Toronto Alexithymia Scale-20 Items Research Articles

Research on Depression in Children with Severe Bronchial Asthma: The Impact of Alexithymia and Somatic Symptoms.

The prevalence of depression in children with severe bronchial asthma is a significant concern due to its potential effects on illness burden and quality of life. This cross-sectional study aims to explore the relationship between depression and severe bronchial asthma in children, focusing on the impact of alexithymia and somatic symptoms. The study includes a total of 186 children aged 6-14 years diagnosed with severe bronchial asthma between 2008 and 2022 in our institute. Alexithymia was assessed using the Toronto Alexithymia Scale-20 items (TAS-20). Somatization symptoms were measured using the children's somatization inventory (CSI). The Hamilton depression scale (HAMD) was used to evaluate depression. Spearman correlation analysis was used to describe the correlation between alexithymia, somatization symptoms, and depression. Children with bronchial asthma are found to have a significantly higher prevalence of depression, estimated to be around 16.67%. Approximately 98.92% of children exhibit varying degrees of somatic symptoms. Approximately 3.23% of children have alexithymia. The Spearman correlation analysis revealed that somatic symptoms and alexithymia were positive correlated with the depression. The correlation coefficients were 0.986 and 0.981 (P < .01), respectively. moreover, according to the results of multiple linear regression analysis, somatization symptoms and alexithymia significantly affects depression in children with severe bronchitis asthma (P < .01). These findings suggest that children with severe bronchial asthma experience a higher prevalence of depression, impacting their overall quality of life. In addition, the presence of somatic symptoms is prevalent among these children, further contributing to the burden on their quality of life. Moreover, somatization symptoms and alexithymia have been identified as a significant factor positive affecting depression in this population. Addressing these factors in clinical interventions may be beneficial for improving the overall well-being in this population.

A Case Series of Study of Childhood Psychological Trauma and Alexithymia Among Persons with Alcohol Dependence Syndrome Attending Inpatient De-addiction Facility from Central Rural India

Psychological trauma occurs when a person suffers from serious threat or loss to his/her life. Childhood psychological trauma can be of various forms such as physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. Such adverse childhood experiences, if not effectively dealt or resolved, may lead to the development of drug dependence including alcohol dependence syndrome (ADS) in adult life. In many cases, development of ADS is preceded by the occurrence of childhood psychological trauma(s). Such a person with a history of childhood psychological traumas may consume alcohol to cope with his/her trauma-related distress. Alexithymia is a state characterized by a triad of difficulty in identifying one's own feelings, difficulty in differentiating between physical sensations and emotional arousal, and difficulty in explaining one's own feelings to others. Alexithymia has a role in the development of drug dependence including ADS. The number of childhood psychological trauma among persons with ADS was associated with alexithymia in adulthood. Childhood psychological traumas, mainly emotional abuse, might act as a predisposing factor for the development of alexithymia in persons suffering from ADS. This case series presented clinical picture of two individuals with ADS in which both childhood psychological trauma(s) and alexithymia were assessed by using standard and psychometrically valid psychological tools such as Childhood Trauma Questionnaire and Toronto Alexithymia Scale-20 item, respectively. This case series is unique because the assessment of childhood psychological trauma(s) and alexithymia is neglected area in Indian psychiatric research field and detailed ample of literature is not available at present in which the relationship between childhood psychological traumas, alexithymia, and ADS has been assessed. In the present case series, first individual with ADS had clinically significant alexithymia, severe emotional abuse, severe emotional neglect, moderate physical abuse, and moderate physical neglect, while second individual with ADS had no alexithymia but he had moderate-level emotional neglect and mild levels of emotional abuse, physical abuse, and physical neglect.

A pilot study on alexithymia in adopted youths: prevalence and relationships with emotional-behavioral problems

Adopted adolescents show high rates of emotional-behavioral problems and they could also be more vulnerable to alexithymia, a risk factor for psychopathology in adolescents, that is more frequent in case of early relational trauma(s), often experienced by adoptees in pre-adoption life. However, no studies investigate alexithymia in adopted adolescents, therefore this pilot study aimed to: (a) assess the prevalence of alexithymia in adoptees in comparison with a national representative sample; (b) examine the relationships between alexithymia and emotional-behavioral problems in adoptees. Participants were 33 adoptees aged 10-19 years (54.5% boys), enrolled through social services. Measures were the self-report questionnaire Toronto Alexithymia Scale 20-item to measure participants’ alexithymia, and the Youth Self Report 11-18 years to assess emotional-behavioral problems. Main results highlighted: 1) 71% of adoptees with moderate-to-high levels of alexithymia, with adoptees as significantly more border-alexithymic (55%) than in normative peers; 2) Alexithymia and its factors Difficulty to identifying Feelings and Externally Oriented Thinking were related to more total, internalizing, externalizing and other problems (social, attentional, thought, binge-drinking, substance abuse, suicidality, etc...); 3) The difficulty identifying feelings was the unique predictor for 38% of total problems, 40% of internalizing ones, 22% of externalizing ones and 30% of other problems. In conclusion , the results suggest the clinical and scientific relevance of continuing the study of alexithymia in adopted adolescents, and future directions of research are suggested.

Quadratic Relationship Between Alexithymia and Interoceptive Accuracy, and Results From a Pilot Mindfulness Intervention

Alexithymia, or a reduced ability to label and describe one's emotions, is a transdiagnostic construct associated with poor psychosocial outcomes. Currently, the mechanisms underlying affective deficits associated with alexithymia are unclear, hindering targeted treatment delivery. Recent research suggests deficient interoceptive awareness, or reduced awareness of one's internal bodily state, may be key in the etiology of alexithymia. It has long been demonstrated that mindfulness meditation can alter perceptions of one's own emotions and bodily cues. Therefore, it is possible that mindfulness meditation may reduce affective deficits associated with alexithymia by improving interoceptive awareness. In this study, we aimed to (1) elucidate the role of interoceptive accuracy and sensibility, two dimensions of interoceptive awareness, in alexithymia, and (2) test the efficacy of a brief mindfulness meditation for improving interoceptive accuracy, interoceptive sensibility, and emotional awareness. Seventy six young adults completed a baseline heartbeat detection task, to assess interoceptive accuracy and sensibility, and the Toronto Alexithymia Scale—20 item. They were randomly assigned to a brief mindfulness-based body scan meditation intervention or control condition. Afterwards, participants completed tasks assessing emotional awareness (i.e., affect labeling, emotional granularity) and follow-up heartbeat detection task. Relationships between alexithymia and interoceptive accuracy and sensibility were best described as quadratic (p = 0.002) and linear (p = 0.040), respectively. Participants in both conditions showed robust improvements in interoceptive accuracy from baseline to follow-up (p < 0.001; = 0.15); however, there were no group (meditation or control) differences in degree of improvement. Similarly, there were no group differences in affect labeling or emotional granularity. These preliminary results suggest that heightened alexithymia may be associated with either relatively high or low interoceptive accuracy. The meditation condition did not result in improved interoceptive accuracy or sensibility above and beyond that of a control group. Improvements in interoceptive accuracy, interoceptive sensibility, and emotional awareness may require longer or more interactive intervention approaches. More research is needed to parse the potentially complex relationship between alexithymia and interoceptive awareness, and to develop targeted treatment approaches to ameliorating associated affective deficits.

Hepatitis C virus eradication with directly acting antivirals improves health-related quality of life and psychological symptoms.

BACKGROUNDAlterations in health-related quality of life (HRQoL) and neuropsychological disorders were described in the hepatitis C virus (HCV) patients. Although several studies investigated the modifications of HRQoL after HCV eradication, no data exists on the modifications of neuropsychological symptoms.AIMTo investigate the effect of directly acting antivirals (DAAs) treatment on HRQoL and neuropsychological symptoms.METHODSThirty nine patients with HCV infection underwent a neuropsychological assessment, including Zung-Self Depression-Rating-Scale, Spielberg State-Trait Anxiety Inventory Y1-Y2 and the Toronto-Alexithymia Scale-20 items before and after DAAs treatment. HRQoL was detected by Short-Form-36 (SF-36).RESULTSAll HRQoL domains, but role limitation physical and bodily pain, significantly improved after treatment. Interestingly, after DAAs treatment, all domains of HRQoL returned similar to those of controls. Each neuropsychological test significantly improved after HCV eradication. A significant correlation was observed among each psychological test and the summary components of SF-36. At multiple linear regression analysis including each psychological test as possible covariates, Zung-Self Depression Rating Scale (Zung-SDS) score was independently and significantly related to summary components of the SF-36 in the basal state and the difference between Zung-SDS score before and after treatment was the only variable significantly and independently related to the modification of HRQoL induced by the treatment.CONCLUSIONNeuropsychological symptoms strongly influenced HRQoL in HCV patients and there was a significant improvement of neuropsychological tests and HRQoL after DAAs treatment.

Food Addiction is Associated with Higher Neuroticism, Lower Conscientiousness, Higher Impulsivity, but Lower Extraversion in Obese Patient Candidates for Bariatric Surgery

ABSTRACTBackground: The “food addiction” phenotype identifies a subpopulation of individuals experiencing substance-dependence symptoms toward specific foods. In the current debate on whether the “food addiction” phenotype should be considered as an addictive disorder, assessment of the personality traits associated with this phenotype would provide arguments for or against the “food addiction” phenotype and its inclusion in the “substance-related and addictive disorder” category. Objectives: To assess the personality characteristics associated with the “food addiction” phenotype in obesity surgery candidates (i.e., big five personality dimensions, alexithymia and impulsivity). Methods: We assessed food addiction (Yale Food Addiction Scale), personality dimensions (Big Fig Inventory), impulsivity (Barratt Impulsiveness Scale-11th version) and alexithymia (Toronto Alexithymia Scale-20 items) in 188 bariatric surgery candidates recruited between July 2013 and November 2015 in the Nutrition Department of the University Hospital of Tours. We used chi-squared tests and Student's tests or Mann-Whitney-U-tests to determine the factors associated with food addiction. Results: Prevalence of current food addiction was 16.5%. Patients with (vs. without) food addiction had lower conscientiousness (p = .047), higher neuroticism and lower extraversion (ps < 0.001), but there was no difference in terms of agreeableness (p = 0.42) or openness (p = 0.16). They were more frequently single (p = .021) and reported higher alexithymia (ps < .001) and higher impulsivity sub-scores (ps<.05). Conclusions/Importance: Food addiction shares personality traits with substance-related disorders (regarding neuroticism, conscientiousness, impulsivity, alexithymia), and one distinctive trait (low extraversion). This study provides additional data that enrich the discussion on whether the “food addiction” phenotype should be included or not in the “substance-related and addictive disorder” category.

Gender, alexithymia and physical inactivity associated with abdominal obesity in type 1 diabetes mellitus: a cross sectional study at a secondary care hospital diabetes clinic

BackgroundObesity is linked to cardiovascular diseases and increasingly common in type 1 diabetes mellitus (T1DM) since the introduction of intensified insulin therapy. Our main aim was to explore associations between obesity and depression, anxiety, alexithymia and self-image measures and to control for lifestyle variables in a sample of persons with T1DM. Secondary aims were to explore associations between abdominal and general obesity and cardiovascular complications in T1DM.MethodsCross sectional study of 284 persons with T1DM (age 18–59 years, men 56%), consecutively recruited from one secondary care hospital diabetes clinic in Sweden. Assessments were performed with self-report instruments (Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale-20 items and Structural Analysis of Social Behavior). Anthropometrics and blood samples were collected for this study and supplemented with data from the patients’ medical records. Abdominal obesity was defined as waist circumference men/women (meters): ≥1.02/≥0.88, and general obesity as BMI ≥30 kg/m2 for both genders. Abdominal obesity was chosen in the analyses due to the high association with cardiovascular complications. Different explanatory logistic regression models were elaborated for the associations and calibrated and validated for goodness of fit with the data variables.ResultsThe prevalence of abdominal obesity was 49/284 (17%), men/women: 8%/29% (P < 0.001). Abdominal obesity was associated with women (AOR 4.9), physical inactivity (AOR 3.1), alexithymia (AOR 2.6) and age (per year) (AOR 1.04). One of the three alexithymia sub factors, “difficulty identifying feelings” (AOR 3.1), was associated with abdominal obesity. Gender analyses showed that abdominal obesity in men was associated with “difficulty identifying feelings” (AOR 7.7), and in women with use of antidepressants (AOR 4.3) and physical inactivity (AOR 3.6). Cardiovascular complications were associated with abdominal obesity (AOR 5.2).ConclusionsAlexithymia, particularly the alexithymia subfactor “difficulty identifying feelings”, physical inactivity, and women, as well as cardiovascular complications were associated with abdominal obesity. As abdominal obesity is detrimental in diabetes due to its association with cardiovascular complications, our results suggest two risk factor treatment targets: increased emotional awareness and increased physical activity.

The relationships between interoception and alexithymic trait. The Self-Awareness Questionnaire in healthy subjects.

Interoception is the basic process enabling evaluation of one's own bodily states. Several previous studies suggested that altered interoception might be related to disorders in the ability to perceive and express emotions, i.e., alexithymia, and to defects in perceiving and describing one's own health status, i.e., hypochondriasis. The main aim of the present study was to investigate the relationships between alexithymic trait and interoceptive abilities evaluated by the “Self-Awareness Questionnaire” (SAQ), a novel self-report tool for assessing interoceptive awareness. Two hundred and fifty healthy subjects completed the SAQ, the Toronto Alexithymia Scale-20 items (TAS-20), and a questionnaire to assess hypochondriasis, the Illness Attitude Scale (IAS). The SAQ showed a two-factor structure, with good internal consistency (Cronbach's alpha = 0.88). We observed significant direct correlations between SAQ, TAS-20 and two of its subscales, and the IAS. Regression analysis confirmed that the difficulty in identifying and expressing emotions is significantly related with awareness for one's own interoceptive feelings and with a tendency to misinterpret and amplify bodily sensations. From a clinical point of view, the assessment of interoceptive awareness by the SAQ could be pivotal in evaluating several psychopathological conditions, such as the somatoform disorders.

Interrelation among alexithymia and negative psychology of nursing personnel and their coping style

Objective The purpose of the current study was to discuss the interrelation among alexithymia and negative psychology of nursing personnel and their coping style, so as to provide a theoretical basis for better mental health education and psychological intervention for nursing personnel. Methods A questionnaire survey was administered to 503 nursing personnel sampled from a hospital in Henan Province between May and June 2010 by means of survey instruments of the Toronto Alexithymia Scale-20 Items (TAS-20), the Trait Coping Style Questionnaire (TCSQ), and the General Health Questionnaire (GHQ-20). Results (1) Alexithymia and a negative coping style had a positive correlation with negative psychology (P Conclusion Alexithymia and coping style were very important factors for improvement of current mental status of the nursing personnel, especially for a change in negative coping style and selection of good coping style.

Alexithymia, Physiological Reactivity and Cognitive Appraisals of Emotional Stimuli in Opiate Dependents: A Pilot Study.

Objective: The aim of this study was to investigate psychophysiological reactivity to daily-life stimuli in opiate dependents and associations with alexithymia. Methods: The sample (n=72) was composed of a heroin addicts group treated with methadone and a healthy group, studied in several variables. Participants completed the Portuguese versions of the Toronto Alexithymia Scale-20 items, the Hospital Anxiety and Depression Scale and the Mini-Mental State Examination. They were also exposed to images from The International Affective Pictures System (IAPS) and physiological parameters and ratings of valence and arousal were collected. Results: Opiate dependents showed more alexithymia than controls and higher autonomic reactivity to stimuli. Higher levels of alexithymia seems to moderate an inverse association between heart rate and cognitive appraisals of unpleasant stimuli in this sample. Conclusion: A dysregulated brain-peripheral integration increased by the long term-use of drugs and damage in prefrontal regions are discussed as potential etiological factors supporting the presence of emotional deficits in these populations.

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders

BackgroundThis study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression. MethodsThirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D). ResultsThe differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels. ConclusionsOur data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself.

177 BEHAVIOR DISORDERS IN CIRRHOTIC PATIENTS AND THEIR RELATIONSHIP WITH HEALTH RELATED QUALITY OF LIFE (HRQOL)

Background and Aim: Cirrhosis is an important chronic disease worldwide. The relationship between cirrhosis and behavior disorders, such as depression, anxiety and alexithymia is unknown. The aim of this study was investigating the prevalence of these psychiatric symptoms in cirrhotics and their relationship with HRQoL and minimal hepatic encephalopathy (MHE). Patients/methods: 39 cirrhotics (29M, Age 64±12; Child– A/B/C = 21/15/3), consecutively observed without evidence of severe cognitive impairment (Mini Mental State Examination >26) and overt HE (excluded by West Haven criteria and CHESS score), underwent an extensive neuropsychological assessment, including ZUNG-Self Depression Rating Scale (Zung-SDS), the State-Trait Anxiety Inventory Y1-Y2 (S.T.A.I.) for state and trait anxiety and the Toronto Alexithymia Scale-20 items (TAS-20). These tests were specifically chosen because they explore the fronto-subcortical circuits, which are probably involved in patients with MHE. Patients were examined for MHE detection using the psychometric hepatic encephalopathy score (PHES), adjusted for age and education of healthy Italian population. HRQoL was evaluated by Short Form36 questionnaire corrected for age, education and occupation of healthy Italian population. Results: Depression (ZUNG-SDS ≥50) was detected in 24 patients (62%, 95%CI = 46–77%), state anxiety (STAI-Y1 ≥60) in 12 patients (31%, 95%CI = 16–46%), trait anxiety (STAI-Y2 ≥60) in 12 patients (31%, 95%CI = 16–46%) and alexithymia (TAS-20 ≥60) in 12 patients (31% 95%CI = 16–46%). At least one behavioural test was pathological in 26 patients (67% 95%CI = 51–82%). MHE (diagnosed as PHES ≤−4) was detected in 14 cirrhotics (36% 95%CI = 20–52%). The number of patients with at least one altered behavioural test was similar in the two groups of patients with and without MHE (9 vs 17; p =NS). HRQoL was compromised in vitality, social functioning and mental health in depressed patients. State anxiety did not worsen HRQoL, while trait anxiety impaired bodily pain, vitality and mental health. Moreover, alexithymia impaired HRQoL in all domains, but bodily pain and mental health (Figures). Conclusions: Depression, state and trait anxiety and alexithymia are frequent in cirrhotic patients. These conditions, overall alexithymia, have a negative impact on HRQoL and are not related to MHE.

Internet addiction, dissociation, and alexithymia

Objective: The aim of this research was to study the association between dissociation, alexithymia, adult attachment, and Internet addiction. Methods: A group of 335 students aged between 18 and 21 years (151 boys, 184 girls) were investigated. Alexithymia, dissociation, attachment styles, and Internet addiction were assessed using the Toronto Alexithymia Scale-20 Items, Dissociation Experiences Scale, Relational Questionnaire, and Internet Use, Abuse, Dependence. Results: Significant correlations exist between IUAD, alexithymia, and dissociation. In addition, both non-alexithymia and non-dissociation were related more often with secure attachment style. Conclusions: Internet addiction could represent a psychic retreat necessary to modulate the painful emotions in subject with an insecure attachment.

Alexithymia among students of different disciplines

The main goal of this work is to describe a concept of alexithymia and confirm if there is a difference in the rate of alexithymia among graduate students of different disciplines. The theoretical part is focused on alexithymia and associated areas. The experimental part compares rates of alexithymia among the third-year students of Masaryk University (n=282), namely psychology, science and medicine. TAS-20 (Toronto Alexithymia Scale 20-Item) was used for alexithymia analysis. Higher rates of alexithymia were found for life science students in comparison to psychology students. Between these two fields are students of medicine, no significant difference in score of medical students and other student groups were found. The results for selected subscales of TAS-20 were also analyzed, the difference was observed only for the subscale ‘externally oriented thinking’.

Factor Analysis of the French Version of the 20-ltem Toronto Alexithymia Scale (TAS-20)

A French version of the Toronto Alexithymia Scale-20 Items (TAS-20) was factor-analyzed on a sample of 263 university students and its factor solution analyzed along with the studies using the Canadian version. Our results show a two-factor solution where the items rating the difficulty to identify feelings and the items rating the difficulty to describe feelings constitute a sole factor contrary to the Canadian version. These data are reviewed in the context of previous research and offer two subscales for future investigations utilizing the TAS-20.