Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples

Preece, David A.; Becerra, Rodrigo; Boyes, Mark; Northcott, Chelsea; McGillivray, Lauren; Hasking, Penelope

doi:10.1016/j.paid.2019.109721

Cited by 59 publications

(47 citation statements)

References 46 publications

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“…We too found that depression and anxiety were related to the DDF and DIF subscales of the TAS-20 (and not to the LEAS). While some have found DIF especially related to distress [115], others studying the construct with relation to AN have identified contributions of DIF which are distinct from those of depression, at least [154]. Our data supports this view, as DIF remained a significant mediator once depression and anxiety were controlled for.…”

Section: Anxiety and Depressionsupporting

confidence: 84%

“…Moreover, the TAS-20 may more reflect people’s beliefs about themselves rather than provide an accurate representation of their ability [ 111 ]. It is known to detect neuroticism, shame, and general negative affect, as well as somatic or medically unexplained symptoms [ 112 – 115 ]. This issue is averted via behavioural measures which can corroborate poorer ability to identify, differentiate between, and describe emotions.…”

Section: Experiments 1: Results and Interim Discussionmentioning

confidence: 99%

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Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

et al. 2020

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Background: Autistic people are disproportionately vulnerable to anorexia nervosa and other eating disorders (ED), and within the general population, autistic traits correlate with ED psychopathology. A putative mechanism which may underpin this heightened risk is alexithymia, a difficulty identifying and describing emotional states which is observed in both autism and ED. In two experiments with independent non-clinical samples, we explored whether alexithymia might mediate the heightened risk of eating psychopathology in individuals high in autistic traits. Methods: Our first experiment used the PROCESS macro for SPSS to examine relationships between alexithymia (measured by the Toronto Alexithymia Scale (TAS-20)), autistic traits (autism quotient (AQ)), and eating psychopathology (Eating Attitudes Test (EAT-26)) in 121 participants. Our second experiment (n = 300) replicated and furthered this analysis by examining moderating effects of sex and controlling for anxiety and depression as covariates. We also included an additional performance-based measure of alexithymia, the Levels of Emotional Awareness Scale (LEAS). Results: Study 1 suggested that TAS-20 scores mediated the relationship between heightened autistic traits and eating psychopathology. Replication and further scrutiny of this finding, in study 2, revealed that this mediation effect was partial and specific to the female participants in this sample. The mediation effect appeared to be carried by the difficulty identifying feelings subscale of the TAS-20, even when depression and anxiety were controlled for. LEAS scores, however, were not significantly related to autistic traits or eating psychopathology. Limitations: Cross-sectional data prevents any conclusions around the direction and causality of relationships between alexithymia, autistic traits, and eating psychopathology (alongside depression and anxiety), necessitating longitudinal research. Our non-clinical sample was predominantly Caucasian undergraduate students, so it remains to be seen if these results would extrapolate to clinical and/or autistic samples. Divergence between the TAS-20 and LEAS raises crucial questions regarding the construct validity of these measures. Conclusions: Our findings with respect to autistic traits suggest that alexithymia could partially explain the prevalence of ED in autistic people and may as such be an important consideration in the pathogenesis and treatment of ED in autistic and non-autistic people alike. Further research with clinical samples is critical to explore these ideas. Differences between men and women, furthermore, emphasize the importance of looking for sexspecific as well as generic risk factors in autistic and non-autistic men and women.

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Section: Anxiety and Depressionsupporting

confidence: 84%

Section: Experiments 1: Results and Interim Discussionmentioning

confidence: 99%

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

et al. 2020

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“…Among alexithymia subscales of the TAS-20, the DIF includes the highest level of negative affect (Preece et al, 2020). The experience of elevated negative affect is associated with physical symptoms, compared with when negative affect is at a very low level (Bogaerts et al, 2010).…”

Section: Structural Equation Modelmentioning

confidence: 99%

Alexithymia, empathy, negative affect and physical symptoms in patients with asthma

Khosravani

Ardestani

Alvani

et al. 2020

Clin Psychology and Psychoth

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Although alexithymia has been found to be associated with physical symptoms in psychosomatic disorders such as asthma, mechanisms linking this association are unknown. However, affective alexithymic features may be associated with physical symptoms in the presence of deficits in affective characteristics such as low empathy and high negative affect. This study aimed to assess direct effects of alexithymic traits on physical symptoms and indirect effects of these subscales through empathy and negative affect (e.g. depressive, anxious and stress symptoms) by controlling for asthma severity in patients with asthma. Three hundred patients with asthma completed the Toronto Alexithymia Scale-20 (TAS-20), the Basic Empathy Scale (BES), the Depression Anxiety Stress Scales-21 (DASS-21) and the Physical Symptoms Inventory (PSI). After controlling for asthma severity, the results showed that alexithymia subscales of the TAS-20 had no direct effects on physical symptoms, but the difficulty in identifying feelings (DIF) subscale of the TAS-20 was associated with affective empathy and negative affect. Affective empathy was significantly related to negative affect. Affective empathy and negative affect were associated with physical symptoms. The affective subscale of alexithymia on the TAS-20, that is DIF, indirectly affected physical symptoms through affective empathy and negative affect. Findings suggest that patients with asthma who have high levels of DIF may show high physical symptoms in the presence of low affective empathy and high negative affect.

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“…has long been the gold-standard tool for assessing alexithymia, there are some concerns that it might actually be a measure of psychopathology symptoms or current levels of psychological distress (see 51,52,[54][55][56][57]. Further studies may try to replicate our results using alternative measures of alexithymia such as the Perth Alexithymia Questionnaire (62) or Bermond Vorst Alexithymia Questionnaire (BVAQ; 42), which have been argued to index an alexithymia construct that is distinct from individuals' current level of psychological distress (61). However, since our aim was to investigate whether the alexithymia hypothesis applies, not only to emotion recognition from static face stimuli, but also to recognition from dynamic stimuli, it was crucial for the design of the current study that we employ the same measure of alexithymia (i.e.…”

Section: Limitationsmentioning

confidence: 90%

Differences Between Autistic and Non-autistic Adults in the Recognition of Anger From Dynamic Expressions Remain After Controlling for Alexithymia.

Keating

Sowden

Fraser

et al. 2020

Preprint

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BackgroundFor many years, research has suggested that autistic individuals have difficulties recognising the emotions of other people. However, a burgeoning literature argues that these difficulties may be better explained by co-occurring alexithymia rather than autistic characteristics. Importantly, extant studies in this field have focused on the recognition of emotion from static images. Here we investigated whether there are differences with respect to emotion recognition from dynamic facial stimuli between autistic and non-autistic groups matched on alexithymia.Methods29 control and 31 autistic adults, matched on age, gender, non-verbal reasoning ability and alexithymia, completed a facial emotion recognition task which employed dynamic point light displays of happy, angry and sad facial expressions. Stimuli were manipulated such that expressions were reproduced at 50%, 100% and 150% of their normal speed and spatial extent. ResultsThe ASD group exhibited significantly lower emotion recognition accuracy for angry, but not happy or sad, expressions at the normal (100%) spatial and speed level. Whilst the control group exhibited increasing accuracy across all levels of the speed manipulation, the ASD group only showed improvement from the 100% to 150% level. Non-verbal reasoning and level of autistic traits (and not age, gender or alexithymia) were significant predictors of accuracy for angry videos at the 100% spatial and speed level. LimitationsDue to COVID-19 restrictions, only 22 members of the ASD group completed the ADOS-2 assessments and 7 of those who did, scored below threshold for an autism or ASD diagnosis. Therefore, our ASD group may display less frequent or lower intensity autistic behaviours than would typically be seen in an ASD population. The TAS, which has recently been questioned for its construct validity, was used to measure alexithymia. ConclusionsSince our participants were matched on alexithymia, and we identified that level of autistic traits (and not alexithymic traits) was a significant predictor of the accuracy of angry expression recognition at the normal level, we conclude that a difficulty with recognising angry expressions is relevant to autism and cannot be explained by alexithymia. Future research should elucidate why autistic individuals exhibit differences with angry expressions in particular.

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Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples

Cited by 59 publications

References 46 publications

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

Alexithymia, empathy, negative affect and physical symptoms in patients with asthma

Differences Between Autistic and Non-autistic Adults in the Recognition of Anger From Dynamic Expressions Remain After Controlling for Alexithymia.

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