Stability of alexithymia in late adolescence: Results of a 4-year follow-up study

The aim of the present study was to assess the stability of alexithymia in adolescents and the effects of parental factors and social support thereon. The sample comprised 315 late adolescents, of whom 259 were female and 56 male. At baseline, the mean age of the subjects was 19 years (range 17–21 years). The follow-up period was 4 years (2008–2012). The 20-item Toronto Alexithymia Scale (TAS-20) was used for the assessment of alexithymia both at baseline and follow-up. The Multidimensional Scale of Perceived Social Support (MSPSS) and the Parental Bonding Instrument (PBI) were used as measures at baseline. Regarding absolute stability, the changes in the TAS-20 total scores and two subscales (DIF and EOT) were statistically significant but the effect sizes for the changes were small (Cohen?s d 0.21–0.24). The test–retest correlations for the TAS-20 total and subscale scores were high (ρ=0.50–0.64, P<0.001), indicating relative stability. While several parental and social support variables were associated with alexithymia at baseline, low social support from friends was the only to predict higher alexithymia at follow-up. Alexithymia is a stable personality trait also in late adolescence. Low social support from friends is related to alexithymia in young adulthood.     

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.     

Depressive personality dimensions and alexithymia in eating disorders

An association has been reported between high levels of alexithymia and depression in patients with eating disorders. This study has examined alexithymic features and depressive experiences in patients with DSM-IV eating disorder (restricting anorexia, n=105; purging anorexia, n=49; bulimia, n=98) and matched controls (n=279). The subjects were assessed with the Toronto Alexithymia Scale (TAS-20); the Beck Depression Inventory; and the Depressive Experiences Questionnaire, which defines two types of depressive personality style (dependent and self-critical). The patients had high levels of alexithymic features and depressive symptoms. Comparisons of alexithymic features between patients and controls after adjustment for depression showed a significant difference between bulimic patients and controls for the TAS Difficulty Identifying Feelings factor, and between restricting anorexic patients and controls for the TAS Difficulty Describing Feelings factor. With regard to depressive personality styles, only scores on the self-critical dimension were significantly higher in bulimic patients than in restricting anorexic patients and controls. In the entire group of eating disorders, dependency was associated with the TAS Difficulty Identifying Feelings factor only in anorexic patients. Self-criticism, on the other hand, was associated with the TAS Difficulty Identifying Feelings factor in all subtypes of eating disorders, although the relationship was significantly stronger in restricting anorexic than in bulimic patients. The results of this study suggest that people with restricting anorexia and bulimia show specific clinical profiles associating alexithymic features and depressive dimensions.     

Parental bonding and alexithymia: A meta-analysis

Aim

The primary purpose of this meta-analysis was to explore, clarify and report the strength of the relationship between alexithymia, as measured by the Toronto Alexithymia Scale (TAS-20), and parenting style as measured by the Parental Bonding Instrument (PBI).

Methods

Web of Science, PsycInfo, PubMed and ProQuest: Dissertations and Theses searches were undertaken, yielding nine samples with sufficient data to be included in the meta-analysis.

Results

Evidence indicated moderate to strong relationships between maternal care and alexithymia, and between maternal care and two of the three TAS-20 alexithymia facets (Difficulties Describing Feelings and Difficulties Identifying Feelings, but not Externally Oriented Thinking). Moderate relationships were observed for both maternal- and paternal-overprotection and alexithymia respectively, and for overprotection (both maternal and paternal) and Difficulties Describing Feelings.

Conclusion

This study is the first meta-analysis of the relationship between parenting styles and alexithymia, and findings confirm an especially strong association between maternal care and key elements of alexithymia. This review highlights the issues that still remain to be addressed in exploring the link between parenting style and alexithymia.     

Alexithymia,Suicide Ideation,C-Reactive Protein,and Serum Lipid Levels Among Outpatients with Generalized Anxiety Disorder

The aim of the present study was to investigate the relationships between alexithymia, suicide ideation, C-Reactive Protein (CRP), and serum lipid levels in adult outpatients with a DSM-IV diagnosis of Generalized Anxiety Disorder (GAD). Seventy consecutive patients with GAD were recruited and evaluated. Measures were the Hamilton Anxiety Scale, the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation (SSI), and the Montgomery Åsberg Depression Rating Scale (MADRS). All patients were assessed for: CRP, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG), and very-low-density lipoprotein cholesterol (VLDL-C). TC/HDL-C and LDL-C/HDL-C ratios were also evaluated. Alexithymic patients showed higher scores on almost all rating scales and altered serum CRP and lipid levels vs. non-alexithymics. In the hierarchical regression model, the presence of higher MADRS scores together with higher scores at the Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher rates of suicide ideation. Although alexithymic subjects with GAD may show a CRP and cholesterol dysregulation, this latter seems independent on increased suicide ideation, rather to Difficulty in Identifying Feelings, and subthreshold depressive symptoms. Study limitations and future research implications are discussed.     

Alexithymia and its relationships with C-reactive protein and serum lipid levels among drug naïve adult outpatients with major depression

Several studies have investigated the relationship between C-reactive protein (CRP) and serum lipid levels in Major Depression (MD), but no study has, to date, evaluated the impact of alexithymia on these parameters. Therefore, the aim of the present cross-sectional study was to evaluate the relationship between alexithymia, suicide risk, C-reactive protein (CRP) and serum lipid levels in adult outpatients suffering from moderate to severe MD. CRP and serum lipid levels data were analyzed in 145 drug-naïve adult outpatients (69 men, 76 women) with a DSM-IV diagnosis of MD. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), depression severity was evaluated with the 17-item Hamilton Depression Rating Scale (HAM-D) and suicide risk was determined using the Scale of Suicide Ideation (SSI). Alexithymics showed altered serum lipid levels and higher CRP than non-alexithymics. In the linear regression models, lower total cholesterol levels and “Difficulty in Identifying Feelings” dimension of TAS-20 were significantly associated with depression severity, whereas lower high-density lipoprotein levels and “Difficulty in Identifying and Describing Feelings” dimensions of TAS-20 were associated with higher suicide risk. Authors discuss study limitations and future research needs.     

Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study

OBJECTIVE: Several cross-sectional studies have reported high levels of alexithymia in populations with eating disorders. However, only few studies, fraught with multiple methodological biases, have assessed the prognostic value of alexithymic features in these disorders. The aim of the present study was to investigate the long-term prognostic value of alexithymic features in a sample of patients with eating disorders. METHODS: Within the framework of a European research project on eating disorders (INSERM Network No. 494013), we conducted a 3-year longitudinal study exploring a sample of 102 DSM-IV eating disorder patients using the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory. RESULTS: At the 3-year assessment, 74% (n=76) of the sample still presented a syndromal or subsyndromal eating disorder (unfavorable outcome: score of > or =3 on the Psychiatric Status Rating Scale for anorexia nervosa or bulimia nervosa). In logistic and hierarchical regression analyses, the Difficulty Identifying Feelings factor of the TAS-20 emerged as a significant predictor of treatment outcome, independent of depressive symptoms and eating disorder severity. CONCLUSIONS: The results of this study indicate that difficulty in identifying feelings can act as a negative prognostic factor of the long-term outcome of patients with eating disorders. Professionals should carefully monitor emotional identification and expression in patients with eating disorders and develop specific strategies to encourage labeling and sharing of emotions.     

Social support, ethnicity and mental health in adolescents

Objective In this study, we explored whether social support varied with ethnic group in young people, and if it explained ethnic differences in prevalence of psychological distress. Methods A representative sample of 2790 East London adolescents (11–14 years) completed a classroom-based self-report questionnaire for this cross sectional survey. Social support was assessed using the Multidimensional Scale of Perceived Social Support (MSPSS). Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Short Moods and Feelings Questionnaire (SMFQ). Results High levels of social support were reported by most participants, with some variation by ethnic group and gender. Participants reporting low family and overall social support had an increased likelihood of psychological distress compared with those who reported high support. Low support from friends, family and overall was also associated with depressive symptoms. These relationships did not alter with adjustment for ethnic group. Conclusions This study identified an independent association between different sources of social support and mental health in a young, ethnically diverse sample. Differences in social support did not explain ethnic differences in psychological distress.     

Relationship and differential validity of alexithymia and depression: a comparison of the Toronto Alexithymia and Self-Rating Depression Scales

Theoretically, the constructs of alexithymia and depression share many common characteristics. Empirically moderate correlations between measures of alexithymia and depression have been found, hence it has been argued that the Toronto Alexithymia Scale (TAS) may be, at least in some part, just another measure for depression. The purpose of this study was to evaluate the construct validity of alexithymia and to analyze the relationship between alexithymia and depression. Exploratory and confirmatory factor analyses were conducted on the combined items of the TAS-20 and the Self-Rating Depression Scale (SDS) in a psychosomatic and alcoholic inpatient sample (n = 199) and a sample of normal adults (controls, n = 174). The exploratory factor analysis in the patient sample yielded a 4-factor structure. Within each factor there was no overlap between the items of the TAS-20 and the SDS. Two factors were comprised of items of the TAS-20 and two factors consisted of items of the SDS. This 4-factor model also showed an acceptable fit for the data of the normal sample in a confirmatory factor analysis. Moderate correlations between the TAS- 20 and SDS total scores and some factors were found. Both instruments, the TAS-20 and the SDS, seem to measure distinct constructs and are not just different measures for the same underlying construct. This provides support for the differential validity of the alexithymia and depression constructs and is in accordance with previous findings.     

Comparative study of the relationship between alexithymia and affective dependence on 60 alcoholics and 57 control subjects]

Several authors have shown that alexithymia characterizes patients suffering from substance abuses. Moreover emotional and perceptual dependencies have also been described in these disorders. The aim of this study is to test two hypotheses: First that the emotional components of alexithymia and dependency were linked in alcoholics and secondly that the cognitive components of these two dimensions were also linked in these subjects. Two groups were recruited: 60 inpatients filled out the DSM IV criteria for alcohol dependence and 57 healthy subjects were the controls. All the subjects completed the following rating scales: the twenty items Toronto Alexithymia Scale (TAS-20), the Interpersonal Dependency Inventory (IDI), the Beck Depression Inventory, the Embedded Figures Test (EFT). Partial correlations (r Bravais Pearson), using BDI score as constant, were calculated. In normals the Feelings subscale of the TAS-20 correlated with the Lack of social self confidence subscale of the IDI (r = 0.43, p < 0.0018) and in alcoholics the Cognitive factor of the TAS-20 correlated with the Lack of social self confidence subscale (r = 0.41, p < 0.0018). Moreover in alcoholics, the cognitive factor of the TAS-20 correlated significantly with the EFT score (r = -0.35, p < 0.003). CONCLUSION: In alcoholics the cognitive component of alexithymia and the perceptual component of dependency were linked, independently of an associated depression. A particular cognitive style characterized by externality and field dependence could characterized dependent alcoholics.     

Alexithymia, depression and drug addiction

Alexithymia is a multidimensional concept associating an emotional component focused on the difficulty in identifying and describing feelings and a cognitive one centred on the use of a concrete and poorly introspective way of thinking. Alexithymia can be assessed by self-assessment instruments and in particular by the 20 items version of the Toronto Alexithymia Scale (TAS-20). Depressive disorders have complex relationships with the construct of alexithymia and there exist few experimental works on the subject. Epidemiological studies frequently raise an overlap between alexithymia and depression, in particular in the context of addiction. The main aim of this study was to confirm the high prevalence of alexithymia among drug addicted patients taking into account socio-demographic variables (sex, age, social and economic categories). The second aim of the study was to investigate the relationships between alexithymia and depression among drug addicted patients. A sample of 128 drug addicted patients answering DSM IV criteria of dependence to a psycho-active substance (alcohol excluded) was paired according to socio-demographic variables to a control sample of 128 normal subjects. Diagnostic assessment was made using the Mini International Neuropsychiatric Interview (MINI). Alexithymia and depression were assessed with the TAS-20 and with the short version of the Beck Depression Inventory (BDI-13). The results confirm the high prevalence of alexithymia among drug addicted patients (43.5%) compared to controls (24.6%). This difference is based namely on the emotional component of alexithymia, the cognitive component failing to show any difference between the two samples. Moreover, alexithymia appears to be independent from socio-demographic variables in our sample of drug addicted patients; 66.4% of drug addicted patients presents a depressive symptomatology (which is significantly more important in female patients), compared to 26% of the controls. Studies using the TAS and the BDI with 21 items have shown that from 10 to 20% of the variance of alexithymia is explained by depression. Our own results show a shared variance of 20% between the TAS-20 and the BDI, going in the direction of a moderated correlation between alexithymia and depressive symptomatology. Moreover, when we retain only subjects without depressive symptomatology at BDI, drug addicted (n=42) are not any more alexithymic than controls (n=114). Our results plead for a positive association between depression and alexithymia in drug addicted, depressed or healthy subjects. Alexithymia and depression would be two associated dimensions, the emotional component explaining alone this association. The emotional component of the alexithymia would be thymo-dependent, whereas the cognitive component (externally oriented thought) would be independent and constitute a stable clinical feature. These results are concordant with other studies in the literature suggesting that alexithymia in its emotional component is supported by depression. Alexithymia thus did not appear as an autonomous dimension which would discriminate between drug addicted and controls, independently of the absence of a depressive state. The Authors discuss the complexity of the relationships between alexithymia and depression and the correlations between TAS and BDI scales especially for the factor Difficulty Identifying Feelings. These results deserve further studies. The cross-sectional nature of this study do not allow to establish if alexithymia is a subjacent and preexistent in the form of a psychopathological dimension in addictive behaviours, so supporting its emergence, and/or if it develops once the dependence is installed and chronicized. Longitudinal studies remain to be realised.     

Alexithymia, depression and tinnitus in elderly people

OBJECTIVE: Tinnitus is known to have an association with depression and other psychiatric disorders. As part of a larger epidemiological survey, we evaluated the associations among tinnitus, depression and alexithymia in a group of elderly people. METHODS: A survey of hearing loss, audiological rehabilitation and associated morbidity in a senior population was conducted in Turku, Finland. The study sample consisted of 583 participants aged between 70 and 85 years. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia, whereas the 13-item version of the Beck Depression Inventory was used to measure depression; the subjective experience of tinnitus was queried with a questionnaire. RESULTS: Depression had a clear association with subjectively annoying tinnitus. Contrary to expectations, the TAS-20 score did not correlate with the severity of tinnitus. In fact, the highest TAS-20 scores were found among the subjects who had tinnitus but did not find it to be subjectively annoying. No significant association between high TAS-20 scores and hearing loss was found. CONCLUSION: Although we found an association between TAS-20 scores and the presence of tinnitus, alexithymia does not seem to be helpful in explaining tinnitus annoyance among elderly people.     

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.     

Alexithymia,suicide ideation,affective temperaments and homocysteine levels in drug naïve patients with post-traumatic stress disorder: an exploratory study in the everyday ‘real world’ clinical practice

Objective: The present exploratory study aimed to investigate relationships between alexithymia, suicide ideation, affective temperaments and homocysteine levels among drug-naïve adult outpatients with Post-Traumatic Stress Disorder (PTSD) in an everyday ‘real world’ clinical setting.

Method: Sixty-four adult outpatients with PTSD were evaluated using the Davidson Trauma Scale (DTS), the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation (SSI), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire. As well, homocysteine levels were measured.

Results: Alexithymic subjects showed higher values on all scales but not homocysteine levels. Partial correlations showed that almost all studied variables were correlated with each other, except homocysteine levels. Regression analysis showed that higher disorder severity as measured by DTS and TAS-20 ‘Difficulty in Identifying Feelings’ dimension was associated with higher SSI scores.

Conclusions: In conclusion, alexithymic PTSD outpatients may be characterised by higher disorder severity and difficulty in identifying feelings that may be linked to increased suicide ideation, regardless of affective temperaments or homocysteine levels. Homocysteine levels were not related to any studied variable. However, study limitations are discussed and must be considered.

• Keypoints

• Patients with alexithymia showed increased PTSD severity, a higher score on TEMPS-A subscales, and more severe suicide ideation.

• The Difficulty in Identifying Feelings (DIF) dimension of TAS-20 was associated with suicide ideation in patients with PTSD.

• Homocysteine did not correlate with any studied variables.

• This study was exploratory and cross-sectional: further larger and prospective studies are needed.

     

Alexithymia and occupational burnout are strongly associated in working population

OBJECTIVE: The relationship between alexithymia and occupational burnout has not previously been studied. We investigated the association between alexithymia and occupational burnout in a representative nationwide population health study. METHODS: This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 3322 employees aged 30-64 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and occupational burnout with the Maslach Burnout Inventory-General Survey. Sociodemographic and health-related variables including depression were treated as confounders in the logistic regression analyses, which were performed alternately with TAS-20 total score and the scores of the three TAS-20 factor scales as alexithymia variables. RESULTS: Alexithymia and its three facets were significantly associated with occupational burnout even when controlled for confounding factors. CONCLUSIONS: Even though both alexithymia and depression are associated with burnout, alexithymia may be an independent risk factor for occupational burnout.     

Prevalence and sociodemographic correlates of alexithymia in a population sample of young adults

We examined the prevalence of alexithymia and its associations with sociodemographic factors in a population cohort. The study forms part of the Northern Finland 1966 Birth Cohort. The original material consisted of all 12,058 live-born children in the provinces of Lapland and Oulu in Finland with an expected delivery date during 1966. The material represents 96% of all births in the region. In 1997, a 31-year follow-up study was conducted on a part of the initial sample. The 20-item version of the Toronto Alexithymia Scale (TAS-20) was given to 5,993 subjects; 84% returned the questionnaire properly answered. It is known that alexithymia is associated with psychological distress. This was measured with the 25-item version of the Hopkins Symptom Check List (HSCL-25). The prevalence of alexithymia (TAS-20 score > 60) was 9.4% in male and 5.2% in female subjects. Alexithymia was associated with poor education and low income level and it was more common among unmarried subjects. After adjusting for psychological distress, these associations remained statistically significant. The prevalence of alexithymia was higher in men than in women and alexithymia was associated with poor social situation. As far as we know, this was the first study to assess the prevalence of alexithymia and its associations with sociodemographic factors in a large and representative cohort sample, adjusted for psychological distress.     

Independent associations of alexithymia and social support with depression in hemodialysis patients

OBJECTIVE: The influences of alexithymia and social support on depression among chronically ill patients were examined prospectively. METHODS: The study population was 230 outpatients receiving chronic hemodialysis (HD) therapy. The Beck Depression Inventory-II (BDI-II), the 20-item Toronto Alexithymia Scale (TAS-20), and two subscales of the Social Support Questionnaire were given to the subjects. The BDI-II was readministered after a 6-month interval, and subjects who showed deterioration in their depression score above the level predicted from their baseline score were identified. Multivariate logistic analysis adjusted for age, gender, cause of dialysis, and psychosocial variables were performed. RESULTS: Baseline depression was significantly and independently associated with alexithymia and low satisfaction with available support. Deterioration of depression after 6 months was predicted by alexithymia and poor available support. CONCLUSIONS: Alexithymia and reduced social support might have independent associations with the presence and the prognosis of depression among HD patients.     

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.     

Cognitive and psychosocial correlates of alexithymia following traumatic brain injury

Changes in emotional and social behaviour are considered to be amongst the most common and debilitating consequences of traumatic brain injury (TBI). Little is known of the effects of TBI on alexithymia, which refers to impairment in aspects of understanding emotions. In the current study TBI patients (N=28) were compared with demographically matched healthy controls (N=31) on the Toronto Alexithymia Scale-20 (TAS-20), a measure that taps three distinct characteristics of the alexithymia concept; difficulty in identifying emotions, difficulty in describing emotions and externally oriented thinking. Patients and controls also completed measures of anxiety, depression, quality of life, and measures of fluency to assess executive function. Patients showed greater levels of alexithymia, in terms of difficulty identifying emotions and reduced introspection. Difficulty in identifying emotions was associated with poorer quality of life, even when depression and anxiety were controlled. Difficulty in identifying emotions was also uniquely associated with executive function deficits. Thus, although studies typically focus on aspects of cognitive change following head injury, these results lend support to Becerra et al.'s (Becerra, R., Amos, A., & Jongenelis, S. (2002). Organic alexithymia: a study of acquired emotional blindness. Brain Injury, 16, 633-645.) notion of an 'organic alexithymia', and suggest that more attention should be focused upon assessment of emotional change post-head injury.     

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.