Assessment of alexithymia: the downside of a success story

Alexithymia refers to an impairment in psychic functioning and consists of four dimensions: (1) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal, (2) difficulty describing feelings to other people, (3) constricted imaginal processes, and (4) a stimulus-bound, externally orientated style. Since its introduction in the seventies, this concept was studied in an intensive paradigm of empirical research. Thirty years after the onset of this paradigm, validity of measurement instruments is taken for granted. However, literature review revealed that several crucial aspects of validity were never adequately addressed. Therefore, the present study investigated convergent validity among four widely used alexithymia instruments, namely the 20-item Toronto Alexithymia Scale, the Toronto Structured Interview for Alexithymia, the Observer Alexithymia Scale, and the revised Beth Israel Psychosomatic Questionnaire; construct validity of the same instruments was assessed by examining associations with independently measured variables, like emotional language use and affective experience and regulation (Q-sort). The mean intercorrelation between the total scores of the alexithymia instruments was .46 (meaning that they have 21.2% of common variance). Relationships with language use and affect regulation strategies were theoretically meaningful when considered at the level of separate instruments, yet, showed to be inconsistent over instruments. Consequently, it is often unclear how the (small) common and (large) unique parts of these instruments should be interpreted. It is concluded that validity of alexithymia measures is not guaranteed; clinical use of measurement instruments is only meaningful when considered in the context of narrative data of a patient.Alexithymia refers to an impairment in psychic functioning and consists of four dimensions: (1) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal, (2) difficulty describing feelings to other people, (3) constricted imaginal processes, and (4) a stimulus-bound, externally orientated style. Since its introduction in the seventies, this concept was studied in an intensive paradigm of empirical research. Thirty years after the onset of this paradigm, validity of measurement instruments is taken for granted. However, literature review revealed that several crucial aspects of validity were never adequately addressed. Therefore, the present study investigated convergent validity among four widely used alexithymia instruments, namely the 20-item Toronto Alexithymia Scale, the Toronto Structured Interview for Alexithymia, the Observer Alexithymia Scale, and the revised Beth Israel Psychosomatic Questionnaire; construct validity of the same instruments was assessed by examining associations with independently measured variables, like emotional language use and affective experience and regulation (Q-sort). The mean intercorrelation between the total scores of the alexithymia instruments was .46 (meaning that they have 21.2% of common variance). Relationships with language use and affect regulation strategies were theoretically meaningful when considered at the level of separate instruments, yet, showed to be inconsistent over instruments. Consequently, it is often unclear how the (small) common and (large) unique parts of these instruments should be interpreted. It is concluded that validity of alexithymia measures is not guaranteed; clinical use of measurement instruments is only meaningful when considered in the context of narrative data of a patient.C