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Zahid A, Taylor GJ, Lau SCL, Stone S, Bagby RM. Examining the Incremental Validity of the Perth Alexithymia Questionnaire (PAQ) Relative to the 20-Item Toronto Alexithymia Scale (TAS-20). J Pers Assess 2024; 106:242-253. [PMID: 37144843 DOI: 10.1080/00223891.2023.2201831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/28/2023] [Indexed: 05/06/2023]
Abstract
The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for assessing alexithymia, with more than 25 years of research supporting its reliability and validity. The items that compose this scale were written to operationalize the components of the construct that are based on clinical observations of patients and thought to reflect deficits in the cognitive processing of emotions. The Perth Alexithymia Questionnaire (PAQ) is a recently introduced measure and is based on a theoretical attention-appraisal model of alexithymia. An important step with any newly developed measure is to evaluate whether it demonstrates incremental validity over existing measures. In this study using a community sample (N = 759), a series of hierarchical regression analyses were conducted that included an array of measures assessing constructs closely associated with alexithymia. Overall, the TAS-20 showed strong associations with these various constructs to which the PAQ was unable to add any meaningful increase in prediction relative to the TAS-20. We conclude that until future studies with clinical samples using several different criterion variables demonstrate incremental validity of the PAQ, the TAS-20 should remain the self-report measure of choice for clinicians and researchers assessing alexithymia, albeit as part of a multi-method approach.
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Affiliation(s)
- Aqsa Zahid
- Department of Psychological Clinical Science, University of Toronto
| | | | | | | | - R Michael Bagby
- Department of Psychological Clinical Science, University of Toronto
- Department of Psychiatry, University of Toronto
- Department of Psychology, University of Toronto
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Ying W, Shen Y, Ou J, Chen H, Jiang F, Yang F, Li J, Qian X, Luo W, Wang G, Dong H. Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults. Eur Arch Psychiatry Clin Neurosci 2024; 274:291-300. [PMID: 37314538 DOI: 10.1007/s00406-023-01636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
Non-suicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Recent literature suggests that persistent, repetitive, and uncontrollable NSSI can be conceptualized as a behavioral addiction. The study aimed to examine the prevalence of NSSI with addictive features and the association of this prevalence with demographic and clinical variables using a cross-sectional and case-control design. A total of 548 outpatients (12 to 22 years old) meeting the criteria for NSSI disorder of DSM-5 were enrolled and completed clinical interviews by 4 psychiatrists. NSSI with addictive features were determined by using a single-factor structure of addictive features items in the Ottawa self-injury inventory (OSI). Current suicidality, psychiatric diagnosis, the OSI, the revised Chinese Internet Addiction Scale, the Childhood Trauma Questionnaire, and the 20-item Toronto Alexithymia Scale were collected. Binary logistic regression analyses were used to explore associations between risk factors and NSSI with addictive features. This study was conducted from April 2021 to May 2022. The mean age of participants was 15.93 (SD = 2.56) years with 418 females (76.3%), and the prevalence of addictive NSSI was 57.5% (n = 315). Subjects with addictive NSSI had a higher lifetime prevalence of nicotine and alcohol use, a higher prevalence of current internet addiction, suicidality, and alexithymia, and were more likely to have physical abuse/neglect, emotional abuse, and sexual abuse than NSSI subjects without addictive features. Among participants with NSSI, the strongest predictors of addictive features of NSSI were female (OR = 2.405, 95% CI 1.512-3.824, p < 0.0001), alcohol use (OR = 2.179, 95% CI 1.378-3.446, p = 0.001), current suicidality (OR = 3.790, 95% CI 2.351-6.109, p < 0.0001), and psysical abuse in childhood (OR = 2.470, 95% CI 1.653-3.690, p < 0.0001). Nearly 3 out of 5 patients (12-22 years old) with NSSI met the criteria of NSSI with addictive features in this psychiatric outpatients sample. Our study demonstrated the importance of the necessity to regularly assess suicide risk, and alcohol use, as well as focus more on females and subjects who had physical abuse in childhood to prevent addictive NSSI.
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Affiliation(s)
- Wang Ying
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yidong Shen
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jianjun Ou
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hui Chen
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Furong Jiang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fangru Yang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianling Li
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao Qian
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenfeng Luo
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Gang Wang
- Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Huixi Dong
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Harms CA, Barley OR. Alexithymia and Impulsivity in Combat Sports - A Tale of Three Measures. Psychol Rep 2023:332941231201951. [PMID: 37732934 DOI: 10.1177/00332941231201951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
The purpose of this study was to compare the psychometric properties of two measures of alexithymia - the Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) - as well as the Barratt Impulsiveness Scale 11 measure of behavioural impulsivity because the psychometric properties of these scales have not been established in athletes. As part of a larger study, 298 participants completed an online survey that included the TAS-20, PAQ, and BIS 11, as well personal- (age and gender) and sport-specific (primary combat sport and level of competition) demographic measures. A unidimensional model was retained for the TAS-20. A unidimensional model with the possibility of multidimensional measure was retained for the PAQ, with the viability of a subscale for Generalised Externally Orientated Thinking supported. The only versions of the BIS that were retainable were unidimensional models for the BIS-15 (a 15-item version of the BIS 11) and the BIS-Brief (an 8-item version of the BIS 11). As expected, the measures of alexithymia were highly correlated. The associations between impulsivity and alexithymia as well as age and alexithymia were small in nature, with none these associations moderated by level of gender, level of competition, or primary sport for the participants. No differences in alexithymia or impulsivity according to gender, level of competition, or primary sport were noted for the participants. Implications of these findings for the measures of alexithymia - the TAS-20 and PAQ - and impulsivity - the BIS-15 and BIS-Brief - examined in the present study with athletes (as well as with other populations) are discussed.
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Affiliation(s)
- Craig A Harms
- School of Arts and Humanities, Psychology and Criminology, Edith Cowan University, Joondalup, WA, Australia
| | - Oliver R Barley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Preece DA, Mehta A, Petrova K, Sikka P, Bjureberg J, Chen W, Becerra R, Allan A, Robinson K, Gross JJ. The Perth Alexithymia Questionnaire-Short Form (PAQ-S): A 6-item measure of alexithymia. J Affect Disord 2023; 325:493-501. [PMID: 36642314 DOI: 10.1016/j.jad.2023.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Alexithymia is a trait characterized by difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is widely regarded as an important transdiagnostic risk factor for a range of psychopathologies, including depressive and anxiety disorders. Whilst several well-validated psychometric measures of alexithymia exist, these are relatively lengthy, thus limiting their utility in time-pressured settings. In this paper, we address this gap by introducing and validating a brief 6-item version of the Perth Alexithymia Questionnaire, called the Perth Alexithymia Questionnaire-Short Form (PAQ-S). METHOD Across two studies with adult samples (Study 1 N = 508 United States community; Study 2 = 378 Australian college students), we examined the psychometric properties of the PAQ-S in terms of its factor structure, reliability, and concurrent/criterion validity. RESULTS In exploratory and confirmatory factor analyses, all PAQ-S items loaded well on a single general alexithymia factor. The PAQ-S total score had high reliability, and correlated as expected with the long-form of the PAQ, as well as other established markers of alexithymia, emotion regulation, and affective disorder symptoms. LIMITATIONS Our samples were general community or college student samples from two Western countries; future validation work in clinical samples and more diverse cultural groups is thus needed. CONCLUSIONS The PAQ-S retains the psychometric strengths of the PAQ. As such, the PAQ-S can be used as a quick, robust measure of overall alexithymia levels. The introduction of the PAQ-S hence enables valid assessments of alexithymia in a more diverse range of settings and research designs.
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Affiliation(s)
- David A Preece
- Curtin University, Curtin enAble Institute, Perth, Australia; Curtin University, School of Population Health, Perth, Australia; University of Western Australia, School of Psychological Science, Perth, Australia.
| | - Ashish Mehta
- Stanford University, Department of Psychology, Stanford, United States
| | - Kate Petrova
- Stanford University, Department of Psychology, Stanford, United States
| | - Pilleriin Sikka
- Stanford University, Department of Psychology, Stanford, United States; University of Turku, Department of Psychology and Speech-Language Pathology, Finland; University of Turku, Turku Brain and Mind Center, Finland; University of Skövde, Department of Cognitive Neuroscience and Philosophy, Sweden
| | - Johan Bjureberg
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Sweden; Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Wai Chen
- Curtin University, Curtin enAble Institute, Perth, Australia; Curtin University, Curtin Medical School, Perth, Australia; University of Western Australia, Graduate School of Education, Perth, Australia; University of Notre Dame Australia, School of Medicine, Perth, Australia; Murdoch University, Perth, Australia; Fiona Stanley Hospital, Mental Health Service, Perth, Australia
| | - Rodrigo Becerra
- University of Western Australia, School of Psychological Science, Perth, Australia
| | - Alfred Allan
- Edith Cowan University, School of Arts and Humanities, Perth, Australia
| | - Ken Robinson
- Edith Cowan University, School of Arts and Humanities, Perth, Australia
| | - James J Gross
- Stanford University, Department of Psychology, Stanford, United States
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Kadhem SH, Nikoloulopoulos AK. Bi-factor and Second-Order Copula Models for Item Response Data. PSYCHOMETRIKA 2023; 88:132-157. [PMID: 36414825 PMCID: PMC9977904 DOI: 10.1007/s11336-022-09894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/22/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Bi-factor and second-order models based on copulas are proposed for item response data, where the items are sampled from identified subdomains of some larger domain such that there is a homogeneous dependence within each domain. Our general models include the Gaussian bi-factor and second-order models as special cases and can lead to more probability in the joint upper or lower tail compared with the Gaussian bi-factor and second-order models. Details on maximum likelihood estimation of parameters for the bi-factor and second-order copula models are given, as well as model selection and goodness-of-fit techniques. Our general methodology is demonstrated with an extensive simulation study and illustrated for the Toronto Alexithymia Scale. Our studies suggest that there can be a substantial improvement over the Gaussian bi-factor and second-order models both conceptually, as the items can have interpretations of discretized maxima/minima or mixtures of discretized means in comparison with discretized means, and in fit to data.
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Affiliation(s)
- Sayed H Kadhem
- School of Computing Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
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Herpertz J, Taylor J, Allen JJB, Herpertz S, Opel N, Richter M, Subic-Wrana C, Dieris-Hirche J, Lane RD. Development and validation of a computer program for measuring emotional awareness in German-The geLEAS (German electronic Levels of Emotional Awareness Scale). Front Psychiatry 2023; 14:1129755. [PMID: 37032926 PMCID: PMC10076697 DOI: 10.3389/fpsyt.2023.1129755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Emotional awareness is the ability to identify, interpret, and verbalize the emotional responses of oneself and those of others. The Levels of Emotional Awareness Scale (LEAS) is an objective performance inventory that accurately measures an individual's emotional awareness. LEAS assessments are typically scored manually and are therefore both time consuming and cognitively demanding. This study presents a German electronic scoring program for the LEAS (geLEAS), the first non-English computerized assessment approach of the LEAS. Methods Data were collected from a healthy German community sample (N = 208). We developed a modern software for computerizing LEAS scoring, an open-source text-based emotion assessment tool called VETA (Verbal Emotion in Text Assessment). We investigated if the software would arrive at similar results as hand scoring in German and if emotional awareness would show similar associations to sociodemographic information and psychometric test results as in previous studies. Results The most frequently used scoring method of the geLEAS shows excellent internal consistency (α = 0.94) and high correlations with hand scoring (r = 0.97, p < 0.001). Higher emotional awareness measured by the geLEAS is associated with female gender, older age, and higher academic achievement (all p < 0.001). Moreover, it is linked to the ability to identify emotions in facial expressions (p < 0.001) and more accurate theory of mind functioning (p < 0.001). Discussion An automated method for evaluating emotional awareness greatly expands the ability to study emotional awareness in clinical care and research. This study aims to advance the use of emotional awareness as a clinical and scientific parameter.
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Affiliation(s)
- Julian Herpertz
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- *Correspondence: Julian Herpertz
| | - Jacob Taylor
- David A. Dunlap Department of Astronomy and Astrophysics, University of Toronto, Toronto, ON, Canada
| | - John J. B. Allen
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Jena, Germany
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Maike Richter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Dieris-Hirche
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
- Jan Dieris-Hirche
| | - Richard D. Lane
- Departments of Psychiatry, Psychology and Neuroscience, University of Arizona, Tucson, AZ, United States
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Andersson B, Luo H. Impact of Sampling Variability When Estimating the Explained Common Variance. APPLIED PSYCHOLOGICAL MEASUREMENT 2022; 46:338-341. [PMID: 35601260 PMCID: PMC9118930 DOI: 10.1177/01466216221084215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Hao Luo
- The University of Hong Kong, Hong Kong
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Fynn DM, Preece DA, Gignac GE, Pestell CF, Allan A, Kraats CV, Green SL, Weinborn M, Becerra R. Assessing alexithymia in adults with acquired brain injury: Psychometric properties of the Perth Alexithymia Questionnaire. J Affect Disord 2022; 302:224-233. [PMID: 35092756 DOI: 10.1016/j.jad.2022.01.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/13/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alexithymia is a multidimensional personality trait comprised of difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking. The assessment of alexithymia in people with acquired brain injury (ABI) is of clinical interest because alexithymia is linked to poor psychosocial functioning and community reintegration after ABI. To date, alexithymia measures have not been psychometrically investigated/validated in an ABI sample, restricting confident empirical work in this area. We aimed to fill this gap by assessing the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) in adults with ABI and determining whether the alexithymia construct manifests similarly in ABI samples compared to the general community. METHODS The PAQ and Depression Anxiety Stress Scales-21 were administered to an ABI sample (N = 350) and a community sample (N = 1012). Factor structure, measurement invariance, internal consistency reliability, and concurrent/discriminant validity were explored. RESULTS Our confirmatory factor analysis of the PAQ supported the intended five-factor correlated model as the best solution, where items loaded well onto the five intended subscales. This factor structure was invariant across ABI and community samples. Good reliability and concurrent and discriminant validity were also established. LIMITATIONS The PAQ is a self-report measure and may be impacted by insight deficits known to occur after ABI. CONCLUSION Our data suggests that the PAQ has good validity and reliability as a measure of alexithymia. The latent structure of alexithymia manifests similarly in ABI and community samples. This study provides the first psychometric foundation for confident assessment of alexithymia in ABI.
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Affiliation(s)
- Danielle M Fynn
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | | | - Gilles E Gignac
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Carmela F Pestell
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | | | | | - Sarah L Green
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Michael Weinborn
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Rodrigo Becerra
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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A cross-modal component of alexithymia and its relationship with performance in a social cognition task battery. J Affect Disord 2022; 298:625-633. [PMID: 34763032 DOI: 10.1016/j.jad.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/24/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The personality trait alexithymia describes an altered emotional awareness that is associated with a range of social impairments and constitutes a transdiagnostic risk factor for various psychopathologies. Despite the characteristic interoceptive deficits in alexithymia, it is predominantly assessed via self-reports. This can result in unreliable measurements and arguably contributes to the prevailing uncertainty regarding its components, including constricted imaginal processes and emotional reactivity. METHODS The current study employed an interview and two validated questionnaires to derive a shared component of multi-modally assessed alexithymia in a German non-clinical sample (n = 78) via prinicipal component analysis. This component was used as a predictor for performance in four behavioural social cognition tasks. The relative importance of this predictor against related variables was assessed via dominance analysis. RESULTS The identified component reflected cognitive alexithymia. Higher cognitive alexithymia scores were associated with less affective distress in an ostracizing task. Dominance analysis revealed the dominance of competing autism traits relative to cognitive alexithymia and competing predictors empathy, depression, and anxiety, in predicting affective distress. LIMITATIONS Emotional reactivity was only assessed via self-report and no implicit measures of alexithymia were employed. Due to the low reliability of the self-report measure, no measure of emotional reactivity could be included in the principal component analysis. CONCLUSIONS Our results provide compelling evidence that cognitive interoceptive deficits are at the core of alexithymia across assessment modalities. Behavioural data suggest that these deficits result in diminished emotional sensitivity to high-pressure social situations, which may cause a lack of behavioural adaptation.
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Pedersen G, Normann-Eide E, Eikenaes IUM, Kvarstein EH, Wilberg T. Psychometric evaluation of the Norwegian Toronto Alexithymia Scale (TAS-20) in a multisite clinical sample of patients with personality disorders and personality problems. J Clin Psychol 2021; 78:1118-1136. [PMID: 34716595 DOI: 10.1002/jclp.23270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/17/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Psychometric properties of 20-item Toronto Alexithymia Scale (TAS-20) have been widely analyzed, but the validity and psychometric qualities of the TAS-20 in populations with personality disorders are still poorly understood. The aim of the current study was to analyze the factor structure and validity of TAS-20. METHOD Data were extracted from a multisite clinical sample of patients with personality disorders or personality-related problems referred to specialist mental health services in Norway. RESULTS With one exception, TAS-20 revealed acceptable psychometric properties. Variations of TAS-20 are associated with other clinical measures of distress and severity. Anxiety disorders, borderline, and avoidant personality disorders were all highly related to levels of TAS-20. The TAS-20 also revealed unique variance not accounted for by subjective distress, symptom disorders, or dysfunctional personality traits. CONCLUSION The TAS-20 is a relevant instrument for use in assessment of personality disorders, but one subscale should be improved.
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Affiliation(s)
- Geir Pedersen
- Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,The Norwegian Centre of Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eivind Normann-Eide
- National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingeborg Ulltveit-Moe Eikenaes
- National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Theresa Wilberg
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Williams ZJ, Gotham KO. 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. Mol Autism 2021; 12:56. [PMID: 34376227 PMCID: PMC8353782 DOI: 10.1186/s13229-021-00463-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/31/2021] [Indexed: 03/21/2023] Open
Abstract
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 ).
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN 37232 USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN USA
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Nunes da Silva A. Developing Emotional Skills and the Therapeutic Alliance in Clients with Alexithymia: Intervention Guidelines. Psychopathology 2021; 54:282-290. [PMID: 34749373 DOI: 10.1159/000519786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022]
Abstract
Despite being a longstanding and well-established concept, alexithymia is unfamiliar for many clinicians. This article aimed to address the alexithymia concept from a clinical perspective based on a review of the research on alexithymia intervention. Several strategies are proposed to help clinicians better work with alexithymic clients in psychotherapy. Alexithymia assessment, its impact on the therapeutic alliance, and the difficulties in emotional tasks are highlighted points. Considering alexithymia will inform clinicians' current diagnosis and conceptualization and provide specific targets and venues for intervention, increasing the effectiveness of psychotherapy.
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