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Objective The alexithymia personality construct encompasses difficulties identifying and describing feelings, restricted imaginal processes, and an externally oriented cognitive style. The construct was derived initially from observations of patients with classic psychosomatic diseases. The self-report 20-item Toronto Alexithymia Scale (TAS-20) is the most frequently used measure to assess alexithymia. A concern associated with the TAS-20 is whether individuals can accurately self-report difficulties identifying and describing feelings if they are deficient in those abilities. To address this issue, we sought to develop and validate an informant form (version) of the TAS-20, the 20-item Toronto Alexithymia Scale – Informant Form (TAS-20-IF). Method We employed a three-phase methodological strategy. In the first phase, items from the TAS-20 were re-written into a third person version by a team of experts. In the second phase, the “traditional” three-factor structure was tested in the TAS-20-IF using confirmatory factor analysis in a large sample of young adults (N = 857). The third phase was conducted with another sample (N = 430) composed of “informants” (n = 215), who completed the TAS-20-IF, and “targets” (n = 215), who completed the TAS-20 (informants were nominated by the targets). Results The psychometric properties (items and scales) of both versions were adequate and the three-factor structure of the TAS-20-IF was supported; the correlation between the two versions was statistically significant and the factor structures were similar. Conclusion Although further research is needed to replicate these findings, especially in clinical samples, the results support the reliability and validity of the TAS-20-IF.

Objective Twenty-five years ago, this journal published two articles reporting the development and initial validation of the 20-Item Toronto Alexithymia Scale (TAS-20). Since then the literature on alexithymia has burgeoned with the vast majority of this research using the TAS-20, including multiple language translations of the scale. Method In this article we review the psychometric literature evaluating various aspects of the reliability and validity of the TAS-20 and examine some of the controversies surrounding the scale and the construct it assesses. We reflect on the ways in which the TAS-20 has advanced the measurement of the construct and theory of alexithymia. We also discuss recent developments and some future directions for the measurement of alexithymia. Results Although not without some controversy, the preponderance of the accumulated evidence over a 25-year period supports various aspects of the reliability and validity of the TAS-20, including findings from confirmatory factor analytic and convergent and discriminant validity studies which are consistent with Nemiah et al.'s (Nemiah et al., 1976 [3]) and Taylor and colleagues (Taylor et al., 1997 [9]) theoretical formulations and definition of the alexithymia construct. Conclusions Based on the accumulated empirical evidence of 25 years, we conclude that the TAS-20 is a reliable and valid instrument and accurately reflects and measures the construct as it was originally defined by Nemiah et al. Nemiah et al. (1976) [3] as composed of deficits in affect awareness and expression and pensee operatoire (operational thinking). Clinicians and researchers can use the TAS-20 to confidently measure alexithymia, the roots of which have foundations in psychosomatic medicine.

Objective: The generalizability of the alexithymia construct to North American aboriginal culture was examined by assessing the replicability of the factor structure of the 20-item Toronto Alexithymia Scale (TAS-20) in two different adult samples. The study also assessed the reliability of the scale and the influence of gender, age, and education on alexithymia levels. Method: The first sample was a community-based group of 123 aboriginal men and women; the second sample was 102 male aboriginal offenders. Both samples completed the TAS-20. Results: The replicability of the three-factor structure for the TAS-20 was supported in both groups using confirmatory factor analysis (CFA). The TAS-20 and its three factors demonstrated adequate internal reliability, and the variables of gender, age, and education accounted for small or nonsignificant amounts of variability in total TAS-20 and factor scale scores. Conclusion: The results provide additional support for the factorial validity of the TAS-20 in diverse cultural groups. D 2005 Elsevier Inc. All rights reserved.

Objective: Some researchers have questioned the stability of the three-factor structure of the 20-Item Toronto Alexithymia Scale (TAS-20) or the reliability of one or more factors of the scale. The aim of this study was to assess the replicability of the factor structure of the TAS-20 in a large community sample and to determine also whether the same three-factor structure can be recovered in men and women. The study also assessed the reliability of the scale and the influence of gender, age, and education on TAS20 scores. Method: The TAS-20 was administered to 1933 adults (880 men and 1053 women) residing in several small cities and towns in Ontario, Canada. The factor structure of the scale was assessed using confirmatory factor analysis (CFA). Results: The three-factor structure of the TAS-20 was replicable in the entire community sample and also separately in men and women. The TAS-20 and its three factors demonstrated internal reliability, and the variables of gender, age, and education accounted for relatively small or modest amounts of variability in total TAS-20 and factor scale scores. Conclusion: The results provide strong support for the reliability and factorial validity of the TAS-20 and indicate the importance of using CFA when assessing the replicability and theoretical integrity of the factor structure of the scale.

The 20-item Toronto Alexithymia Scale (TAS-20) has been shown in previous research to measure a general dimension of alexithymia with three intercorrelated factors. This study evaluated the reliability and factorial validity of an Italian translation of the TAS-20 in a group of normal adults (N = 206) and in a mixed group of medical and psychiatric outpatients (N = 642). Using confirmatory factor analyses, the previously established three-factor model of the TAS-20 was found to be replicable in both groups. In addition, the Italian TAS-20 demonstrated adequate estimates of internal reliability and test-retest reliability. Although evaluation of the convergent, discriminant, and concurrent validity of the TAS-20 is required in Italian populations, the present results support the use of the Italian translation of the scale for clinical and research purposes.

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

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

The generalizability of the alexithymia construct to North American aboriginal culture was examined by assessing the replicability of the factor structure of the 20-item Toronto Alexithymia Scale (TAS-20) in two different adult samples. The study also assessed the reliability of the scale and the influence of gender, age, and education on alexithymia levels.The first sample was a community-based group of 123 aboriginal men and women; the second sample was 102 male aboriginal offenders. Both samples completed the TAS-20.The replicability of the three-factor structure for the TAS-20 was supported in both groups using confirmatory factor analysis (CFA). The TAS-20 and its three factors demonstrated adequate internal reliability, and the variables of gender, age, and education accounted for small or nonsignificant amounts of variability in total TAS-20 and factor scale scores.The results provide additional support for the factorial validity of the TAS-20 in diverse cultural groups.

The aim of this paper was to review findings from studies that have evaluated the reliability and factorial validity of the 20-item Toronto Alexithymia Scale (TAS-20) in different languages and cultures.Data from published articles as well as unpublished data from various countries were reviewed to determine whether the three-factor structure of the TAS-20 is replicable in different cultures by the method of confirmatory factor analysis (CFA), and whether the scale and its three-factor scales show internal reliability in these cultures.The TAS-20 has been translated adequately into 18 different languages and evaluated by CFA in 19 different countries. There is strong support for the generalizability of the three-factor structure of the scale across languages and cultures. In addition, the full-scale TAS-20 and the first two factors show adequate to good internal reliability for most of the translations. In most cultures where English is not the primary language, however, the third factor lacks internal reliability; this might be due to cultural differences or a response bias to the several negatively keyed items on this factor.The findings support the use of the TAS-20 in cross-cultural research, and suggest that alexithymia may be a universal trait that transcends cultural differences.

Some researchers have questioned the stability of the three-factor structure of the 20-Item Toronto Alexithymia Scale (TAS-20) or the reliability of one or more factors of the scale. The aim of this study was to assess the replicability of the factor structure of the TAS-20 in a large community sample and to determine also whether the same three-factor structure can be recovered in men and women. The study also assessed the reliability of the scale and the influence of gender, age, and education on TAS-20 scores.The TAS-20 was administered to 1933 adults (880 men and 1053 women) residing in several small cities and towns in Ontario, Canada. The factor structure of the scale was assessed using confirmatory factor analysis (CFA).The three-factor structure of the TAS-20 was replicable in the entire community sample and also separately in men and women. The TAS-20 and its three factors demonstrated internal reliability, and the variables of gender, age, and education accounted for relatively small or modest amounts of variability in total TAS-20 and factor scale scores.The results provide strong support for the reliability and factorial validity of the TAS-20 and indicate the importance of using CFA when assessing the replicability and theoretical integrity of the factor structure of the scale.

This study examines the relationships between alexithymia and psychological characteristics and behaviors that are commonly associated with eating disorders. The 20-item Toronto Alexithymia Scale (TAS-20) and the Eating Disorder Inventory (EDI) were administered to a group of 48 female patients with anorexia nervosa, a matched comparison group of 30 normal women, and an unmatched comparison group of 116 male and 118 female university students. In the anorexic and male student groups, the TAS-20 correlated significantly and positively with the EDI subscales, Ineffectiveness, Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears. The TAS-20 correlated significantly only with Interpersonal Distrust in the matched comparison group, and only with Ineffectiveness and Interpersonal Distrust in the female student group. The results suggest that alexithymia is related to several psychological traits that are characteristic of patients with eating disorders and thought to play a role in the development of the disorders, but is unrelated to attitudes and behaviors concerning abnormal eating and body weight and shape.

The purported association between alexithymia and essential hypertension was investigated in a sample of 114 hypertensive patients using the well-validated twenty-item Toronto Alexithymia Scale. Alexithymia was also assessed in a group of 113 general psychiatric outpatients and in a group of 130 normal adults. A rate of 55.3% of alexithymia was found in the hypertensive group compared with significantly lower rates of 32.7% in the psychiatric group and 16.3% in the normal controls. The results support the view that a high prevalence of alexithymia may be found among patients with disorders that were categorized in the past as “classical” psychosomatic diseases. It is hypothesized that a deficit in the cognitive processing and modulation of emotions may leave alexithymic individuals prone to states of heightened sympathetic arousal that are conducive to the development of essential hypertension.

The prevalence of alexithymia in fifty-five motor vehicle accident survivors who had chronic pain complaints and met DSM-III-R criteria for somatoform pain disorder was 53%. Alexithymic and non-alexithymic patients did not differ on self-reports of current pain severity or in the number of pain locations. Alexithymic patients were found to use significantly more words to describe their pain, suggesting they may have a more diffuse style in communicating their pain experience.