The Perth Alexithymia Questionnaire (PAQ) was developed to assess alexithymia as a multidimensional construct consistent with the attention-appraisal model. This study evaluated the hierarchical structure of the PAQ using Goldberg's bass-ackwards method across student and community samples. Results consistently revealed a general alexithymia factor at the highest level of the hierarchy, with limited evidence of stable or distinct dimensions at the lower levels. Although some components, such as externally oriented thinking and positive emotion valence items showed partial differentiation, the overall pattern did not support the proposed five-factor dimensional model, indicating that the PAQ does not provide a reliable multidimensional assessment of the alexithymia construct. While the PAQ was developed to provide a multidimensional profile by incorporating both positive and negative emotion processing, our results indicate that it is best conceptualized and interpreted as measuring a single, unidimensional construct.

Alexithymia is a trait-like deficit in the cognitive processing of emotions, characterized by difficulty identifying and describing feelings, externally oriented thinking, and limited imaginal capacity. It reflects a deficit in emotional intelligence, specifically in the intrapersonal ability to understand and manage one’s own emotional states and to similarly recognize how others might view them. Emotional intelligence has been conceptualized as a distinct form of intelligence that involves emotion-related mental abilities and meets standard psychometric criteria for inclusion within the broader taxonomy of human intelligences. Increasingly, alexithymia is also understood as a failure of affect-focused mentalization, or the ability to perceive emotions in oneself and others as intentional states. This study examined alexithymia using a multi-informant approach to assess intrapersonal and interpersonal emotional awareness. A sample of 211 university students and their informants completed the Toronto Alexithymia Scale (TAS-20), an informant version (TAS-20-IF), and a novel meta-perception version (TAS-20-Meta). Two hypotheses were tested and supported: (1) participants underestimated their alexithymia traits relative to informant ratings and (2) self- and meta-perception ratings were more strongly correlated than either was with informant ratings. These findings support the view that alexithymia reflects deficits in both affective mentalization and a specific domain of human intelligence.

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.

Objective: Our goal was to compare the original conceptualization of the alexithymia construct with the attention-appraisal model, focusing primarily on the removal of the reduced imaginal activity component, a seminal aspect of the construct in the original model. We also examined associations between alexithymia and emotional distress and emotion regulation, attachment, and trauma, and whether alexithymia is a transdiagnostic risk factor. We discuss differences between the models in the treatment of alexithymia and also differences in measurement. Method: We conducted a narrative review of the scientific literature validating the original model of alexithymia and examined the comparatively few empirical studies evaluating the attention-appraisal model. Articles describing contemporary theoretical ideas about the relationship between imagination and emotion were reviewed, as well as studies exploring associations between alexithymia and imaginal activity. Results: The attention-appraisal model of alexithymia is theoretically derived and examined empirically in studies using correlationlmeasurement-based methods that employed self-report measures with mostly non-clinical samples and conducted primarily by researchers led by developers of the model. The original model of alexithymia is derived from observations of patients in clinical settings; its validity is supported by findings from hundreds of empirical investigations spanning nearly four decades with nonclinical and a variety of clinical samples using both correlation- based and experimental studies and methods of measurement other than self-report, and by independent teams of researchers. The reduced imaginal activity component of the alexithymia construct is mostly supported by these studies. Conclusions: Because of the dearth of studies with clinical samples, the absence of investigations by independent researchers, and the limited range of methods and measurements to evaluate and assess the model, there is insufficient evidence to warrant removal of the imaginal activity component of the alexithymia construct and for replacing the original conceptualization of the construct with the attention- appraisal model.

The concept of pensée opératoire (operational thinking) was introduced by French psychoanalysts in 1963 and a decade later was included as an essential component of the alexithymia construct as formulated by the U.S. analysts John Nemiah and Peter Sifneos. Despite a large body of research on alexithymia, the pensée opératoire component is not well understood, especially among clinicians and researchers who are not familiar with French psychoanalytic literature. In this article we clarify the definition and metapsychological conceptualization of the concept, review findings from some relevant empirical studies, and critique a recent proposal for redefining the alexithymia construct that departs from the original understanding of pensée opératoire. We also discuss some clinical implications of the concept and some strategies that psychotherapists can employ in the treatment of patients with this mode of thinking.

Objective: The alexithymia personality construct encompasses difficulties identifying and describing feelings, restricted imaginal processes, and an externally oriented cognitive style. The construct was derived initially from observations of patients with classic psychosomatic diseases. The self-report 20-item Toronto Alexithymia Scale (TAS-20) is the most frequently used measure to assess alexithymia. A concern associated with the TAS-20 is whether individuals can accurately self-report difficulties identifying and describing feelings if they are deficient in those abilities. To address this issue, we sought to develop and validate an informant form (version) of the TAS-20, the 20-item Toronto Alexithymia Scale - Informant Form (TAS-20-IF). Method: We employed a three-phase methodological strategy. In the first phase, items from the TAS-20 were rewritten into a third person version by a team of experts. In the second phase, the "traditional" three-factor structure was tested in the TAS-20-IF using confirmatory factor analysis in a large sample of young adults (N = 857). The third phase was conducted with another sample (N = 430) composed of "informants" (n = 215), who completed the TAS-20-IF, and "targets" (n = 215), who completed the TAS-20 (informants were nominated by the targets). Results: The psychometric properties (items and scales) of both versions were adequate and the three-factor structure of the TAS-20-IF was supported; the correlation between the two versions was statistically significant and the factor structures were similar. Conclusion: Although further research is needed to replicate these findings, especially in clinical samples, the results support the reliability and validity of the TAS-20-IF.

The 20-Item Toronto Alexithymia Scale (TAS-20) is the most widely used measure to assess the personality construct of alexithymia and is composed of three-factor analytically derived subscales. These subscales measure and represent three critical, theoretically based facets of alexithymia. The subscales are distinct, yet highly interrelated and only as a collective body do they reflect adequately the alexithymia construct. Although different studies using both university student and community samples suggest that TAS-20 total scores are largely reflective of variation on a single construct, and that subscale scores do not provide unique and reliable information beyond total scores, many users of the scale frequently continue to employ and even rely more heavily on subscale scores rather than total scale scores when interpreting research study outcomes. Our goal in this study is to provide clinicians and researchers with replicable psychometric information for the TAS-20 estimated from bifactor modeling in an attempt to provide further support for using total rather than subscale scores. In general, our findings were consistent with previous studies indicating that TAS-20 total scores can be considered indicative of a single construct. The replication of these earlier results from previous investigations provides additional support for the use of a total TAS-20 score and questions the utility of using TAS-20 subscale scores. Based on these results, we recommend that researchers and clinicians use a single total TAS-20 score and not subscale scores. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Four subtypes of the alexithymia construct have been proposed based on different response patterns to the Cognitive and Affective dimensions of the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Previous studies investigating whether alexithymia subtypes can be statistically estimated have not found complete support for these specific subtypes. These previous studies, however, contained several methodological limitations such as relatively small sample sizes, and considerations of only a limited number of proposed subtypes. In the current investigation, we examined whether the four proposed subtypes could be statistically detected in a large sample of undergraduate students (N = 612) who completed the BVAQ, using latent profile analysis (LPA). Based on observed responses to the five BVAQ subscales, consistent with previous studies, our results did not find support for the four proposed alexithymia subtypes. Rather, our results suggested LPA solutions that correspond to individuals with various degrees of alexithymia ?severity?. Although further studies are needed, especially with clinical samples, these results question the idea of four alexithymia subtypes and suggest that the implementation of these subtypes into various research studies may be a premature endeavour.

Objective: Twenty-five years ago, this journal published two articles reporting the development and initial validation of the 20-Item Toronto Alexithymia Scale (TAS-20). Since then the literature on alexithymia has burgeoned with the vast majority of this research using the TAS-20, including multiple language translations of the scale. Method: In this article we review the psychometric literature evaluating various aspects of the reliability and validity of the TAS-20 and examine some of the controversies surrounding the scale and the construct it assesses. We reflect on the ways in which the TAS-20 has advanced the measurement of the construct and theory of alexithymia. We also discuss recent developments and some future directions for the measurement of alexithymia. Results: Although not without some controversy, the preponderance of the accumulated evidence over a 25-year period supports various aspects of the reliability and validity of the TAS-20, including findings from confirmatory factor analytic and convergent and discriminant validity studies which are consistent with Nemiah et al.'s (Nemiah et al., 1976 [3]) and Taylor and colleagues (Taylor et al., 1997 [9]) theoretical formulations and definition of the alexithymia construct. Conclusions: Based on the accumulated empirical evidence of 25 years, we conclude that the TAS-20 is a reliable and valid instrument and accurately reflects and measures the construct as it was originally defined by Nemiah et al. Nemiah et al. (1976) [3] as composed of deficits in affect awareness and expression and pensee operatoire (operational thinking). Clinicians and researchers can use the TAS-20 to confidently measure alexithymia, the roots of which have foundations in psychosomatic medicine.

Response to Peter Olsson's Critical Opinion Discussion of My Essay on “The Alternative Universe of the Trump Administration”Graeme J. TaylorGraeme J. TaylorProfessor Emeritus of Psychiatry, University of Toronto, Toronto, Ontario, Canada.Graeme J. Taylor, M.D., 1406-130 Carlton Street, Toronto, Ontario, M5A4K3, Canada. [email protected]Search for more papers by this authorPublished Online:July 2020https://doi.org/10.1521/pdps.2020.48.2.194PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutREFERENCESArendt H. (1951). The origins of totalitarianism. New York: Harcourt, Brace & World. Google ScholarAuchincloss E. L., , & Samberg E. (2012). Psychoanalytic terms and concepts. New Haven: Yale University Press. Google ScholarBirmingham P. (2010). A lying world order: Political deception and the threat of totalitarianism. In Berkowitz R., , Katz J., , & Keenan T. (Eds.), Thinking in dark times. 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Fifty years ago, Psychotherapy and Psychosomatics published an article by John Nemiah and Peter Sifneos [1] in which they reported some clinical observations on the mentation of a group of patients with “classic” psychosomatic diseases. This article, together with a book chapter published in the same year [2], heralded the soon to be introduced concept of alexithymia [3], which encompassed the cognitive characteristics that Nemiah and Sifneos had reported. The concept was not entirely new, which Nemiah and Sifneos readily acknowledged, and they noted that Ruesch [4] had described some of the same characteristics in the late 1940s; in addition, the cognitive style resembled the operational thinking (pensée opératoire) that Marty and de M’Uzan [5] had observed among somatically ill patients in France. As a theoretical concept, alexithymia quickly captured the interest of psychosomatic medicine specialists and was chosen as the main theme of the 11th European Conference on Psychosomatic Research held in Heidelberg in 1976 [6]. Though there were some critics of the concept, the majority of conference delegates agreed that alexithymia should be conceptualized as a hypothetical multifaceted construct that could be operationalized and evaluated empirically. On the final day of the conference, Sifneos [7] confidently predicted that “alexithymia is here to stay whether we like it or not and it is going to be with us for the rest of our lives” (p. 369). He recommended that a scientific approach be taken to further investigate the construct. Half a century since the publication of Nemiah and Sifneos’s initial report, it seems timely to evaluate Sifneos’s prediction and recommendation, particularly because several alexithymia researchers have proposed various changes to the manner in which the construct was originally conceptualized and defined. These changes include adding an emotionalizing component to the alexithymia construct, removing the restricted imaginal activity facet, dividing alexithymia into categorically distinct subtypes, renaming severe degrees of alexithymia as “affective agnosia,” reconceptualizing the construct within the framework of an attention-appraisal model, and theorizing alexithymia as a general deficit in interoception. These proposals raise a number of intriguing questions about the nature of alexithymia and present perspectives that we believe drift from the original observations of “psychosomatic” patients, which directly informed the theoretical parameters of the construct. In this editorial, we consider these various perspectives and evaluate each of the proposed changes from both a

The psychoanalytic concept of an "anal universe" is a type of alternative universe in which reality is denied and falsehood prevails. This essay demonstrates how this concept illuminates much of the confusion and distortion of truth generated by the Trump administration. The author comments on several behaviors of President Trump and his administration including perverse thinking and lying, mocking disabled people, demeaning women, labeling journalists as enemies of the people, encouraging regressive forces in groups, and promoting policies that cruelly affect immigrants and refugees. The author also comments on the primacy of the male phallus in American politics. He contrasts the spatial metaphor of an "anal universe," where there is distortion of language and an absence of moral constraints and ethical principles, with the metaphor of a feminine psychic space, which enhances the capacity for symbolic thinking and the generation of creative ideas and solutions.

The alexithymia construct is commonly measured with the 20-Item Toronto Alexithymia Scale (TAS-20), with more than 20 different language translations. Despite replication of the factor structure, however, it cannot be assumed that observed differences in mean TAS-20 scores can be interpreted similarly across different languages and cultural groups. It is necessary to also demonstrate measurement invariance (MI) for language. The aim of this study was to evaluate MI of the English and French versions of the TAS-20 using data from 17,866 Canadian military recruits; 71% spoke English and 29% spoke French as their first language. We used confirmatory factor analyses (CFAs) to establish a baseline model of the TAS-20, and four increasingly restrictive multigroup CFA analyses to evaluate configural, metric, scalar, and residual error levels of MI. The best fitting factor structure in both samples was an oblique 3-factor model with an additional method factor comprised of negatively-keyed items. MI was achieved at all four levels of invariance. There were only small differences in mean scores across the two samples. Results support MI of English and French versions of the TAS-20, allowing meaningful comparisons of findings from investigations in Canadian French-speaking and English-speaking groups.

Although there is an extensive psychoanalytic literature on perversion, and numerous articles about creativity, few authors have explored relations between creativity and perversion. In particular, the role of childhood trauma and its impact on object relations has not been examined in patients with perversions whose creativity is blocked. In association with preoedipal anxieties and fantasies, childhood trauma can not only contribute to the development of perversion, but can also inhibit or distort the creative process by establishing an inner world characterized by the presence of a threatening internal bad object and the elusiveness of an internal good object. Though it is essential to help these patients establish an identification with the phallic father, an internal good maternal object, in the form of a muse, needs to be retrieved to bring inspiration and reduce the anxieties generated by an internal bad object, thereby facilitating the pursuit of authentic creative work. A detailed case report illustrates how this theoretical perspective guided the treatment approach to a male patient with macrophilia who was struggling to realize his creative potential.

This chapter shows how some limitations of earlier psychosomatic theories have been surmounted by a contemporary theory. It focuses on the adverse impact of traumatic events on the symbolizing function of the mind, a capacity that is essential for the cognitive processing and regulation of emotions and thereby helps protect the integrity of the body. The dissociation or desymbolization within the schemas creates a potential for high arousal of the somatic and motoric components, as these are no longer organized and regulated through links with the symbolic components. To illustrate the process of symbolization in psychoanalytic therapy with somatically ill patients, the chapter describes some aspects of the work with two men (Jorge and Tom) who suffered from cervical dystonia (spasmodic torticollis), which is a form of focal dystonia. From this perspective, cervical dystonia may signify an instinctual bodily response to threat that is now organized by the repetition-compulsion.