The Relationship Between Alexithymia and Emotional Awareness: A Meta-Analytic Review of the Correlation Between TAS-20 and LEAS

Abstract

Background: Alexithymia and emotional awareness may be considered overlapping constructs and both have been shown to be related to psychological and emotional well-being. However, it is not clear how the constructs relate to each other empirically or if they may overlap more or less in different populations. The aim of this review was therefore to conduct a meta-analysis of correlations between the most commonly used measures of alexithymia (i.e., the self-report instrument Toronto Alexithymia Scale; TAS-20) and emotional awareness (i.e., the observer-rated instrument Level of Emotional Awareness Scale; LEAS) and to explore potential moderators of their relationship.Methods: Electronic databases were searched for studies published until the end of February 2018. Study samples were coded as medical conditions, psychiatric disorders and/or healthy controls and sample mean age and gender distribution were extracted. Correlations between the TAS-20 and the LEAS were subjected to a random effect of meta-analysis and moderators were explored in subgroup analyses and meta-regressions. Publication bias was considered.Results: 21 studies reporting on 28 independent samples on correlation analysis were included, encompassing a total of 2857 subjects (57% women). The aggregated correlation between TAS-20 and LEAS was r = −0.122 (95% CI [−0.180, −0.064]; Z = −4.092; p < 0.001), indicating a significant, but weak, negative relationship between the measures. Heterogeneity was moderate, but we found no indication of significant differences between patients with medical conditions, psychiatric disorders or healthy controls, nor that mean age or percentage of female subjects moderated the relationship. The overall estimate became somewhat weaker after adjusting for possible publication bias.Conclusions: Our results indicate that TAS-20 and LEAS measure different aspects of emotional functioning. The small overlap suggests that alexithymia and emotional awareness are distinct constructs of emotional well-being. Clinicians need to assess both aspects when considering treatment options for individual patients. Moreover, from the clinical standpoint, an easy reliable and valid way of measuring emotional awareness is still needed. More research should be focus on the differences between alexithymia and emotional awareness in specific conditions, but also how to integrate self-report instrument and observed based measures in a clinical situation.

Ecological momentary assessment of emotional awareness: Preliminary evaluation of psychometric properties

“…Contrary to our expectations, a positive association was found between state EA and perceived difficulty in revealing and describing emotions. This finding is in contrast with previous studies (e.g., Lane et al 2000;Maroti et al 2018) and might be due to our sample. Compared with previous studies, the current sample had unusually high EA levels, specifically in males.…”

Emotional Awareness Correlated With Number of Awakenings From Polysomnography in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome—A Pilot Study

“…In the present study, the different correlation results between polysomnography measures and TAS-20 vs. LEAS, indicate that alexithymia and emotional awareness could have different associations with sleep, and probably are regulated in different ways, though overlapping each other. This is also in line with our previously published meta-analytic review on correlation patterns between TAS-20 and LEAS in different psychiatric, psychosomatic, and somatic disorders (17). It is known that arousals and awakenings contribute to daytime sleepiness (18).…”

“…Emotional awareness is another construct related to alexithymia but does not include externally-oriented thinking (16). Both measures show a significant but weak negative correlation (17).…”

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

“…Self-report measures such as the TAS-20 that was used in the current study may not be reliable because of the very nature of alexithymia which may make it difficult for individuals to reflect on their emotions [36,62]. As such, the TAS-20 may more reflect people's beliefs about themselves rather than provide an accurate representation of their ability [63]. It is therefore possible that our sample did not have any perceived difficulties identifying and regulating their feelings, but rather behavioural, or real-life difficulties.…”