithymia Scale (TAS-20), and the Mood Awareness Scale (MAS). A factor analysis revealed two dimensions, attention to and clarity of emotions, that cut across all three instruments. These two dimensions were differentially associated with personality, as measured by the neuroticism, extraversion, and openness to experience portions of the NEO-FFI, and with performance on an emotional Stroop task. We discuss the implications for the conceptualisation of broad constructs such as emotional intelligence and alexithymia, as well as the potential utility of more narrowly defined individual differences.     

Apathy in frontotemporal dementia: behavioral and neuroimaging correlates

We investigated the occurrence of goal-directed motivational change in the form of apathy in patients with frontotemporal dementia (FTD), particularly those with behavioral variant social and executive deficits (bvFTD). Standardized behavioral inventory was employed to survey and compare apathy ratings from patients and caregivers. In cases of bvFTD, apathy ratings were further related to measures of social cognition, executive function, and atrophy on brain MRI. Results indicated that caregivers rated bvFTD patients as having significantly elevated apathy scores though patient self-ratings were normal. Caregiver and self-ratings of FTD samples with progressive nonfluent aphasia and semantic dementia did not differ from healthy controls and their informants. In the bvFTD sample, caregiver apathy scores were not correlated with general cognitive screening or depression scores, but were significantly correlated with social cognition and executive function measures. Voxel-based morphometry revealed that apathy ratings in bvFTD were related to prominent atrophy in the right caudate (including the ventral striatum), the right temporo-parietal junction, right posterior inferior and middle temporal gyri, and left frontal operculum- anterior insula region. Findings suggest that bvFTD is associated with a significant breakdown in goal-directed motivated behavior involving disruption of cortical-basal ganglia circuits that is also related to social and executive function deficits.     

Shyness: conceptualization and measurement

The concept of shyness and its measurement were investigated in a series of studies (total N = 1,687). Data collection and analysis proceeded in three phases: the revision and continued development of a measure of shyness, the Social Reticence Scale; a psychometric comparison among five measures of shyness; and an examination of the factor structure underlying the construct of shyness. Phase 1 assessed the reliability and validity of the Social Reticence Scale, including ratings of videotaped monologues and ratings by significant others. Phase 2 compared the five shyness measures with one another on indices of internal consistency and with other relevant measures of emotionality, personality, relationships, and behavior. Items from the five shyness measures were combined in a factor analysis in Phase 3, and the resulting factors were correlated with the self-report and rating data obtained in Phase 2. Overall, the results from these studies confirmed that the shyness measures were valid, reliable, and empirically distinct from measures of related constructs. Behavioral validity was observed for several of the shyness scales. Additional analyses suggested that three interpretable factors underlie responses to the shyness scales but provided little support for drawing conceptual distinctions among types of shyness. Discussion focuses on the implications of these data for the measurement and conceptualization of shyness.     

Depression and bulimia: the link between depression and bulimic cognitions

This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder.     

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.     

The construct validity of burnout

Considerable confusion exists in the burnout literature about the similarities and separateness among the constructs of burnout, depression and job satisfaction. This study examined the construct validity of burnout using Campbell & Fiske's multitrait-multimethod approach. The constructs of burnout, depression and orderliness (chosen as a discriminant construct) were assessed by three types of self-report instruments. Data were analysed for 181 females and 139 male faculty members who spent at least 50 per cent of their time in teaching. Results indicated that measures of burnout largely met Campbell & Fiske's criteria for construct validity: burnout measures possessed adequate to good internal reliability and convergent validity. However, burnout measures also correlated substantially with measures of depression. Results are discussed in terms of possible explanations for the substantial overlap that has been demonstrated among measures of burnout, depression and job satisfaction.     

Self-criticism, dependency and the five factor model of personality in depression: assessing construct overlap

The construct overlap between the lower-ordered personality constructs linked to depression, dependency and self-criticism, and higher-ordered personality constructs of the Five Factor Model (FFM) were assessed by exploratory factor analysis in a depressed sample. Three robust factors were extracted: negative affectivity (Neuroticism, Self-Criticism), positive affectivity (Extraversion, Openness), and interpersonal sensitivity (Dependency, Agreeableness). These findings suggest that there is significant construct redundancy between self-criticism and Neuroticism, while dependency appears to represent a more unique dimension associated with, but relatively distinct from Neuroticism and the other dimensions of the FFM.     

Breathing Characteristics and Symptoms of Psychological Distress: An Exploratory Study

In this exploratory study of the relationship between characteristics of breathing and 3 common psychological issues (i.e., symptoms of anxiety, alexithymia, and depression), 79 college‐age adults were examined using self‐report, rater observation, and physiological measures. Results indicated significant positive relationships between dysfunctional breath characteristics and symptoms of both anxiety and alexithymia. A significant positive correlation was found between self‐reported symptoms of dysfunctional breathing and symptoms of depression, but no significant relationships existed between symptoms of depression and either rater‐observed breath characteristics or physiological measures.