Psychometric Properties of the Emotional Processing Scale in Individuals with Psychiatric Symptoms and the Development of a Brief 15-Item Version

Objective The 25-item Emotional Processing Scale (EPS) is a measure of emotional processing. There is a scarcity of research about its factor structure, test-retest reliability, and validity in individuals with psychiatric symptoms. Method We administered the EPS-25 to a sample (N=512) of people with elevated psychiatric symptoms, using confirmatory factor analysis to evaluate three a priori models from previous research. We then evaluated discriminant and convergent validity against measures of alexithymia (Toronto Alexithymia Scale-20; TAS-20), depressive symptoms (Patient Health Questionaire-9; PHQ-9) and anxiety symptoms (Generalized Anxiety Disorder-7; GAD-7). Results None of the a priori models achieved acceptable fit, and subsequent exploratory factor analysis did not lead to a convincing factor solution for the 25 items. A 5-factor model did, however, achieve acceptable fit if we retained only 15 items (EPS-15) and this solution could be replicated in a holdout sample. Convergent and discriminant validity for EPS-15 was r=-.19-.46 vs. TAS-20, r=.07-.25 vs. PHQ-9, r=.29-.57 vs. GAD-7. Test-retest reliability was ICC=.73. Conclusions This study strengthens the case for the reliability and validity of the five factor Emotional Processing Scale but suggest that only 15 items should be retained. Future studies should further examine the reliability and validity of the EPS-15.

Multi-Method Approach in the Assessment of Alexithymia in Patients With Scleroderma: Use of Two Different Tools

Objective: Alexithymia is frequent in patients with some chronic dermatological conditions. The aim of the study was to measure the prevalence of alexithymia in patients with systemic sclerosis (SSc) using two different tools.Methods: Consecutive patients diagnosed with SSc were recruited at day hospital and hospitalization regimen. Alexithymia was measured using the self-administered questionnaire 20-item Toronto Alexithymia scale (TAS-20) and the semi-structured interview 24-item Toronto Structured Interview for Alexithymia (TSIA).Results: The study sample consisted of 67 female patients, aged from 29 to 82 years. According to TAS-20, 22.4% of patients were alexithymic and 17.9% were borderline alexithymic. Also, in our sample mean TAS-20 value was 48.9 and TSIA mean value was 20.3. Spearman’s correlation coefficient between TAS-20 total score and TSIA total score was 0.603. A high correlation was observed between TAS total score and the “Affective Awareness” (AA) scale of the TSIA. TSIA total score significantly correlated with the “Difficulty describing feeling to others” (DDF) scale of the TAS-20. The highest correlation between scales of the two instruments was that between TAS-20 DDF and TSIA AA (r = 0.675).Conclusion: The prevalence of alexithymia in SSc patients was higher than in the general population, and similar to that of psoriasis patients. The measurements obtained using the TAS-20 and the TSIA were highly correlated. However, they also showed some diversities in the scales, indicating that they may measure different domains.

Alexithymia and Insecure Attachment among Male Intimate Partner Violence Aggressors in the Dominican Republic

The complexity of intimate partner violence and the impossibility of understanding it from single factors have been studied from different biological, psychological, and socio-cultural factors. A cross-sectional study was conducted on 187 men involved in legal proceedings for problems of violence in their intimate partner relationships in the Dominican Republic in order to explore whether insecure attachment represents a risk factor for alexithymia in men with violent behaviors. The attachment style was determinate by the Casullo and Fernández-Liporace Attachment Styles Scale, and alexithymia was assayed using the Latin American Consensual Toronto Alexithymia Scale (LAC TAS-20), a modification of the Toronto Alexithymia Scale (TAS-20). Chi-square test and multiple binary logistic regression analysis were performed to explore the phenomena of alexithymia and attachment styles in the context of a confinement center for male intimate partner offenders in the Dominican Republic. The results showed that insecure attachment represents a risk factor for alexithymia, being highest for avoidant attachment in the population studied. The results also highlight the influence of other factors such as education and maternal–familial relationships as a factor risk for alexithymia.

Коморбидные расстройства, связанные с неблагоприятным детским опытом, у наркологических пациентов

Обоснование. Для пациентов, имеющих проблемы употребления алкоголя или наркотиков, характерна доказанная связь диссоциативных и аффективно-когнитивных расстройств с неблагоприятными травмирующими переживаниями в детстве. Цель исследования. Анализ выраженности диссоциативных расстройств, расстройств посттравматического кластера, депрессивных и алекситимических нарушений у пациентов, зависимых от ПАВ, и определение/оценка взаимосвязи с факторами неблагоприятных событий детства. Материалы и методы. Общее число участников исследования составило 402 наблюдения (293 мужчины и 109 женщин). Использованы стандартизированные психометрические шкалы: Международный опросник неблагоприятного детского опыта (ACE-IQ WHO, 2009), шкала оценки влияния травматического события (IES-R), шкала диссоциации (DES), шкала депрессии Бека (BDI), Торонтская шкала алекситимии (TAS-20). Статистическая обработка проведена с помощью программы SPSS-20v. Результаты. Статистически значимые различия обнаружены между группой интактных неблагоприятному детскому опыту и всеми респондентами, перенесшими детские психотравмы, по показателям травматического опыта и депрессии, но не алекситимических и диссоциативных расстройств. Наиболее сильные связи обнаружены между диссоциативными переживаниями, симптомами посттравматического кластера и факторами физического, эмоционального, сексуального насилия; между депрессивными расстройствами и факторами семейной дисфункции; между алекситимическими расстройствами и факторами коллективного, общественного и эмоционального насилия, пренебрежения. Заключение. Диссоциативные, депрессивные расстройства и проявления алекситимии свойственны наркологическим пациентам независимо от интенсивности детского неблагоприятного опыта, перенесённые травматические события детства способствуют большей выраженности указанных расстройств.

Does alexithymia, independent of depressive and anxiety disorders, correlate with the severity of somatic manifestations among patients with medically unexplained physical symptoms?

Background: Medically unexplained physical symptoms (MUPS) are highly prevalent, frequently co-occurring with psychiatric symptoms such as depression, alexithymia, and anxiety. Objective: To evaluate the relation between depression, anxiety, and alexithymia and severity of somatic symptoms in patients with MUPS. Method: This is a cross-sectional study conducted on 196 patients suffering from MUPS. The patients were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. The Patient Health Questionnaire (PHQ-15), (PHQ-9), Generalized Anxiety Disorder (GAD-7), Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (SCID-I-CV), and Toronto Alexithymia Scale (TAS-20) were employed to assess somatic severity, depression, anxiety, major mental disorders, and alexithymia in the sample of patients. Results: The results of the study indicate that GAD-7 and PHQ-9 scores had a positive correlation with PHQ-15 ( p < 0.05) in multivariate regression. In contrast, TAS-20 was not independently correlated with PHQ-15. Adding TAS-20 to GAD-7 and PHQ-9 in the equation of the regression model enhances the predictive capacity of the model ( p < 001). Conclusion: The results of the study indicate that only anxiety and depressive symptoms, but not alexithymia, were associated independently with MUPS severity.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory

Background Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. Methods This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1–40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a “general alexithymia” factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample. Results The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with “TAS” no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants. Limitations Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations. Conclusions These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia).

Frecuencia de alexitimia y factores relacionados en pacientes con fibromialgia tratados en un hospital público de Lima, Perú.

Objetivo: Determinar la frecuencia de alexitimia y factores relacionados en pacientes con fibromialgia, y la relación entre alexitimia y capacidad funcional, intensidad de dolor, depresión y variables generales (edad, sexo, tiempo de enfermedad, grado de instrucción y años de estudio) en fibromialgia. Material y métodos: Se realizó un estudio descriptivo transversal en pacientes con fibromialgia del Servicio de Reumatología de un hospital público de Lima, Perú. Se aplicó una ficha sociodemográfica, la TAS-20, el MD-HAQ y la CES-D. Resultados: De los 126 pacientes con fibromialgia, 60 (47,62 %) mostraron alexitimia, 24 de ellos presentaron depresión (40%) y 39, discapacidad funcional (65%). En el análisis bivariado la alexitimia se relacionó significativamente con mayor comorbilidad, menor grado de instrucción, mayor intensidad de dolor, mayor fatiga y más síntomas reportados. En el análisis multivariado, años de estudio (£11 años) fue el único factor relacionado a alexitimia (TAS-20) (p=0,010, OR: 2,589 [1,249 – 5,365]). Conclusiones: Se demuestra una frecuencia considerable de alexitimia en pacientes con fibromialgia y, en el análisis multivariado, este hallazgo se relaciona significativamente con un número menor de años de estudio.

The Structure of the Toronto Alexithymia Scale (TAS-20): A Meta-Analytic Confirmatory Factor Analysis

Alexithymia is defined as the inability of persons to describe their emotional states, to identify the feelings of others, and a utilitarian type of thinking. The most popular instrument to assess alexithymia is the Toronto Alexithymia Scale (TAS-20). Despite its widespread use, an ongoing controversy pertains to its internal structure. The TAS-20 was originally constructed to capture three different factors, but several studies suggested different factor solutions, including bifactor models and models with a method factor for the reversely keyed items. The present study examined the dimensionality of the TAS-20 using summary data of 88 samples from 62 studies (total N = 69,722) with meta-analytic structural equation modeling. We found support for the originally proposed three-dimensional solution, whereas more complex models produced inconsistent factor loadings. Because a major source of misfit stems from translated versions, the results are discussed with respect to generalizations across languages and cultural contexts.

Maternal Alexithymic Traits Are Related to Lower Maternal Sensitivity and Higher Hostility in Maternal Caregiving Behavior—The FinnBrain Birth Cohort Study

Background: The quality of parental caregiving behavior with their child plays a key role in optimal mother–infant interaction and in supporting child adaptive development. Sensitive caregiving behavior, in turn, requires the ability to identify and understand emotions. Maternal alexithymia, with difficulties in identifying and describing feelings or emotions, as well as a concrete way of thinking, could potentially complicate the quality of caregiving. In this study, we aim to explore the possible association between maternal alexithymic traits and the quality of maternal caregiving behavior.Methods: The study sample consisted of 158 mother–infant dyads within the FinnBrain Birth Cohort Study population with an available report of maternal alexithymic traits at 6 months postpartum and observational data on maternal caregiving behavior at 8 months postpartum. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20) including three alexithymia dimensions—Difficulty Identifying Feelings, Difficulty Describing Feelings (DDF), and Externally Oriented Thinking (EOT). Maternal caregiving behavior was assessed using the Emotional Availability Scale and in this study, all four parent dimensions (Sensitivity, Structuring, Non-intrusiveness and Non-hostility) were included. Maternal depressive and anxiety symptoms at 6 months postpartum were controlled for as potential confounders. In addition, background factors of mother's age and gestational weeks at the time of child birth, maternal educational level, monthly income and parity, as well as relationship status and the gender of the baby were assessed.Results: Maternal TAS-20 total score correlated negatively with Sensitivity (r = −0.169, p = 0.034) and with non-intrusiveness (r = −0.182, p = 0.022). In addition, maternal DDF correlated negatively with Sensitivity (r = −0.168, p = 0.035) and EOT with Non-hostility (r = −0.159, p = 0.047). Furthermore, in regression analyses with controlling for the associated background factors, maternal total score of alexithymic traits (p = 0.034, η2p = 0.029) and higher DDF (p = 0.044, η2p = 0.026) remained significantly associated with lower Sensitivity and higher EOT remained significantly associated with lower Non-hostility (p = 0.030, η2p = 0.030).Conclusions: In this explorative study we found preliminary evidence for the hypothesis that higher maternal alexithymic traits associate with lower maternal sensitivity and more hostile maternal caregiving behavior. Further studies are needed to explore these hypotheses and to investigate their possible implications for child development.