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We investigated if alexithymia, a personality construct with difficulties in emotional processing, is stable in the general population.Altogether 3083 unselected subjects aged 30 and older in Finland completed the 20-item Toronto Alexithymia Scale (TAS-20) in the longitudinal Health 2000 and Health 2011 general population surveys (BRIF8901). The stability of alexithymia at the 11-year follow-up was assessed with t-tests, correlations, and separate linear regression models with base-line and follow-up age, gender, marital status, education, and 12-month depressive and anxiety disorders as confounders.The mean score (SD) of the TAS-20 for the whole sample was 44.2 (10.4) in 2000 and 44.2 (10.9) in 2011 (p=0.731). The mean score of the TAS-20 subscale Difficulty Identifying Feelings increased by 0.3 points, Difficulty Describing Feelings decreased by 0.6 points and Externally Oriented Thinking increased by 0.3 points. The effect sizes of the changes varied from negligible to small. Age had little effect except for the group of the oldest subjects (75-97years): the TAS-20 mean (SD) score was 49.1 (10.1) in 2000 and 53.1 (10.3) in 2011 (p0.001), the effect size for the increase was medium. TAS-20 score in 2000 explained a significant proportion of variance in TAS-20 score in 2011. Controlling for all baseline confounders improved the model incrementally; the same applied to controlling for confounders at follow-up. Baseline depression or anxiety disorders were not associated with the TAS-20 scores in 2011, whereas current diagnoses were.According to our large longitudinal study both the absolute and relative stability of alexithymia assessed with the TAS-20 are high in the adult general population.

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.

The recent proposal of a new type of agnosia termed 'affective agnosia' extends Freud's legacy and captures the concept of not knowing one's own emotions. This concept links well with the theory of levels of emotional awareness and maps onto a hierarchical model of neural substrates of emotional experience, but does not encompass the pensée opératoire component of the alexithymia construct. Moreover, identifying agnosia and anomia subtypes, which connotes a categorical conceptualization of alexithymia, is inconsistent with the dimensional nature of the construct. We describe a more widely accepted definition of alexithymia, and argue that although aptly descriptive, the concept of affective agnosia does not advance the theory, measurement, and treatment of alexithymia. A review of alexithymia literature indicates that impairment in the mental representation of emotions has been a central aspect of alexithymia theory since the concept was introduced, and guided the development of the Toronto Alexithymia Scale and other measures of the construct. Moreover, techniques to enhance mentalization of emotions have been used by psychotherapists for several decades.

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.

Results from a recent taxometric investigation of the alexithymia construct, measured by the 20-Item Toronto Alexithymia Scale (TAS-20), with English-speaking samples in Canada provided evidence that alexithymia is best conceptualized as a dimensional rather than a categorical construct. The aim of the current investigation was to attempt to generalize the outcome of this earlier investigation by examining the latent structure of the alexithymia construct in a sample whose primary language was not English. A second aim was to examine the latent structure in men and women separately as some investigators propose that typological differences in the nature of alexithymia may differ by gender. The sample comprised 5194 (2377 men, 2817 women) residents of Finland who as part of a population-based health survey, supported by the Finnish government, had completed a Finnish-language translation of the TAS-20. Three non-redundant taxometric analyses were performed in the total sample and for men and women separately, using item sets from the TAS-20 as indicators. The outcomes of the taxometric analyses for all three samples were similar to those in the Canadian study. These findings provide further evidence that alexithymia is a dimensional construct.

Background The purpose of the current investigation was (1) to test whether the 3-factor structure of the 20-item Toronto Alexithymia Scale (TAS-20) corresponding to the theoretical conceptualization of the alexithymia construct could be recovered in a Greek translation of the scale (the TAS-20-G), (2) to assess if a 3-factor structure provides a better fit to the TAS-20-G compared with the recently proposed alternative factor structures, and (3) to evaluate the internal reliability of the TAS-20-G. Methods The English version of the TAS-20 was translated into Greek and then back-translated and modified until cross-language equivalence was established. The Greek version was then administered to 340 university students. Confirmatory factor analyses were conducted, and 4 different factor structure models were compared. Internal consistency and item-to-scale homogeneity of the TAS-20-G and its factor scales were also evaluated. Results The 3-factor model provided a good fit to the data and proved superior to alternative 1-, 2-, and 4-factor models. Apart from a coefficient α below the recommended range for the externally oriented thinking factor, the TAS-20-G and its factor scales demonstrated adequate internal consistency and homogeneity. Conclusion The TAS-20-G is a valid and reliable measure of alexithymia in university students and may be suitable for investigations of alexithymia in other Greek-speaking population samples.

The aim of this study was to investigate the viability of Type I and Type II alexithymia proposed by Vorst and Bermond (2001) and defined by Affective and Cognitive higher-order factors as measured by the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Using data from a large international database, confirmatory factor and cluster analyses were conducted with a pooled sample (N = 1696), as well as with five samples of subjects that composed the pooled sample, in which subjects had completed different language versions of the BVAQ, A correlated five-factor model produced the best fit in the pooled sample and in each of the five samples: this model was also a better fit than the higher-order, two-factor model on which the Type I and Type II distinction rests. Across the five samples and in the pooled sample, a two-cluster solution did not emerge. In sum, the results failed to provide empirical support for the Type I and Type II alexithymia distinction. (C) 2009 Published by Elsevier Ltd.

Background Recently, the Toronto Structured Interview for Alexithymia (TSIA) was developed to supplement the self-assessment of alexithymia and/or offer a different method of measuring the alexithymia construct. The aim of this study was to evaluate the psychometric properties of a German language translation of the TSIA in a psychiatric patient sample. Methods Translation and back-translation were performed until a high agreement of cross-language equivalence was obtained between the German and the original English language version of the TSIA. The TSIA and the German language version of the 20-Item Toronto Alexithymia Scale were administered to 237 psychiatric patients at the departments of psychiatry and psychotherapy in Germany and Switzerland. Videotapes of some of the interviews were recorded for the assessment of interrater reliability. Results The German version of the TSIA and its 4 scales correlated significantly with the German version of the 20-Item Toronto Alexithymia Scale and its 3 factor scales, providing support for concurrent validity of the interview. Confirmatory factor analyses supported the hierarchical, 4-factor structure obtained with the original English version, with 4 lower-order factors nested within 2 higher-order latent factors. Acceptable levels of internal reliability and interrater reliability were also demonstrated. Conclusion The TSIA is a valid and reliable measure for assessing alexithymia, at least in clinical samples. The TSIA, together with a self-report alexithymia scale, allow for a multimethod approach to assessing alexithymia.

The present study examined the relationship between alexithymia and self-reported sleep problems and the influence of sleep hygiene on sleep problems. The 20-item Toronto Alexithymia Scale and the Sleep Problems Inventory were administered to a non-clinical sample of 2045 young adults. Alexithymic individuals (N = 228) scored significantly higher than non-alexithymic individuals (N = 228) on sleep symptoms associated with insomnia, excessive sleepiness, sleepwalking, and nightmares. These differences could not be attributed to poor sleep hygiene behaviours or differences in general mood. The association between alexithymia and sleep disorder symptoms may reflect either the presence of subjective sleep problems or a preoccupation with sleep-related symptomatology.

Alexithymia is a multifaceted personality construct that is thought to reflect a deficit in the cognitive processing of emotions. The effects of low vs. high Alexithymia, neutral vs. positive vs. negative words processed, and perceptual vs. semantic processing on memory were investigated in a group of 82 students using the levels of processing paradigm and the Remember/Know procedure. No differences were observed between low and high Alexithymia students when neutral material was considered. However, for both levels of processing, high Alexithymia students recalled fewer emotion words (both positive and negative) when "Remember" responses were considered. "Know" responses were comparable across Alexithymia groups. The deficit in the ability to consciously access emotional material (the "Remember" responses) may help explain the impaired regulation of intense emotional states by high Alexithymia individuals. (c) 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.

In this study, the empirical association between the apparently similar constructs of emotional intelligence and alexithymia was examined using latent variable analysis in a large community sample of adults (N=734). The Twenty-Item Toronto Alexithymia Scale (TAS-20) and the BarOn Emotional Quotient Inventory (EQ-i) were used to assess alexithymia and emotional intelligence. Results revealed that although the constructs are independent, they overlap considerably and are strongly and inversely related.

The outcome of reactions between antimony, bismuth, lanthanum, neodymium, europium, thulium, gold or nickel and the one-electron oxidizing agents, molybdenum hexa-fluoride, tungsten hexa-fluoride or the nitrosonium cation in the presence of acetonitrile, cannot always be predicted on the basis of the relative oxidizing abilities of the reagents. Fluoride ligand transfer from hexafluorometallate(V) anions to the solvated cation is a major factor in reactions that involve oxidation of antimony and bismuth, although the solvated bismuth(III) cation can be stabilized by the macrocycle, 1,4,8,11-tetraazacyclotetradecane. Passivation of the metal surface by an oxide layer appears to be important in lanthanum and nickel oxidations, resulting in an apparent inversion of reactivity between molybdenum and tungsten hexafluorides.

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.

Previous research showing moderate to high correlations between the Toronto Alexithymia Scale (TAS) and Beck Depression Inventory (BDI) has generated controversy as to whether alexithymia and depression are distinct or overlapping constructs. The present study addressed this controversy using the statistical method of factor analysis. In a sample of undergraduate university students, a correlation matrix comprising items from both the TAS and BDI yielded a four-factor solution with virtually no overlap of the significant factor loadings for the items from each scale, and with the factors corresponding closely with their respective construct. These results were replicated and cross-validated with a sample of psychiatric outpatients. The findings support the view that alexithymia is a construct that is distinct and separate from depression.

During the past decade, the alexithymia construct has undergone theoretical refinement and empirical testing and has evolved into a potential new paradigm for understanding the influence of emotions and personality on physical illness and health. Like the traditional psychosomatic medicine paradigm, the alexithymia construct links susceptibility to disease with prolonged states of emotional arousal. But whereas the traditional paradigm emphasizes intrapsychic conflicts that are presumed to generate such emotional states, the alexithymia construct focuses attention on deficits in the cognitive processing of emotions, which remain undifferentiated and poorly regulated. This paper reviews the development and validation of the construct and discusses its clinical implications for psychosomatic medicine.

The mind-body problem has been pondered by philosophers and physicians since antiquity, yet remains unsolved despite frequent appeals for a holistic approach. The perpetuation of Cartesian dualism has been attributed to many factors ranging from the limitations of Indo-European languages to the founding of scientific medicine on Newtonian physics instead of the more modern quantum and relativity theories. Liaison psychiatry is described as the latest attempt to eradicate mind-body dualism and to treat the patient and his illness as one.

Conflicting results have been reported in studies examining the relationships between alexithymia and the variables of age, gender, social class, and intelligence. Moreover, these results are of dubious validity and generalizability because many of the studies used psychometrically poor scales to measure the alexithymia construct. The present study reexamined the relationships between alexithymia and sociodemographic variables and intelligence in a sample of normal adults using the Toronto Alexithymia Scale (TAS), a recently developed self-report measure with evidence of reliability and validity. The results indicate that alexithymia, as measured by the TAS, is not associated with age, gender, educational level, socioeconomic status, and intelligence.

This study evaluates and compares the psychometric properties of three self-report measures of alexithymia — a hypothetical personality construct thought to be associated with hypochondriasis, somatization disorder and a variety of other medical and psychiatric disorders. Two hundred and nine college students were administered the Schalling-Sifneos Personality Scale (SSPS), MMPI alexithymia scale (MMPI-A), Toronto Alexithymia Scale (TAS), and two measures of functional somatic symptoms. Results indicated that the TAS is internally consistent and sensitive to reports of somatic symptoms. In contrast, the SSPS and MMPI-A were found to have response and/or gender biases, poor internal reliabilities, and no systematic relationship with somatic symptoms. In addition, factor analysis showed the TAS to have a stable, replicable factor structure, while the SSPS demonstrated little factor stability. These findings suggest that the TAS is the most psychometrically sound measure of the alexithymia construct.

The clinical assessment of alexithymia and research investigating its neurobiologic correlates require standardized assessment instruments. Observer-rated questionnaires, self-report scales, and projective techniques are currently available for measuring alexithymia, but most of these lack adequate reliability and validity. The Toronto Alexithymia Scale appears to have excellent psychometric properties, but a multimethod, multimeasure approach will enhance both measurement and further evaluation of the alexithymia construct.

The present study examined the relationships between the Toronto Alexithymia Scale (TAS), the scales of the EPQ, and self-report measures of somatic complaints. One hundred and ninety undergraduates completed the TAS, EPQ and two measures of somatic complaints. As expected, the TAS and EPQ Neuroticism scale correlated positively with each other and with somatic complaints; the Extraversion scale correlated negatively with the TAS. The Neuroticism scale was found to be highly correlated with the somatic complaint scales. Directions for future research relating personality variables and somatic complaints are suggested.