The 20-Item Toronto Alexithymia Scale. IV. Reliability and factorial validity in different languages and cultures

OBJECTIVE: 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. METHOD: Data from published articles as well as unpublished data from various countries were reviewed to determine whether the three-factor structure of the TAS-20 is replicable in different cultures by the method of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. RESULTS: 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. CONCLUSION: 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.     

Reliability and Validity of the 20-Item Toronto Alexithymia Scale in Korean Adolescents

Objective

Adolescence is a period of developing emotional regulation. However, alexithymia has rarely been examined during this period. The objective of this study is to examine the factor structure and internal consistency of the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K) in normal adolescents in South Korea.

Methods

The TAS-20K was administered to a sample of 290 adolescents aged from 12 to 16 years old. Internal reliability, test-retest reliability, and factorial validity were evaluated.

Results

The three factors of the TAS-20K were confirmed by confirmatory factor analysis. The internal consistency, measured using Cronbach''s alpha coefficient was acceptable for difficulty in identifying feelings, good for difficulty in describing feelings, and acceptable for externally oriented thinking.

Conclusion

Our study indicates that the TAS-20K is an appropriate instrument to assess alexithymia in Korean adolescents.     

An investigation of the construct validity of the 20-Item Toronto Alexithymia Scale through the use of a verbalization task

OBJECTIVE: The construct validity of the 20-Item Toronto Alexithymia Scale (TAS-20) was examined through a verbalization task requiring participants to discuss a past distressing event. METHODS: Verbalizations were transcribed and coded for the frequency and number of different negative and positive emotion words used. Relationships between the TAS-20 and these variables were examined. RESULTS: Controlling for negative affect (NA), the difficulty identifying feelings (DIF) subscale was positively associated with the frequency of negative emotion words used and negatively associated with the frequency and number of different positive emotion words used during the verbalization task. High, compared with low, scoring TAS-20 participants used a lower frequency of and fewer different positive emotion words. CONCLUSION: The TAS-20 may be measuring negative emotional expressivity separate from negative affectivity, as well as a reduced capacity to access and elaborate upon positive emotion. Findings are discussed in regard to improving the conceptualization and measurement of emotional deficits in alexithymia.     

Cross-cultural alexithymia: validity of the 20-item Toronto Alexithymia Scale in North American aboriginal populations

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.     

Reliability and validity of the Toronto Structured Interview for Alexithymia in a mixed clinical and nonclinical sample from Italy

The reliability and validity of the Toronto Structured Interview for Alexithymia (TSIA) have been demonstrated in previous studies with English-speaking community and psychiatric samples and a German-speaking psychiatric sample. The aim of this study was to evaluate the psychometric properties of the TSIA in a mixed clinical and nonclinical sample from Italy. The original English version of the TSIA was translated into Italian and administered, along with the 20-item Toronto Alexithymia Scale (TAS-20), to 80 healthy subjects, 69 medical outpatients, and 62 psychiatric outpatients. Eighty-one videotaped interviews were used for assessing the interrater reliability. Confirmatory factor analysis supported the hierarchical, four-factor structure of the TSIA obtained in previous studies, with four lower-order factors nested within two higher-order latent factors. The TSIA also demonstrated internal and interrater reliability, and concurrent validity with the TAS-20. The results support the use of the TSIA to assess alexithymia especially when a multimethod approach to measurement is possible.     

Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study

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.     

Psychometric Properties of the 20-Item Toronto Alexithymia Scale in a Group of Italian Younger Adolescents

Objective

Alexithymia is a personality construct that inhibits and interferes with normal affect regulating abilities. The purpose of our study was to assess psychometric properties of TAS-20 in younger adolescents.

Methods

Data were collected from 508 younger adolescents (48.8% male and 51.2% female) with a mean age of 12.56 years (DS=0.50, range: 12-13 years). We administered the following scales: 20-Item-Toronto Alexithymia Scale.

Results

The confirmatory factor analysis performed on the second random subsample showed reasonable goodness-of-fit for the oblique bi-factorial model: [chi]² (32, n=254)=54.22; p=0.008; χ²/df=1.69; NNFI=0.92; CFI=0.95; SRMR=0.05; RMSEA=0.05; 90% confidence interval=0.027-0.078.

Conclusion

Based on the outcomes of our research we support the idea of evaluating adolescents for alexithymia.     

Psychometric properties of the Toronto Alexithymia Scale (TAS-20) for substance users

OBJECTIVE: To determine the psychometric properties of the Toronto Alexithymia Scale (TAS-20), an established self-report measure of alexithymia, for a substance user sample participating in a clinical trial of outpatient cognitive-behavioral therapies (N=230). METHODS: Confirmatory and exploratory factor analyses were used to determine the number and nature of the factors underlying the TAS-20 in a sample of substance users. Structural equation modeling was used to determine the predictive validity of the TAS-20. RESULTS: A factor structure comparable, but not identical, with TAS-20 psychometric results with other populations was found; alpha coefficients were .88 for the feelings factor, .62 for the external thinking factor, and .87 for the total score. Although, on average, the substance users did not appear to have elevated alexithymia scores compared with the undergraduate students, alexithymia predicted less treatment engagement, i.e., fewer sessions attended and weaker helping alliance. Alexithymia also predicted alcohol use outcomes but not drug use outcomes. The relation between alexithymia and drinking outcome was conditional on whether the patient was using solely alcohol at baseline. CONCLUSION: The TAS-20 has reasonably good psychometric properties in this sample, which might be improved by dropping several marginal questionnaire items. Alexithymia appears to attenuate substance abuse treatment engagement. More clinical and research experience with this construct and specific instrument in substance user samples is needed.     

神经症和抑郁障碍患者的述情障碍及相关因素研究

目的探讨神经症和抑郁障碍患者的述情障碍及影响因素。方法对57例神经症和抑郁障碍患者运用多伦多述情障碍量表(TAS)进行评定，并与常模进行比较。结果神经症和抑郁障碍患者存在明显的述情障碍，TAS总分及各因子分明显高于常模，男女之间无显著性差异，多元回归分析进入方程的是SCL-90躯体化因子和焦虑因子。结论正确评定神经症和郁郁障碍患者的述情障碍及影响因素，具有重要的临床现实意义，对采用适当的心理治疗提供依据。     

The predictive value of the Toronto Alexithymia Scale among patients with asthma

Objective: The present study examines how alexithymia, self-report of symptoms, and pulmonary function are related to each other among a sample of patients with asthma. The goal was to extend previous research showing that alexithymia may complicate treatment of asthma. Methods: Seventy-four participants with asthma completed the Toronto Alexithymia Scale (TAS), Asthma Symptom Checklist (ASC), Taylor Manifest Anxiety Scale (TMAS), and spirometry testing. Results: The “Difficulty identifying feelings” subscale (IDE) of the TAS was associated with increased report of emotional symptoms (panic–fear) as well as physical symptoms (fatigue) during the past week, but not pulmonary function on the day of testing. This relationship appeared to be influenced by trait anxiety. The “Difficulty communicating feelings” subscale (COM) was correlated with decreased pulmonary function, but not report of emotional or physical sensations experienced during the prior week. The “Externally oriented thinking” subscale (EOT) was not related to any of the dependent measures. Conclusion: These data suggest that alexithymia may complicate optimal management of asthma and this relationship is best studied by examining the subscales of the TAS separately.     

心身疾病与神经症患者的述情障碍

“述情障碍”(Alexithymia)在国外已有不少报告,国内则较少见。本文观察各种心身疾病86例,神经症121例,以117例正常人为对照,以多伦多述情障碍量表(TAS)评定,结果发现心身疾病及神经症患者的TAS平均总分皆较对照组显著为高。因子分Ⅲ(缺乏幻想)均未见增加,男性神经症组较对照组显著为低。     

Alexithymia in patients with psoriasis: clinical correlates and psychometric properties of the Toronto Alexithymia Scale-20

OBJECTIVE: The objective of this study was to examine the psychometric properties and clinical correlates of the 20-item Toronto Alexithymia Scale (TAS-20) in patients with psoriasis. METHODS: Three hundred patients with psoriasis completed the TAS-20 and had the severity of their psoriasis clinically assessed. Test-retest reliability was assessed over 10 weeks in a subset of 71 patients receiving standard medical treatment for their psoriasis. Examination of the factor structure employed both exploratory (EFA) and confirmatory (CFA) factor analysis techniques. RESULTS: The overall prevalence of alexithymia in this population of psoriasis patients, as indicated by the TAS-20, was 33%. The TAS-20 total score was not related to clinical severity, age, age at onset or duration of psoriasis. The 10-week test-retest reliability on a sample of 71 psoriasis patients, pre- and posttreatment with photochemotherapy, was found to be acceptable (r=.69; P<.001). EFA produced no stable solutions. The three-factor structure of the TAS-20 using CFA was also not replicable in this sample. CONCLUSIONS: The findings of this study support the contention that alexithymia is not significantly influenced by either disease severity or chronicity in patients with psoriasis. It is recommended that when employing the TAS-20 in patients with psoriasis, caution is exercised in the interpretation of the scale scores and that further psychometric evaluation of the scale is undertaken as appropriate.     

多伦多述情障碍量表(TAS-20)的信度和效度研究

目的：评价TAS-20量表的信度和效度。方法：使用TAS-20对112例正常人对照样本和102例精神病人样本进行评定。结果：TAS-20具有良好的心理测量特性，Caronbachα系数在0.581-0.739，TAS-20各分量表的劈半相关系数在0.558-0.803，TAS-20各分量表得分在正常人对照样本和精神病人样本之间存在非常显著性差异。结论：TAS-20量表具有良好的信度和效度，值得推广使用。     

Reliability,validity and factorial dimensions of the Interactive Observation Scale for Psychiatric Inpatients

The Interactive Observation Scale for Psychiatric Inpatients (IOSPI) is characterized by the necessity of interaction between the rater and the patient during the evaluation process. The reliability, validity and factor structure of the IOSPI were evaluated by using a total of 186 sets of ratings accomplished by 2 nursing aides on 34 adult psychiatric inpatients submitted to weekly evaluations during the 3 first weeks of hospitalization. The patients were observed by the 2 nursing aides simultaneously during the morning shift (5 h). In the afternoon of the same day, they were interviewed by two psychiatrists who filled in separately the Brief Psychiatric Rating Scale (BPRS). Factor analysis of the 16 IOSPI items revealed 5 distinct clusters of items, which represented higher-order constructs of social interest, psychomotor agitation, psychoticism, neatness and irritability. It was found that the IOSPI has significant interrater reliability, estimated by an intraclass correlation coefficient of total score and factor score. The total scores of the IOSPI showed a significant correlation with the total scores of the BPRS, meeting the criteria of concurrent validity. The criteria of predictive validity were also met, since the patients who could be discharged presented IOSPI scores significantly lower than the patients who could not be discharged. In conclusion, the IOSPI met the requirements of an evaluation scale and can stimulate therapeutic attitudes of the nursing staff by its characteristics of interactive observation.     

Reliability and validity of the Turkish form of the Somatosensory Amplification Scale

In this study, the authors aimed to investigate the reliability and validity of the Somatosensory Amplification Scale (SSAS) that was developed by Barsky et al. in the Turkish population. The study was carried out with 42 patients with Fibromyalgia Syndrome and Asthma Diseases attending to outpatient Physical Therapy and Rehabilitation and Chest Diseases clinics and 86 healthy students from Karadeniz Technical University. SSAS scores were normally distributed, and had acceptable test-retest reliability (r: 0.73) and internal consistency (alpha, 0.62-0.76). Item to scale correlations varied from 0.10 to 0.72, and most were highly significant. Whereas, one item (item 1) in the control group and one item (item 2) in the patients group had low item-total score correlation (r < 0.15). Criterion related validity of the SSAS was shown with significant correlation between the Symptom Interpretation Questionnaire, the Toronto Alexithymia Scale and the Symptom Check List 90 Revised somatization subscale. The validity analysis of the scale resulted in a very high significant difference (P < 0.01) between the mean SSAS scores of the control and patient's group. Test-retest, internal reliability, and item-total score correlation, discriminating power for specific groups and criterion related validity of the SSAS show that the scale has acceptable reliability and validity for the Turkish population.     

Factorial structure of the 20-item Toronto Alexithymia Scale: confirmatory factorial analyses in nonclinical and clinical samples

OBJECTIVE: The 20-item Toronto Alexithymia Scale (TAS-20) measures three intercorrelated dimensions of alexithymia: (1) difficulties identifying feelings (DIF), (2) difficulties describing feelings (DDF), and (3) externally oriented thinking (EOT). The aim of the study was to test the three-factor model of the TAS-20 using confirmatory factorial analyses (CFA). METHOD: 769 healthy subjects and 659 patients meeting the DSM-IV criteria for substance use disorders or eating disorders completed the TAS-20. The correlation matrices for each of the samples were analyzed with LISREL 7.16. RESULTS: In each sample, the three-factor model was found to be replicable. CONCLUSION: The three TAS-20 subcales can be used to explore the distinct facets of the alexithymia construct.     

Reliability and validity of Persian version of Brief Self-Control Scale (BSCS) in motorcyclists

Abstract

Objective: The present study aimed to investigate the validity and reliability of the Persian version of brief self-control scale (BSCS) in Iranian motorcyclists.

Methods: The original English questionnaire of BSCS has been translated into Persian using the direct-reverse approach. A total of 130 motorcyclists aged 18–65?years old in Iran–Kashan completed the questionnaire. Validity was determined by content validity methods, structural validity through factor analysis, and also the convergence and divergence validity using Spearman correlation coefficient. The intra class correlation coefficient (ICC) was calculated to estimate the reliability of the self-control tool. Reliability was calculated using Cronbach's alpha.

Results: The mean and standard deviation of the age at the time of study was 38.5?±?13.5?years old and all of the subjects were male. Cronbach's alpha coefficient of the whole questionnaire (BSCS) was 0.81, which was good in this regard. The ICC coefficient was 0.88 with confidence interval of (0.8–0.93), which confirmed the repeatability of this tool. Exploratory factor analysis (EFA) yielded a two-factor solution accounted for 42% of the observed variance.

Conclusion: This study showed that Persian version of BSCS has a good reliability and validity for self-control in the Persian language community.

• Key points

• The Brief Self-Control Scale (BSCS) has good internal consistency.

• The Brief Self-Control Scale (BSCS) has acceptable reliability.

• Brief Self-control Scale (BSCS) has acceptable validity and reliability in the population studies.

     

Alexithymia in anorexia nervosa: a controlled study using the 20-item Toronto Alexithymia Scale

The 20-item Toronto Alexithymia Scale (TAS) was completed at the age of 22 years by individuals who had previously suffered from anorexia nervosa (AN), and also by members of a comparison group. The AN and comparison groups had been recruited from community samples. Overall, the TAS scores did not clearly discriminate between the two groups. However, the AN group was significantly more often represented among subjects with the highest TAS scores. A subgroup with empathy disorder tended to have particularly high scores. It is concluded that alexithymia, as defined using the TAS-20, is found only in a subgroup of individuals with AN, and possibly more often in those who are also clinically diagnosed as suffering from empathy disorder. The TAS-20 is not suitable for screening of AN in the general population.     

The Montgomery-Asberg Depression Scale: reliability and validity

The Montgomery-Asberg Depression Scale was evaluated in 44 depressed inpatients. All items of the scale occurred frequently in the sample; the scale exhibited construct validity (internal homogeneity) and concurrent validity relative to the Hamilton Depression Scale and the concepts of endogenous and nonendogenous depression. Sleep disturbance, reduced appetite, and suicidal thoughts, correlated poorly with the remainder of the scale. Reasons for this finding are discussed. Inter-rater reliability was demonstrated between a psychiatrist and a nurse on individual item and total scale scores.