The 20-item Toronto alexithymia scale: structural validity, internal consistency and prevalence of alexithymia in a Swiss adolescent sample

BACKGROUND: The alexithymia construct is mainly characterized by a difficulty in identifying and expressing feelings that is thought to reflect a deficit in cognitive processing and regulation of emotional states. During the last decade, alexithymia has been associated with a large variety of medical and psychiatric disorders in the adult population. Although adolescence is probably an opportune time to explore processes of emotion regulation, alexithymia has been rarely examined during this period. The 20-item Toronto alexithymia scale (TAS-20) is the most widely used self-report measure of alexithymia. For this scale, a three-factor structure was proposed: difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT). Research has yielded considerable evidence that the TAS-20 is a reliable and valid measure of alexithymia in normal and clinical adult samples. To date, no psychometric data concerning the use of the TAS-20 with adolescent samples are available. OBJECTIVES: The aim of the study is to provide psychometric data concerning the TAS-20 when administered to healthy adolescents. Furthermore, in a developmental perspective, this study explores the evolution of alexithymia across age groups in adolescence. METHOD: The TAS-20 was administered to a sample of 264 adolescents aged from 14 to 19 years. In order to compare alexithymia across age groups, the sample was divided into three groups: group 1 (<16 years old), group 2 (16-17 years old) and group 3 (>17 years old). RESULTS: Results of a confirmatory factor analysis (CFA) confirmed that the data fitted well to the three-factor model of the TAS-20 (chi(2)/df=2.22, GFI=0.88, AGFI=0.84 and RMSEA=0.068). The internal reliability coefficients and mean interitem correlations are acceptable for DIF (alpha>0.60; mean interitem correlation=0.22) and good for DDF (alpha>0.70, mean interitem correlation=0.33). As often reported in most translations of the TAS-20, the internal reliability of EOT is poor. Results of a one-way Anova showed a significant linear trend indicating that, with age, the level of alexithymia (TAS-20 total score), the difficulty in identifying feelings and the externally oriented thinking decreased. DISCUSSION: This study demonstrated that the TAS-20 has sufficient construct validity in a non-clinical sample of adolescents. Our results support the idea that adolescence period is associated with the development of the ability to regulate emotions.     

Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia

OBJECTIVE: To determine the role of undifferentiated and dysregulated affects in somatoform disorders by using a multimethod assessment approach of alexithymia. METHODS: Forty patients with ICD-10 somatoform disorders (SoD) and 20 healthy controls, matched for age, education and sex, were included in the study. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), the Affect Consciousness Interview (ACI), and the Levels of Emotional Awareness Scale (LEAS). All classifications were made blinded with regard to clinical status. RESULTS: Scores of the ACI and the TAS-20 showed that alexithymia is higher in SoD than in healthy controls. No differences were found on the LEAS. In terms of the multidimensionality of the alexithymia construct, our results indicate a specific positive association between SoD and a proneness to experience undifferentiated affects. The three subfactors of the TAS-20 were differentially related to non-self-report measures of alexithymia and to negative affectivity (NA). Only the cognitive facet of the TAS-20 (externally oriented thinking [EOT]) was related to the LEAS and the ACI. In contrast, the affective facets of the TAS-20-difficulties identifying feelings (DIF) and difficulties describing feelings (DDF)-were substantially related to NA. CONCLUSION: The findings highlight the important role of impaired affect regulation and NA in the process of somatization.     

Temporal stability and differential relationships with neuroticism and extraversion of the three subscales of the 20-item Toronto Alexithymia Scale in clinical and nonclinical samples

OBJECTIVES: To examine the cross-sample and temporal stability of the three subscales of the 20-item Toronto Alexithymia Scale (TAS-20) and to study the pattern of associations between the TAS-20 scales, neuroticism, and alexithymia. METHODS: Two clinical and three nonclinical samples were included in the cross-sectional part of the study. One clinical and one nonclinical sample also participated in the 6-month follow-up study. To test the replicability of the three-factor structure of the TAS-20 across samples, a principal component analysis was conducted, followed by a Procrustes rotation. Linear regression analyses were conducted to examine temporal stability and to determine the specificity of the associations among the TAS-20 scales, neuroticism, and extraversion. RESULTS: The three-factor structure of the TAS-20 was confirmed across all five samples. With a few exceptions, neuroticism and extraversion attained a higher level of temporal stability than the alexithymia scales. The TAS-subscale measuring difficulty identifying feelings (DIF) was less stable in the clinical than in the nonclinical sample. Neuroticism was most strongly associated with DIF, whereas extraversion was mainly related to externally oriented thinking (EOT). A combination of both neuroticism and extraversion was the best predictor of difficulty describing feelings (DDF). CONCLUSIONS: Future studies on the psychometric properties and the clinical value of the TAS-20 should pay more attention to its subscales. Especially the EOT facet needs further examination.     

Is there a reliable factorial structure in the 20-item Toronto Alexithymia Scale? A comparison of factor models in clinical and normal adult samples

OBJECTIVES: The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for measuring alexithymia. However, different studies did not always yield identical factor structures of this scale. The present study aims at clarifying some discrepant results. METHODS: Maximum likelihood confirmatory factor analyses of a German version of the TAS-20 were conducted on data from a clinical sample (N=204) and a sample of normal adults (N=224). Five different models with one to four factors were compared. RESULTS: A four-factor model with factors (F1) "Difficulty identifying feelings" (F2), "Difficulty describing feelings" (F3), "Low importance of emotion" and (F4) "Pragmatic thinking" and a three-factor model with the combined factor "Difficulties in identifying and describing feelings" described the data best. Factors related to "externally oriented thinking" provided no acceptable level of reliability. CONCLUSIONS: Results from the present and other studies indicate that the factorial structure of the TAS-20 may vary across samples. Whether factor structures different from the common three-factor structure are an exception in some mainly clinical populations or a common phenomenon outside student populations has still to be determined. For a further exploration of the factor structure of the TAS-20 in different populations, it would be important not only to test the fit of the common three-factor model, but also to consider other competing solutions like the models of the present study.     

Are alexithymia, depression, and anxiety distinct constructs in affective disorders?

OBJECTIVE: the present study was undertaken to gain a better insight into the relationship between alexithymia, anxiety, and depression. Two hypotheses were tested: (1) whether a depressive or anxiety disorder is associated with an elevation of one or more dimensions of alexithymia; and (2) whether alexithymia is an independent construct from depression and anxiety in patients with depressive or anxiety disorders. METHOD: a total of 113 patients with depressive or anxiety disorders (DSM-IV) and 113 control subjects completed the 20-item version of the Toronto alexithymia scale (TAS-20) and the hospital anxiety and depression scale (HADS). RESULTS: the TAS-20 total score was higher in depressed and anxious patients than in controls. This finding mainly depended on an increased score for "difficulty identifying feelings"(DIF), and (only in depressed patients) on an increased score for "difficulty communicating feelings" (DCF). The factor analysis of the TAS-20 and HADS items showed that depression is a construct different from alexithymia, whereas some overlap exists between anxiety and DIF dimension. CONCLUSION: our results suggest that in depressive and anxiety disorders, alexithymia and depression are separate constructs that may be closely related; in contrast, there are some overlaps between the DIF dimension and anxiety.     

Are alexithymia, ambivalence over emotional expression, and social insecurity overlapping constructs?

OBJECTIVE: The aim of the present study was to analyze the relationship and differential validity of three constructs related to reduced emotional expression. METHODS: One hundred six patients of a psychosomatic clinic completed questionnaires assessing alexithymia (TAS-20, BVAQ), ambivalence over emotional expression (AEQ-G18), and social insecurity (UQ). RESULTS: A second-order principal component analysis with the scales of all questionnaires yielded three factors and revealed that the scale Competence Ambivalence assessed by the AEQ-G18 loaded on the same factor as the TAS-20 and BVAQ scales measuring Difficulties Describing and Identifying Feelings. A high correlation between the factor Social Insecurity (composed of all UQ scales) and the factor Difficulty Identifying and Describing Feelings (composed of BVAQ, TAS-20, and AEQ-G18 scales) was found. In contrast to this, the factor Emotionalizing and External Thinking showed only low correlations with the remaining factors. CONCLUSION: The results of the present study did not support the view that the alexithymia facets related to difficulties identifying and describing feelings and Competence Ambivalence are distinct constructs, when measured by self-report. This might be explained by methodological problems with the assessment of alexithymia and ambivalence. Furthermore, the results indicate that social insecurity is strongly related with the "difficulty identifying and describing feelings" facets of alexithymia and with effect ambivalence.     

Alexithymia and temperament and character model of personality in patients with major depressive disorder

Alexithymia is thought to be a stable personality trait and a predisposing risk factor for depression. In this study, we aimed to identify the prevalence of alexithymia in a depressed and nondepressed sample and examined the relationship between Cloninger's psychobiological model of personality with alexithymia. The Turkish version of the 20-item Toronto Alexithymia Scale (TAS-20), the Turkish version of the Temperament and Character Inventory, and the 21-item Beck Depression Inventory (BDI) were administered to 81 depressed patients and 51 controls. The mean age of the groups was 30.5 ± 7.7 and 32.75 ± 8.73, respectively. Depression severity was evaluated with the BDI. In the depressed group, 33.3% were alexithymic, and alexithymic subjects had significantly higher BDI scores. Depressed individuals were significantly more alexithymic than the controls on the total and all the 3 subscales of TAS-20. The TAS-20 total score was negatively correlated with the temperament dimension of Reward Dependence (RD) and the character dimension of Self-Directedness (SD). In the TAS-20 subscale, difficulties in identifying feelings was positively correlated with Self-Transcendence and negatively correlated with SD. The difficulties in expressing feelings subscale was negatively correlated with RD and SD. In the depressed patient group, the temperament dimension of RD was significantly lower in the alexithymic group. The rate of alexithymia is found high among this sample of Turkish depressed patients, and the results suggested a strong connection between alexithymia and depression. Alexithymia is explained by specific dimensions and subscale within Cloninger's psychobiological model of personality in this sample of depressed Turkish patients.     

述情障碍与神经症的关系

目的综合国内关于述情障碍与神经症关系的研究（以TAS-26为测量工具）。方法对已有研究进行元分析。结果情感描述困难（Ⅰ）、情感识别困难（Ⅱ）、缺乏幻想（Ⅲ）、外向性思维（Ⅳ）各维度的平均效应量依次为0.52,1.08,0.03,0.69。结论述情障碍各维度中,Ⅱ、Ⅳ和Ⅰ参与了神经症的发生、发展过程。其中,Ⅱ和Ⅳ对躯体化障碍的影响最为显著,情感描述困难对各类神经症的发生、发展都有一定的影响。     

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.     

述情障碍与心身疾病的关系

目的综合国内关于述情障碍与心身疾病关系的研究（以TAS-26为测量工具）。方法对已有研究进行元分析。结果情感描述困难（Ⅰ）、情感识别困难（Ⅱ）、缺乏幻想（Ⅲ）、外向性思维（Ⅳ）各维度的平均效应量依次为0.80,0.87,0.52,0.71。结论述情障碍各维度均参与了心身疾病的发生、发展过程。其中,以Ⅱ和Ⅰ维度的作用最为显著,其次是Ⅳ和Ⅲ维度。     

Alexithymia and Emotional Intelligence in Patients with Panic Disorder, Generalized Anxiety Disorder and Major Depressive Disorder

Emotional Intelligence (EI) is a broad personality construct signifying the ability to perceive and to regulate affects within oneself. Alexithymia is another personality construct denoting difficulty in identifying and expressing emotions, with an externally oriented thinking style. Although previously considered to be independent, some studies have shown that these constructs overlap. The aim of this study was to evaluate and compare the levels of EI and alexithymia in patients with panic disorder, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The subjects included 171 psychiatric patients and 56 non-clinical controls. Psychiatric diagnoses were based on DSM-IV criteria. The Emotional Intelligence Scale-34 (EIS-34) and the Toronto Alexithymia Scale (TAS-20) were used to assess EI and alexithymia. All three patient groups scored statistically significantly higher than the non-clinical controls on TAS-20 total score and the TAS-20 subfactors of difficulty identifying feelings and difficulty describing feelings. EIS-34 scores were lower in patient groups than in the non-clinical controls, but only the EIS-34 intrapersonal subscale was significant difference. Total TAS-20 and EIS-34 scores in the patient cohort were inversely and significantly correlated These results reaffirm an overlap between EI and alexithymia with the intrapersonal factor of EI to be more dependent on the difficulty identifying feelings dimension of alexithymia in subjects with MDD and GAD.     

Validity of the BVAQ: a study in eating disorder patients and controls

Alexithymia core features are the difficulties in identifying and describing feelings; the difficulties in distinguishing feelings from the bodily sensations of emotional arousal; an impaired symbolization, as evidenced by a paucity of fantasies and other imaginative activity; and a tendency to focus on external events rather than inner experience. Several measures of alexithymia have been developed, including interviewer-rated questionnaires and self-report questionnaires. Among the self-report questionnaires, the 20-item Toronto Alexithymia scale (TAS-20) is the most commonly used, but it fails to measure all the core features of alexithymia. A recently developed instrument, the Bermond-Vorst Alexithymia Questionnaire (BVAQ), allows the measurement of the alexithymia core features, as well as an additional one. It appeared to present good psychometric properties, notably the abbreviated BVAQ-form B. The results of recent studies comparing the psychometric properties of the TAS-20 and the BVAQ have recommended the BVAQ over the TAS-20. However, this questionnaire needed further validation. OBJECTIVES: Thus, the aim of the present study was to determine the convergent, discriminant and concurrent validity of the Bermond-Vorst Alexithymia Questionnaire -- form B (BVAQ-B) in a clinical sample of 59 eating disorder patients, as well as in 191 controls. The TAS-20 constituted the gold standard for the assessment of the BVAQ-B' convergent validity. To compare the concurrent validity of the BVAQ-B and the TAS-20, participants also completed several self-reports investigating different dimensions of emotion regulation capacities: the 13-item Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI-form Y), as well as the Chapman and Chapman Physical and Social Anhedonia Scales (PAS and SAS). One way analyses of variance were used for mean scores comparisons. Convergent validity was determined using Pearson coefficients of correlation. RESULTS: Results of the analyses suggested the BVAQ-B has a satisfying convergent and discriminant validity. This was observed in both the clinical and control samples. Moreover, the comparison of the convergent validity of the BVAQ-B and the TAS-20 revealed several differences between these two alexithymia self-report questionnaires. The BVAQ-B appeared less sensitive to the subjective emotional state of the participants than the TAS-20. Whereas it was argued the TAS-20 overlaps with other emotional state scores, the BVAQ-B would allow to measure alexithymia more specifically. In addition, the present results allowed to further determine the relations between alexithymia and other dimensions of emotion regulation capacities. The analyses confirmed that alexithymia is linked to other emotion regulation dimensions such as depression and anxiety. Moreover, alexithymia was associated with physical and social anhedonia, two dimensions that received less interest in the alexithymia literature to date. This study also showed that control and clinical sample have different emotion regulation capacities. Eating disorder patients were not only more alexithymic and more depressed, but also more anxious and more anhedonic than the controls. Finally, this study revealed that alexithymia differs whether the alexithymic individuals are patients or controls. Healthy alexithymic individuals (ie, individuals categorized as alexithymic in the control group) seemed characterised by a selective deficit of emotional cognition, with sparing of emotional experience (Bermond's type II alexithymia). Alexithymics individuals of the eating -disorder group seemed particularly unabled to experience affect. This pattern could correspond to Bermond's type I alexithymia, which is characterised by the absence of emotional experience and, consequently, by the absence of the cognition accompanying the emotion. In summary, results of the present study add to the literature debating on whether alexithymia is similar in different types of population.     

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.     

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.     

A Comparative Study on Alexithymia in Depressive,Somatoform, Anxiety,and Psychotic Disorders among Koreans

Objective

Little is known about the characteristic differences in alexithymic construct in various psychiatric disorders because of a paucity of direct comparisons between psychiatric disorders. Therefore, this study explored disorder-related differences in alexithymic characteristics among Korean patients diagnosed with four major psychiatric disorders (n=388).

Methods

Alexithymic tendencies, as measured by the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), of patients classified into four groups according to major psychiatric diagnosis were compared. The groups consisted of patients with depressive disorders (DP; n=125), somatoform disorders (SM; n=78), anxiety disorders (AX; n=117), and psychotic disorders (PS; n=68).

Results

We found that substantial portions of patients in all groups were classified as having alexithymia and no statistical intergroup differences emerged (42.4%, 35.9%, 35.3%, and 33.3% for DP, SM, PS, and AX). However, patients with DP obtained higher scores in factor 2 (difficulties describing feelings) than those with SM or AX, after adjusting for demographic variables.

Conclusion

These findings suggest that alexithymia might be associated with a higher vulnerability to depressive disorders and factor 2 of TAS-20K could be a discriminating feature of depressive disorders.     

Le questionnaire d’alexithymie pour enfants (QAE) : étude sur une population clinique de 105 adolescents hospitalisés en pédopsychiatrie

Objective

The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale.

Alexithymia and temperament and character model of personality in alcohol-dependent Turkish men

Aims:  Alexithymia, a personality trait characterized as having problems identifying, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others, is only partly described within the context of personality. The aim of the present study was therefore to study the prevalence of alexithymia among male alcohol-dependent inpatients and investigate the relationship between alexithymia and the dimensions of Cloninger's psychobiological model of personality.
Methods:  The Turkish version of the Toronto Alexithymia Scale (TAS-20) and the Turkish version of the Temperament and Character Inventory (TCI) were administered to 111 male alcohol-dependent inpatients.
Results:  TAS-20 scores correlated positively with harm avoidance and self-transcendence and negatively with self-directedness and cooperativeness. Regression analysis identified high harm avoidance and self-transcendence and low self-directedness as independent predictors of alexithymia. Also harm avoidance and self-transcendence predicted alexithymia in a logistic regression model.
Conclusions:  Alexithymia can be explained by specific dimensions within Cloninger's psychobiological model of personality in alcohol-dependent Turkish men.     

The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder.

PURPOSE: The current paper focused on the validity of using self-reports to assess emotion regulation abilities in autism spectrum disorders (ASD). To assess this we sought responses to two alexithymia self-reports and a depression self-report at two time points from adults with and without ASD. MATERIALS AND METHODS: An initial sample of 27 adults with ASD and 35 normal adults completed the 20-item Toronto alexithymia scale (TAS-20), the Bermond and Vorst alexithymia questionnaire-form B (BVAQ-B), and the Beck depression inventory (BDI), at test time 1. Of these individuals, 19 ASD and 29 controls participated again after a period ranging from 4 to 12 months. RESULTS: ASD participants were able to report about their own emotions using self-reports. BVAQ-B showed reasonable convergent validity and test-retest reliability in both groups. Scores on both alexithymia scales were stable across the two participant groups. However, results revealed that although the TAS-20 total score discriminated between the two groups at both time points, the BVAQ-B total score did not. Moreover, the TAS-20 showed stronger test-retest reliability than the BVAQ-B. CONCLUSION: ASD participants appeared more depressed and more alexithymic than the controls. The use of the BVAQ-B, as an additional assessment of alexithymia, indicated that ASD patients have a specific type of alexithymia characterised by increased difficulties in the cognitive domain rather than the affective aspects of 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.     

Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland

The prevalence of alexithymia and its association with sociodemographic variables were studied in a sample of 1285 subjects representing the general population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). Alexithymia was normally distributed in the population in both genders, confirming that it is a personality dimension. The prevalence of alexithymia was 13%. Men were alexithymic almost twice (17%) as often as women (10%). Multivariate analysis showed that alexithymia was associated with male gender, advanced age, low educational level, and low socioeconomic status. As to the three factors of the TAS-20, men scored higher in factors 2 (difficulty in describing feelings) and 3 (externally oriented thinking). but there was no gender difference in factor 1 (difficulty in identifying feelings). Comparative population studies in other countries are needed to find out whether there are any differences in the prevalence of alexithymia between cultures.