The 20-Item Toronto Alexithymia Scale
Abstract
Objective Some researchers have questioned the stability of the three-factor structure of the 20-Item Toronto Alexithymia Scale (TAS-20) or the reliability of one or more factors of the scale. The aim of this study was to assess the replicability of the factor structure of the TAS-20 in a large community sample and to determine also whether the same three-factor structure can be recovered in men and women. The study also assessed the reliability of the scale and the influence of gender, age, and education on TAS-20 scores.Method The TAS-20 was administered to 1933 adults (880 men and 1053 women) residing in several small cities and towns in Ontario, Canada. The factor structure of the scale was assessed using confirmatory factor analysis (CFA).Results The three-factor structure of the TAS-20 was replicable in the entire community sample and also separately in men and women. The TAS-20 and its three factors demonstrated internal reliability, and the variables of gender, age, and education accounted for relatively small or modest amounts of variability in total TAS-20 and factor scale scores.Conclusion The results provide strong support for the reliability and factorial validity of the TAS-20 and indicate the importance of using CFA when assessing the replicability and theoretical integrity of the factor structure of the scale.
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These ACT mediational studies are preliminary and subject to methodological limitations including measures that lack psychometric evaluation, the use of purely self-report measures and the use of measures that concentrate on a small number of core processes, leaving other parts of the ACT model untested.
“However, these studies are preliminary and subject to several methodological limitations including measures that lack psychometric evaluation, the use of purely self-report measures and the use of measures that concentrate on a small number of core processes, leaving other parts of the ACT model untested [31].”
From Acceptance and commitment therapy for anxious children and adolescents: study protocol for a randomized controlled trial. (2013) · cites this paper as [31]
Hayes et al. observed that, compared to structured interventions, ACT was superior after treatment (d = 0.48) and at follow-up (d = 0.63).
“Hayes et al. [31] observed that, compared to structured interventions, ACT was superior after treatment (d = 0.48) and at follow-up (d = 0.63).”
From Acceptance and commitment therapy for anxious children and adolescents: study protocol for a randomized controlled trial. (2013) · cites this paper as [31]
The estimated effect size of 0.6 to 0.7 is based on the results of three previous meta-analyses of ACT.
“The estimated ES of 0.6 to 0.7 is based on the results of three previous meta-analyses of ACT.”
From Acceptance and commitment therapy for anxious children and adolescents: study protocol for a randomized controlled trial. (2013) · cites this paper as [31]
The TAS-20 is a valid instrument with good internal consistency (α = 0.85-0.86) and test-retest reliability.
“The TAS-20 is a valid instrument with good internal consistency (Cronbach’s α = 0.85–0.86) and test-retest reliability [89].”
The high alexithymia cutoff score of ≥61 was established as being 1.5 SD from the mean score of community samples.
“The high alexithymia cutoff score of ≥61 was established as being 1.5 SD from the mean score of community samples (Parker, Taylor, & Bagby, 2003).”
From ‘Theory of Mind’ is not Theory of Emotion: a cautionary note on the reading the Mind in the Eyes test (2016) · cites this paper as Parker, Taylor, & Bagby, 2003
The TAS-20 has good internal consistency (Cronbach's alpha = 0.81) and good test-retest reliability (0.77, p < 0.01).
“It is the most widely used instrument both in clinical and research for the evaluation of alexithymia and it has good internal consistency (Cronbach’s alpha = 0.81) and good test–retest reliability (0.77, p < 0.01) (Bagby et al., 1994a,b; Parker et al., 2003; Taylor et al., 2003).”
From Alexithymia and Psychological Distress in Patients with Fibromyalgia and Rheumatic Disease (2019) · cites this paper as Parker et al., 2003
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Salminen, J. K., Saarijärvi, S., Toikka, T., Kauhanen, J., & Äärelä, E. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.01.014 · Cited by 104 · see citing works
Mood disorders in high-functioning autism: the importance of alexithymia and emotional regulation
Morie, K. P., Jackson, S., Zhai, Z. W., Potenza, M. N., & Dritschel, B. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04020-1 · Cited by 104 · see citing works
Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. (2019) · Molecular Autism · doi:10.1186/s13229-019-0267-3 · Cited by 97 · see citing works
Critical role of the right VLPFC in emotional regulation of social exclusion: a tDCS study
He, Z., Lin, Y., Xia, L., Liu, Z., Zhang, D., & Elliott, R. (2018) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsy026 · Cited by 100 · see citing works
Smith, R., Lane, R. D., Parr, T., & Friston, K. J. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.09.002 · Cited by 89 · see citing works
Sutherland, M. T., Carroll, A. J., Salmeron, B. J., Ross, T. J., & Stein, E. A. (2013) · Psychopharmacology · doi:10.1007/s00213-013-3018-8 · Cited by 89 · see citing works
Krach, S., Kamp‐Becker, I., Einhäuser, W., Sommer, J., Frässle, S., Jansen, A., Rademacher, L., Müller‐Pinzler, L., Gazzola, V., & Paulus, F. M. (2015) · Human Brain Mapping · doi:10.1002/hbm.22949 · Cited by 87 · see citing works
Schroeders, U., Kubera, F., & Gnambs, T. (2022) · Assessment · doi:10.1177/10731911211033894 · Cited by 76 · see citing works
Students who self-harm: Coping style, Rumination and Alexithymia
Borrill, J., Fox, P., Flynn, M., & Roger, D. (2009) · Counselling Psychology Quarterly · doi:10.1080/09515070903334607 · Cited by 73 · see citing works
Alexithymia and Psychological Distress in Patients with Fibromyalgia and Rheumatic Disease
Marchi, L., Marzetti, F., Orrù, G., Lemmetti, S., Miccoli, M., Ciacchini, R., Hitchcott, P. K., Bazzicchi, L., Gemignani, A., & Conversano, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01735 · Cited by 72 · see citing works
“…higher levels of depressive symptoms and psychological distress in the FMS group compared to other chronic rheumatologic disorders (Ozcetin et al., 2007; Piccinni et al., 2011; Scheidt et al., 2014), our findings showed that patients with FMS and RD displayed similar anxiety and depression levels.”
BackgroundResultA prospective long-term follow-up study of alexithymia in obsessive–compulsive disorder
Rufer, M., Ziegler, A., Alsleben, H., Fricke, S., Ortmann, J., Brückner, E., Hand, I., & Peter, H. (2006) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2005.12.004 · Cited by 66 · see citing works
Gender Differences in Empathy During Adolescence: Does Emotional Self-Awareness Matter?
Trentini, C., Tambelli, R., Maiorani, S., & Lauriola, M. (2022) · Psychological Reports · doi:10.1177/0033294120976631 · Cited by 53 · see citing works
Deborde, A.-S., Berthoz, S., Wallier, J. M., Fermanian, J., Falissard, B., Jeammet, P., & Corcos, M. (2008) · Psychopathology · doi:10.1159/000109955 · Cited by 52 · see citing works
Alexithymia, emotion processing and social anxiety in adults with ADHD
Edel, M.-A., Rudel, A., Hubert, C., Scheele, D., Brüne, M., Juckel, G., & Assion, H.-J. (2010) · European Journal of Medical Research · doi:10.1186/2047-783x-15-9-403 · Cited by 51 · see citing works
Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology
Vuillier, L., Carter, Z., Teixeira, A. R., & Moseley, R. L. (2020) · Molecular Autism · doi:10.1186/s13229-020-00364-z · Cited by 48 · see citing works
Huntjens, A., van den Bosch, L. M. C. W., Sizoo, B., Kerkhof, A., Huibers, M. J. H., & van der Gaag, M. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02531-1 · Cited by 50 · see citing works
Know thyself: Exploring interoceptive sensitivity in Parkinson's disease
Ricciardi, L., Ferrazzano, G., Demartini, B., Morgante, F., Erro, R., Ganos, C., Bhatia, K. P., Berardelli, A., & Edwards, M. (2016) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2016.03.019 · Cited by 46 · see citing works
Simeon, D., Giesbrecht, T., Knutelska, M., Smith, R. J., & Smith, L. M. (2009) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3181aaef6b · Cited by 47 · see citing works
Emotional awareness as a pathway linking adult attachment to subsequent depression.
Monti, J. D., & Rudolph, K. D. (2014) · Journal of Counseling Psychology · doi:10.1037/cou0000016 · Cited by 46 · see citing works
Demers, L. A., Schreiner, M. W., Hunt, R. H., Mueller, B. A., Klimes-Dougan, B., Thomas, K. M., & Cullen, K. R. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.02.038 · Cited by 38 · see citing works
Gaggero, G., Bonassi, A., Dellantonio, S., Pastore, L., Aryadoust, V., & Esposito, G. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.611489 · Cited by 40 · see citing works
Borderline Personality Disorder and Mental Healthcare Service Use Among Adolescents
Cailhol, L., Jeannot, M., Rodgers, R., Guelfi, J. D., Perez-Diaz, F., Pham-Scottez, A., Corcos, M., & Speranza, M. (2013) · Journal of Personality Disorders · doi:10.1521/pedi.2013.27.2.252 · Cited by 39 · see citing works
Swain, J., Hancock, K., Dixon, A., Koo, S., & Bowman, J. (2013) · Trials · doi:10.1186/1745-6215-14-140 · Cited by 37 · see citing works
“The TAS-20 is a 20-item self-report inventory of the construct of alexithymia and produces scores in three related domains: difficulty identifying feelings, difficulty describing feelings and externally-orientated thinking [57].”
BackgroundBrady, R. E., Bujarski, S. J., Feldner, M. T., & Pyne, J. M. (2017) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000155 · Cited by 34 · see citing works
Stability of alexithymia in late adolescence: results of a 4-year follow-up study
Karukivi, M., Pölönen, T., Vahlberg, T., Saikkonen, S., & Saarijärvi, S. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.05.058 · Cited by 36 · see citing works
Eerola, T., Vuoskoski, J. K., Kautiainen, H., Peltola, H., Putkinen, V., & Schäfer, K. (2021) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14660 · Cited by 32 · see citing works
The specificity of the link between alexithymia, interoception and imitation
Sowden, S., Brewer, R., Catmur, C., & Bird, G. (2016) · Journal of Experimental Psychology: Human Perception and Performance · doi:10.1037/xhp0000310 · Cited by 31 · see citing works
Reduced anticipation of negative emotional events in alexithymia
Starita, F., Làdavas, E., & di Pellegrino, G. (2016) · Scientific Reports · doi:10.1038/srep27664 · Cited by 29 · see citing works
Dreaming correlates of alexithymia among sleep-disordered patients
Nielsen, T., Levrier, K., & Montplaisir, J. (2011) · Dreaming · doi:10.1037/a0022861 · Cited by 30 · see citing works
Khanpour Ardestani, S., Karkhaneh, M., Stein, E., Punja, S., Junqueira, D. R., Kuzmyn, T., Pearson, M., Smith, L., Olson, K., & Vohra, S. (2021) · Medicina · doi:10.3390/medicina57070652 · Cited by 30 · see citing works
“Lacking warmth”: alexithymia trait is related to warm-specific thermal somatosensory processing
Borhani, K., Làdavas, E., Fotopoulou, A., & Haggard, P. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2017.07.012 · Cited by 26 · see citing works
Nunes da Silva, A. (2021) · Psychopathology · doi:10.1159/000519786 · Cited by 26 · see citing works
Now or not-now? The influence of alexithymia on intertemporal decision-making
Scarpazza, C., Sellitto, M., & di Pellegrino, G. (2017) · Brain and Cognition · doi:10.1016/j.bandc.2017.03.001 · Cited by 21 · see citing works
Martini, M., Valentini, E., & Aglioti, S. M. (2013) · Experimental Brain Research · doi:10.1007/s00221-012-3365-4 · Cited by 17 · see citing works
Küchler, A.-M., Schultchen, D., Pollatos, O., Moshagen, M., Ebert, D. D., & Baumeister, H. (2020) · Trials · doi:10.1186/s13063-020-04868-0 · Cited by 12 · see citing works
Emotional management and biological markers of dietetic regimen in chronic kidney disease patients
Lai, C., Aceto, P., Luciani, M., Fazzari, E., Cesari, V., Luciano, S., Fortini, A., Berloco, D., Canulla, F., Bruzzese, V., et al. (2017) · Renal Failure · doi:10.1080/0886022x.2016.1256312 · Cited by 11 · see citing works
Ottavi, P., Passarella, T., Pasinetti, M., MacBeth, A., Velotti, P., Velotti, A., Bandiera, A., Popolo, R., Salvatore, G., & Dimaggio, G. (2019) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000001054 · Cited by 10 · see citing works
Kapadi, R., Elander, J., & Bateman, A. H. (2024) · Substance Use & Misuse · doi:10.1080/10826084.2024.2320373 · Cited by 2 · see citing works
“…identifying and describing emotions and gives a total score as well as subscale scores for Difficulty Describing Feelings (DDF), Difficulty Identifying Feelings (DIF) and Externally Oriented Thinking (EOT), each with good internal reliability (Bagby et al., 1994; Parker et al., 1993, 2003).”
Background
- Authors
- Parker, J. D. A., Taylor, G. J., & Bagby, R. M.
- Affiliations
- Trent University (CA)
- Mount Sinai Hospital (CA)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Taylor, Graeme J
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2003-09
- Volume
- 55
- Issue
- 3
- Pages
- 269-275
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2129478806
- Cited by
- 1,036
- References
- 76
- Citations by year
- 2026: 15 · 2025: 15 · 2024: 26 · 2023: 25 · 2022: 35 · 2021: 79 · 2020: 87 · 2019: 60 · 2018: 60 · 2017: 49 · 2016: 56 · 2015: 60 · 2014: 65 · 2013: 59 · 2012: 47
- FWCI
- 13.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Government of Ontario
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- Toronto Alexithymia Scale, alexithymia, factor structure, factorial validity, scale reliability, gender differences, age differences, educational attainment, community-dwelling adults
- MeSH terms
- Adult, Affective Symptoms, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Reference Values, Sensitivity and Specificity, Reproducibility of Results
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