2012. Vol.3, No.3, 231-236
Published Online March 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.33032
Copyright © 2012 SciRes. 231
Assessment of Alexithymia: Pychometric Properties of the
Psychological Treatment Inventory-Alexithymia Scale (PTI-AS)
Alessio Gori1,2*, Marco Giannini1, Giulia Palmieri3, Roberta Salvini4, David Schuldberg5
1Department of Psychology, University of Florence, Florence, Italy
2“Gruppo Incontro” Social Cooperative, Pistoia, Italy
3School of Comparative Psychotherapy, Florence, Italy
4Center for Employment and Guidance, Pisa, Italy
5Department of Psychology, The University of Montana, Missoula, USA
Received April 3rd, 2011; revised December 6th, 2011; accepted January 15th, 2012
Background: The aim of this study is to investigate the psychometric properties of a new measure of
alexithymia, the Psychological Treatment Inventory-Alexithymia Scale (PTI-AS). Method: A group of
778 participants completed the PTI-AS. In order to evaluate aspects of concurrent validity, a part of the
sample (n = 116) completed the PTI-AS, the Twenty-Items Toronto Alexithymia Scale (TAS-20) and the
Bermond-Vorst Alexithymia Questionnaire (BVAQ). In order to evaluate aspects of discriminant validity
a group of patients with a diagnosis of Eating Disorders completed the PTI-AS, the TAS-20 and the Eat-
ing Disorders Inventory (EDI-3). Results: Exploratory Factor Analysis (EFA) showed a solid structure
with one factor. Results were confirmed by Confirmatory Factor Analysis (CFA), which yielded good fit
indices (CFI = .98; TLI = .95; RMSEA = .08; SRMR = .04). The PTI Alexithymia Scale showed a good
degree of internal consistency (α = .88). Correlations between the PTI Alexithymia Scale, the TAS-20 (r
= .74, p < .001) and the BVAQ (r = .40, p < .001) were statistically significant, supporting the scale’s
concurrent validity. Conclusion: Thanks to its good psychometric properties the PTI-AS can be consid-
ered as a brief and useful measure for assessing alexithymia.
Keywords: Alexithymia; Personality Tests; Psychological Assessment; Psychometrics; Affective
The term alexithymia (derived from the Greek a = lack, lexis
= word and thymos = mood) was introduced by Sifneos (1973)
to indicate a cognitive-affective disturbance that affects the way
individuals regulate their emotions. It is defined as a multidi-
mensional construct that refers to personality traits relating to
difficulty in identifying and expressing feelings and the inabi-
lity to distinguish between emotions and bodily sensations.
Furthermore, it is also characterized by a reduction or incapaci-
ty to fantasize and to experience emotions (Nemiah & Sifneos,
1970; Taylor, Ryan, & Bagby, 1985).
Alexithymia should be considered as a risk factor for those
medical, psychiatric, or behavioral problems that are influenced
by disordered affect regulation (Taylor, Bagby, & Parker, 1997).
In fact, alexithymia is associated with a failure to use adaptive
affect regulation processes and it is hypothesized to be one of
several factors that contribute to various physical and mental
health problems including undifferentiated negative moods
such as depression and anxiety, compulsive or addictive be-
haviors, physiological arousal, physical symptoms, and po-
tentially somatic disease (Lumely, Neely, & Burger, 2007;
Taylor et al., 1997). Several research have demonstrated that
alexithymia is commonly related to many psychosomatic syn-
dromes such as gastrointestinal disorders (Galeazzi, Ferrari,
Mackinnon, & Rigatelli, 2004; Porcelli & De Carne, 2001; Por-
celli, De Carne, & Todarello, 2004). It is also a common feature
in patients with psychoactive abuse disorders (Cleland et al.,
2005; De Rick & Vanheule, 2007), Post-Traumatic Stress Dis-
order (PTSD; Spitzer et al., 2007; Zlotnick et al., 2001) and
classic psychosomatic disorders (Porcelli et al., 1999; Portin-
casa et al., 2003). There is also consistent evidence that alex-
ithymia is elevated in people with eating disorders, such as
bulimia and anorexia (Beales & Dolton, 2000; Berthoz et al.,
2007; De Panfilis, Salvatore, Avanzini, Gariboldi, & Maggini,
2001; Kessler, Schwarze, Filipic, Traue, & von Wietersheim,
2006; Mazzeo & Espelage, 2002; Montebarocci et al., 2006;
Pinaquy, Chabrol, Simon, Louvet, & Barbe, 2003; Zonney-
ville-Bender, van Goozen, Cohen-Kettenis, van Elburg, & van
Engeland, 2002). In general, studies investigating alexithy- mia
traits in patients with anorexia and bulimia nervosa have out-
lined that they appear to have high degrees of alexithymia
compared to control groups (Beales & Dolton, 2000; Corcos et
al., 2000; Montebarocci et al., 2006). These studies suggest that
patients with a diagnosis of Eating Disorders have difficulties
with interoceptive awareness and can be categorized as alex-
ithymics. In specific, they seem to present a diminished capac-
ity to articulate their affective experiences and to remain dis-
connected from their own subjective emotional functioning.
This study aims to investigate the presence of alexithymia in a
sample of subjects with a diagnosis of Eating Disorder and to
analyze the psychometric properties of a new measure for as-
A. GORI ET AL.
With regard to alexithymia and its measurement, during the
last few decades, several instruments have been developed with
the aim of assessing and investigating its features, also in order
to plan the psychological treatments (Apfel & Sifneos, 1979;
Bales & Dalton, 2000; Bagby et al., 1994a, 1994b; Bagby et al.,
2006; Bermond et al., 1994; Fava, Baldaro & Osti, 1980; Fava
et al., 1995; Rafanelli et al., 2003). Some of the most known
self-report scales, such as the Schalling-Sifneos Personality
Scales (Apfel & Sifneos, 1979; Sifneos, 1986) and the MMPI
Alexithymia Scale (Kleiger & Kinsman, 1980), were con-
structed hastily and with little attention to standard methods of
test construction. As a result, subsequent investigations have
shown that these scales lack reliability and validity (Taylor and
Taylor, 1997). Measurement of the alexithymia construct re-
mained a major problem until the Toronto Alexithymia Scale
(TAS-20; Bagby et al., 1994a, 1994b) was introduced: in fact,
this self-report measure was developed following test develop-
ment procedures and attention to adequate psychometric quali-
ties; and this is actually one the most frequently used measure
of alexithymia (Taylor et al., 2000).
Although it has good psychometric properties, the TAS-20
has been recently criticized for having various shortcomings.
Vorst and Bermond (2001) argued that this instrument assesses
only three factors of the putative characteristics of alexithymia:
difficulty identifying emotions, difficulty describing emotions,
and externally oriented thinking. Because the inability to fanta-
size and reduced experiencing of emotional feelings are not
represented as separate factors in the TAS-20 (Kooiman, Spin-
hoven, & Trijsburg, 2002), Vorst and Bermond developed the
Bermond-Vorst Alexithymia Questionnaire (BVAQ; Bermond
et al., 1994; Vorst and Bermond, 2001). Results demonstrate
that a Principal Component Analysis of the BVAQ subscale
interrelations yields a clear-cut two factor structure. This factor
structure comprises an affective component and a cognitive
component (Vorst & Bermond, 2001; Bermond et al., 2007).
The total TAS-20 score shows correlations with the cognitive,
but not with the emotional component of the BVAQ (Zech et al.,
1999; Vorst & Bermond, 2001; Müller et al., 2004; Bermond et
al., 2007). Both difficulty fantasizing and difficulty emotion-
alizing measured within the BVAQ remained statistically un-
correlated with the total TAS-20 and weakly correlated or un-
correlated with the TAS-20 scales. Therefore, used as a diag-
nostic instrument, the TAS-20 emphasizes the cognitive and
underestimate the emotional component of alexithymia (Larsen
et al., 2003). Regarding this statement, Parker et al. (2003) have
argued that the TAS-20 yields three factors, which are congru-
ent with and cover the salient facets of the construct. Items
assessing fantasy and imaginal activity, functions which are
reduced in alexithymia, were eliminated during the develop-
ment of the scale primarily because they had high correlations
with measures of social desirability. There is evidence to sug-
gest that reduced fantasy and imaginal activity are assessed
indirectly by the externally oriented thinking factor, which
correlates negatively with a measure of fantasy and imaginal
activity. In addition, the authors have stated that, while the first
four factors correspond to the four salient features in Nemiah et
al.’s (1976) definition of the alexithymia construct, emotional-
izing is not part of the original definition. Therefore these addi-
tional characteristics should not be considered core components
of alexithymia. Moreover, they argue with regard to practicality
that the BVAQ contains forty items and it takes a long time to
Considering these aspects the present article proposes a new,
brief, and easily administered measure of alexithymia created in
line with modern trends in self-report construction (e.g., Robins
et al., 2001). The items of Psychological Treatment Inventory-
Alexithymia Scale (PTI-AS) analyses five important dimen-
sions of the construct: 1) difficulty in analyzing and identifying
feelings; 2) fear of emotions; 3) difficulty in describing feelings;
4) inability to understand emotions; 5) difficulty in verbalizing
The PTI-AS is part of the Psychological Treatment Inventory
(Gori, Giannini, & Schuldberg, 2008) a new, multidimensional
measure that was designed to include items in various domains
central to planning psychological treatment and evaluating its
outcome. In the PTI each scale has been grouped in various
clusters that belongs to 4 main areas. The areas and clusters are:
1) Validity; 2) Resources; it includes 2 clusters: Psychological
Resources and Quality of Life; 3) Clinical; which includes 2
clusters (Symptomatology and Psychological Types); 4) Psy-
chological Treatment; it is composed of 4 clusters: Attachment
Styles; Predominant Defense Styles; Negative Treatment Indi-
cators; Psychological Mindedness.
The PTI-AS has been included in the cluster Negative Treat-
ment Indicators. The purpose of this research is to present evi-
dence that this scale has good psychometric properties and can
serve as a useful proxy for both the TAS-20 and BVAQ in a
variety of research contexts.
First, the factor structure and the internal consistency of the
scale are established. Then some aspects of concurrent validity
are investigated by relating the PTI-AS to the TAS-20 and to
BVAQ scores. Some aspects of discriminant validity are evalu-
ated by comparing a clinical group of patients with eating dis-
orders and a part of the non clinical group.
Participants in this study were 778 persons (50.3% male,
49.7% female) with ages ranging from 18 to 63 years (M =
32.76; SD = 11.88), divided into two groups: 1) a non clinical
sample composed of 743 subjects (54.9% male, 48.4% female)
with a mean age of 33.7 (SD = 1.8); and 2) a clinical sample
composed of 35 patients (17.8% male, 82.2 female) with a
mean age of 26.33 years (SD = 9.27). The first group of par-
ticipants (the non clinical sample) consisted of a convenience
sample recruited for this study. The second group of partici-
pants (n = 35) was composed of patients with diagnoses of
Eating Disorders. These subjects were recruited in various cen-
tres specializing in Eating Disorders treatments. All participants
were Italian and completed the PTI Alexithymia Scale in a
PTI-Alexithymia Scale (PTI-AS; Gori, Giannini, & Schuld-
berg, 2008). The PTI-AS consists of 5 items, each measured on
a five-point Likert scale. The aim of this instrument is to assess
symptoms of alexithymia, which is denoted by difficulty in
identifying feelings, difficulty in describing feelings, difficulty
analyzing feelings, and impoverishment of inner emotional life
(inability to understand emotions and fear of emotions), em-
ploying the smallest number of items as possible.
Twenty-Items Toronto Alexithymia Scale (TAS-20; Bagby et
Copyright © 2012 SciRes.
A. GORI ET AL.
al., 1994a, 1994b; Taylor & Taylor, 1997). The TAS-20 con-
sists of twenty items which load on three factors. These three
factors are denoted as F1 “Difficulty in identifying feelings,”
F2 “Difficulty in describing feelings,” and F3 “Externally-
oriented thinking”. Fifteen items are indicative of the dimen-
sions of alexithymia and five are contra-indicative. The rating
scales have five response categories varying from “strongly dis-
agree” (1) to “strongly agree” (5). A total score is calculated by
summing all items such that higher score reflect a greater level
of alexithymia. Scores higher than 61 are categorized as indi-
cating an alexithymic profile according to the recommendation
of Taylor et al. (1997). The original TAS-20 is characterized by
acceptable psychometric qualities. The reliability of the total
scale equals .81, and the reliabilities of the three factors
are .78, .75, and .66 (F1, F2, F3 respectively; Bagby et al.,
1994). The validity of the TAS-20 is also acceptable (Bagby et
al., 1994a). In this study we used the Italian version of the
TAS-20 (Bressi et al., 1996).
The Bermond-Vorst Alexithymia Questionnaire (BVAQ; Ber-
mond et al., 1994; Vorst & Bermond, 2001). The BVAQ con-
sists of 40 items, making up two parallel forms (BVAQ-20A
and BVAQ-20B) with 20 items each. This self-report measure
was designed to examine five putative facets and two putative
dimensions of alexithymia, as described previously. Each sub-
scale (“identifying,” “describing,” “analyzing,” “fantasizing,”
and “emotionalizing”) consists of 8 items, measured on a five
point Likert scale. The BVAQ exhibits a second-order factor
structure: Two subscales (“fantasizing” and “emotionalizing”)
constitute an affective dimension and three subscales (“identi-
fying,” “describing,” and “analyzing”) make up a cognitive di-
mension. The total score of the BVAQ-40 ranges from 40 to
200 points, with high scores indicating high proneness to
alexithymia. Regarding its psychometric properties, Cronbach’s
alpha coefficients range from .67 to .87 for each of the five
subscales (Müller et al., 2004; Vorst & Bermond, 2001). The
validity of the BVAQ is acceptable (Müller et al., 2004; Vorst &
Bermond, 2001). In this study we used the Italian version of the
BVAQ (Bermond et al., 2007; Ricci Bitti & Codispoti, 2002).
Eating Disorders Inventory-3 (EDI-3; Garner, 2004). The
EDI-3 is a self-report instrument measuring psychological traits
or constructs shown to be clinically relevant in individuals with
Eating Disorders. This test consists of 91 items organized onto
12 primary scales, 3 eating disorder-specific scales (Drive for
Thinness -DT-; Bulimia -B-; Body Dissatisfaction -BD-) and 9
general psychological scales (Low Self-Esteem -LSE-; Personal
Alienation -PA-; Interpersonal Insecurity -II-; Interpersonal
Alienation -IA-; Interoceptive Deficits -ID-; Emotional Dys-
regulation -ED-; Perfectionism -P-; Asceticism -A-; Maturity
Fears -MF-) that are highly relevant to, but not specific to, eat-
It also yields six composites, one that is eating-disorder spe-
cific (Eating Disorder Risk -EDRC-) and five that tap general
integrative psychological constructs (Ineffectiveness -IC-, In-
terpersonal Problems -IPC-, Affective Problems -AP-, Over-
control -OC-, and Global Psychological Maladjustment
-GPCM-). The reliability coefficients of the scales range
from .80 and .90, and test-retest reliability coefficients for the
various composite scales are between .93 and .98. The EDI-3
provides normative information for females with eating disor-
ders who are aged 13 - 53 years. Normative data are also pro-
vided for the following DSM-IV-TR diagnostic groups: 1)
Anorexia Nervosa-Restricting type; 2) Anorexia Nervosa-Binge-
Eating/Purging type; 3) Bulimia Nervosa; and 4) Eating Disor-
ders Not Otherwise Specified. The EDI-3 asks participants to
indicate if items are true of them always (A), usually (U), often
(O), sometimes (S), rarely (R), or never (N). In this study we
used the Italian version of the EDI-3 (Giannini et al., 2008).
Participants completed the Psychological Treatment Inven-
tory-Alexithymia Scale (PTI-AS) in a booklet form. All par-
ticipants, who voluntarily participated in this research gave also
information about age, sex, gender, educational, and profes-
sional activities. For the non-clinical sample (group 1), both
individual and group administration procedures were used.
In order to assess some aspects of concurrent validity, a part
of the non-clinical sample (group 1), composed of subjects with
a mean age of 33.2 years (SD = 12.3), completed the PTI-AS,
the Italian version of the Bermond-Vorst Alexithymia Ques-
tionnaire (BVAQ), the Italian version of Twenty-item Toronto
Alexithymia Scale (TAS-20), and the Italian version of the
Eating Disorders Inventory-3 (EDI-3).
In order to evaluate some aspects of Discriminant Validity,
the PTI-AS was administered to a clinical sample of 35 patients
(group 2). All of these patients had received an Eating Disor-
ders diagnosis and were involved in a specific treatment for
Eating Disorders. The instruments were administered by the
psychiatrists and psychotherapists involved in the treatment of
these patients. All patients completed an informed consent form
after intake assessment.
In order to investigate the distribution of the data in the sam-
ple descriptive statistics were calculated. We used factor analy-
sis to identify the PTI-AS scale dimensionality, with the objec-
tive of assessing the validity of the hypothesized construct.
Thus, for a portion of the sample (n = 378) a series of Explora-
tory Factor Analyses (EFA) with Principal Axis Factoring
(PAF) were conducted in order to verify the factor structure of
the PTI-Alexithymia Scale. Using the other portion of the sam-
ple (n = 400) we carried out a Confirmatory Factor Analysis
(CFA). In order to evaluate the model’s goodness of fit a num-
ber of indices were used. Because the chi-square index is in-
fluenced by sample size (Schermelleh-Engel, Moosbrugger, and
Muller, 2003), two relative indices of fit were evaluated be-
cause they are applicable to both large and small samples, the
NNFI (Non-Normed Fit Index) and the CFI (Comparative Fit
Index). Values greater than .95 for these indices are considered
satisfactory (Schermelleh-Engel, Moosbrugger, and Muller,
2003). In addition, the RMSEA (Root Mean Square Error of
Appoximation) has been used as an absolute index of fit. Reli-
ability was calculated using the Cronbach’s alpha coefficient
(Cronbach, 1951). Aspects of concurrent validity were evalu-
ated using the Pearson r coefficient. Aspects of discriminant
validity was explored using ANOVA between the clinical
group (n = 35) and a randomly selected sub-sample of the non-
clinical group (n = 35). Statistical analysis were performed
using SPSS software v. 18 and AMOS v. 6.0.
Results of the Exploratory Factor Analysis (EFA) showed a
one-factor structure with 71.1% of the total variance explained.
Copyright © 2012 SciRes. 233
A. GORI ET AL.
The Factor Structure Matrix shows the correlations between
variables and the scale’s factor (see Table 1).
The goodness-of-fit indicators showed a good fit of the
model to the data; although the chi-square was significant (χ2 =
20.30, p < .001), the others goodness-of-fit indices showed
satisfactory values (CFI = .98, TLI = .95 RMSEA = .08, SRMR
= .04; see Figure 1).
The reliability of the scale, evaluated using the Cronbach’s
alpha coefficient, showed a good level of internal consistency
(α = .88). Item-Total correlation values ranged from .70 (item 2)
to .85 (item 5).
The PTI-AS showed good levels of correlation with the Ita-
lian version of the twenty-item Toronto Alexithymia Scale (TAS-
20; see Table 2).
In addition correlation among the PTI-AS and the scales of
the Italian version of the Bermond-Vorst Alexithymia Ques-
tionnaire (BVAQ) showed good values (see Table 3).
Correlation between the PTI-AS and the EDI-3 scales
showed significant values: Drive for Thinness (DT) (r < .41, p
< .001); Bulimia (B) (r < .34, p < .01); Body Dissatisfaction
(BD) (r < .40, p < .001); Low Self-Esteem (LSE) (r < .28, p
< .05); Personal Alienation (PA) (r < .45, p < .001); Interper-
sonal Insecurity (II) (r < .33, p < .01); Interpersonal Alienation
(IA) (r < .34, p < .01); Interoceptive Deficits (ID) (r < .39, p
< .01); Emotional Dysregulation (ED) (r < .43, p < .001); Per-
fectionism (P) (r < .24, p < .05); Asceticism (A) (r < .36, p
< .01); Maturity Fears (MF) (r < .25, p < .05).
The ANOVA results showed that the clinical group obtained
higher values of Alexithymia scores than the non-clinical group.
All these differences are statistically significant (see Table 4).
The growing interest in the subject of alexithymia is largely
due to the work of Taylor and colleagues. Their instrument, the
TAS-20, has made large-scale investigation of alexithymia
possible and has served to bring alexithymia to the attention of
scientists and practitioners. Therefore, in addition to the TAS-
20 several measures have been developed, including the BVAQ.
The aim of the present study was to investigate the psychomet-
ric properties of the PTI-AS, a new, brief, measure of alexithy-
mia consisting of five items.
The results of this study with a large Italian-speaking adult
community sample provide strong support for the validity of
the one factor structure of the PTI-AS. This also confirmed the
use of the total score of the scale as a dimensional measure of
alexithymia. In addition, a Confirmatory Factor Analysis (CFA)
of an identical one factor model using a cross-validation sample
indicates a good fit of the model to the data. The internal con-
sistency of the scale is excellent (a = .88), despite the very
Factor structure and content scale of the PTI-AS.
Item number Item content Factor 1
Item 5 Difficulty in verbalizing sensations .85
Item 3 Difficulty in describing feelings .84
Item 1 Difficulty in analyzing and identifying feelings .84
Item 4 Inability to understand emotions .80
Item 2 Fear of emotions .70
Confirmatory factor analysis.
Correlation between the PTI-AS and the TAS-20 factors.
F1 F2 F3 Total
PTI-AS .70** .55** .32* .74**
**p < .001; *p < .01.
small number of items. Therefore, the reliability of the PTI-AS
can also be supported. Regarding the concurrent validity of the
PTI-AS, the pattern of correlations indicates that the PTI-AS is
associated with the three factors of the TAS-20 and the various
aspects of alexithymia measured by the BVAQ. The PTI-AS
and the TAS-20 total correlate highly (r = .74, p < .001). Also
correlations between the PTI-AS and the BVAQ total (r < .40, p
< .001) and the cognitive composite factor (r = .63, p < .001)
are very high.
Correlation between the PTI-AS and the EDI-3 scales also
showed higher values. The interest in evaluating a group of pa-
tients with Eating Disorder diagnoses, is due to the fact that
several studies have suggested that patients suffering from ano-
rexia and bulimia have difficulty with interoceptive awareness
and show high levels of alexithymia (Beales & Dolton, 2000;
Berthoz et al., 2007; Corcos, et al. 2000; De Panfilis, Salvatore,
Avanzini, Gariboldi, & Maggini, 2001; Kessler, Schwarze,
Filipic, Traue, & von Wietersheim, 2006; Mazzeo & Espelage,
2002; Montebarocci et al., 2006; Pinaquy, Chabrol, Simon, Lou-
vet, & Barbe, 2003; Speranza et al., 2005; Zonneyville-Bender,
van Goozen, Cohen-Kettenis, van Elburg, & van Engeland,
The current study confirms results of previous studies on the
importance of alexithymia among patients presenting with an
eating disorder (Corcos et al., 2000; Montebarocci et al., 2006;
Speranza et al., 2005). Specifically, the total PTI-AS scores of
the clinical group were significantly higher compared to those
of the control group (F [1,68] = 14.13, p < .01). In line with this
finding, our clinical sample showed rating scale scores signifi-
cantly higher than the control group scores for the total TAS-20
score and for the TAS-20 F1 and F2 subscales; we did not find
significant differences between clinical group and control group
for the F3 scores (“Externally oriented Thinking”).
Exploratory and Confirmatory Factor Analysis support the
construct validity of the PTI-AS. In addition the PTI-AS has
been demonstrated to provide very good discriminant validity,
and it may be a useful diagnostic instrument in clinical contexts.
A limitation of the instrument is indicated by its low correla-
tions with the affective factors of the BVAQ, although accord-
Copyright © 2012 SciRes.
A. GORI ET AL.
Copyright © 2012 SciRes. 235
Correlation between the PTI-AS and the BVAQ factors.
Analyzing Verbalizing Identifying Emotionalizing Fantasizing Cognitive Affective Total
PTI-AS .29* .65** .44** –.12 –.07 .63** –.12 .40**
**p < .001; *p < .01.
ANOVA between the two groups.
N = 35 NON CLINICAL GROUP
N = 35
M SD M SD df F p
PTI-AS 13.69 4.57 10.26 2.86 1; 68 14.13 .01
TAS-20 54.57 11.94 44.37 11.92 1; 68 12.79 .01
F1 21.97 6.02 13.69 4.51 1; 68 42.45 .01
F2 15.54 4.58 13.29 4.67 1; 68 4.16 .05
F3 17.06 4.49 18.14 4.96 1; 68 .93 .34
ing with Parker et al. (2003) these additional affective charac-
teristics should be considered as correlates of alexithymia rather
than core features of the construct. For future studies it would
be useful to further investigate the psychometric properties of
the PTI-AS scale using a larger clinical sample and it would be
interesting to clarify the association between eating disorders
and alexithymia in order to assess the existence and the direc-
tion of possible cause-effect relationships.
Apfel, R. J., & Sifneos, P. E. (1979). Alexithymia: Concept and meas-
urement. Psychotherapy and Psychosomatics, 32, 180-190.
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994a) The twenty-
item alexithymia scale-I. Item selection and cross-validation of the
factor structure. Journal of Psychosomat i c Research, 38, 33-40.
Bagby, R. M., Taylor G. J., & Parker, J. D. A. (1994b). The twenty-ite-
current validity. Journal of Psychosomatic Research, 38, 33- 40.
Bagby, R. M., Taylor, G. J., Parker, J. D. A., & Dickens, S. E. (2006).
The development of the Toronto Structured Interview for Alexithy-
mia: Item selection, factor structure, reliability and concurrent valid-
ity. Psychotherapy and Psychosomatics, 75, 25-39.
Beales, D. L., & Dolton, R. (2000). Eating disordered patients: Per-
sonality, alexithymia and implication for primary care. British Jour-
nal of General Practice, 50, 21-26.
Bermond, B., Clayton, K., Liberova, A., Luminet, O., Maruszewski, T.,
Ricci Bitti, P., Rimé B., Vorst, H. C. M., Wagner, H., & Wicherts, J.
M. (2007). A cognitive and affective dimension of alexithymia in six
languages and seven populations. Cognitive and Emotion, 21, 1125-
Bermond, B., Oosterveld, P., & Vorst, H. C. M. (1994). Bermond-vorst
alexithymia questionnaire: Construction, validity and uni-dimensio-
nality. Internal Report, University of Amsterdam: Faculty of Psy-
chology, Department of Psychological Methods.
Berthoz, S., Perdereau F., Gokart, N., Colcos, M., & Haviland, M. G.
(2007). Observer- and self-rated alexithymia in eating disorders pa-
tients: Levels and correspondence among three measures. Journal of
Psychosomatic Research, 62, 341-347.
Bressi, C., Taylor, G. J., Parker, J. D. A., Bressi, S., Brambilla, V.,
Aguglia, E. et al. (1996). Cross validation of the factor structure of
the 20 item toronto alexithymia scale: An italian multicenter study.
Journal of Psychosomatic Re sea rch , 41, 551-559.
Cleland, C., Magura, S., Foote, J., Rosenblum, A., & Kosanke, N.
(2005). Psychometric properties of the Toronto Alexithymia Scale
(TAS-20) for substance user. Journal of Psychosomatic Research, 58,
Corcos, M., Guilbaud, O., Speranza, M., Paterniti, S., Loas, G., Stephan,
P. et al. (2000). Alexithymia and depression in eating disorders.
Psychiatry Research, 93, 263-266.
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of
tests. Psychometrika, 16, 297-334.
De Panfilis, C., Salvatore, P., Avanzini, M., Gariboldi, S., & Maggini,
C. (2001). Alexithymia in eating disorders: A personality disturbance?
Psichiatria e Psicoterapia Analitica, 20, 349-361.
De Rick, A., & Vanheule, S. (2007). Alexithymia and DSM-IV person-
ality disorder traits in alchoholic inpatients: A study of the relation
between both constructs. Personality and Individual Differences, 43,
Fava, G. A., Baldaro, B., & Osti, R. (1980). Toward a self-rating scale
for alexithymia. Psychotherapy and Psychosomatics, 34, 34-39.
Fava, G. A., Freyberger, H. J., Bech, P., Christodoulou, G., Sensky, T.,
Theorell, T., & Wise, T. N. (1995). Diagnostic criteria for use in psy-
chosomatic research. Psychotherapy and Psychosom at ics, 63, 1-8.
Garner, D. M. (2004). The eating disorder inventory-3 professional ma-
nual. Lutz, FL: Psychological Assessment Resources (Italian Version;
Giannini, M., Pannocchia, L., Dalle Grave, R., Muratori, F., & Vig-
lione, V. Eating Disorder Inventory-3. Manuale. Giunti OS—Orga-
nizzazioni Speciali: Firenze 2008).
Galeazzi, G. M., Ferrari, S., Mackinnon, A., & Rigatelli, M. (2004).
Interrater reliability, prevalence, and relation to ICD-10 diagnoses of
the Diagnostic Criteria for Psychosomatic Research in consultation-
liaison psychiatry patients. Psychosomatics, 45, 386-393.
Gori, A., Giannini, M., & Schuldberg, D. (2008). Mind and body to-
gether? A new measure for planning treatment and assessing psy-
chotherapy outcome. The International Meeting of the Society for the
Exploration of Psychotherapy Integration (SEPI), Boston, 4 May
Kessler, H., Schwarze, M., Filipic, S., Traue, H. C., & von Wietersheim,
J. (2006). Alexithymia and facial emotion recognition in patients
with eating disorders. International Journal of Eating Disorders, 39,
Kleiger, J. H., & Kinsman, R. A. (1980). The development of an MMPI
A. GORI ET AL.
Alexithymia Scale. Psychotherapy and Psychosomatics, 34, 17-24.
Kooiman, C. G., Spinhoven, P., &Trijsburg, R. W. (2002). The assess-
ment of alexithymia: A critical review of the literature and a psycho-
metric study of the Toronto Alexithymia Scale-20. Journal of Psy-
chosomatic Research, 53, 1083-1090.
Larsen, J. K., Brand, N., Bermond, B., & Hijman, R. (2003). Cognitive
and emotional characteristics of alexithmia. A review of neurobio-
logical studies. Journal of Psychosomatic Resea r ch , 54, 533-541.
Lumely, M. A., Neely, L. C. & Burger, A. J. (2007). The assessment of
alexithymia in medical settings: Implications for understanding and
treating health problems. Journal of Personality Assessment, 89, 230-
Mazzeo, S. E., & Espelage, D. L. (2002). Association between child-
hood physical and emotional abuse and disordered eating behaviors
in female undergraduates: An investigation of the mediating role of
alexithymia and depression. Journal of Counseling Psychology, 49,
Montebarocci, O., Codispoti, M., Surcinelli, P., Franzoni, E., Baldaro
B., & Rossi, N. (2006). Alexithymia in female patients with eating
disorders. Eating and Weight Disorders, 11, 14-21.
Müller, J., Bühner, M., & Ellgring, H. (2004). The assessment of alexi-
thymia: Psychometric properties and validity of the Bermond-Vorst
Alexithymia Questionnaire. Personality and Individual Differences,
37, 373-391. doi:10.1016/j.paid.2003.09.010
Nemiah, J. C., & Sifneos, P. E. (1970). Affects and fantasy in patients
with psychosomatic disorders. In O. Hill (Ed.), Modern trends in
psychosomatic medicine. London: Butterworths.
Nemiah, J. C., Freyberger, H., & Sifneos, P. E. (1976). Alexithymia: A
view of the psychosomatic process. In O. W. Hill (Ed.), Modern
trends in psychosomatic medicine (Vol. 3; pp. 430-439). London:
Pinaquy, S., Chabrol, H., Simon, C., Louvet, J. P., & Barbe, P. (2003).
Emotional eating, alexithymia, and binge-eating disorder in obese-
women. Obesity Research, 11, 195-201. doi:10.1038/oby.2003.31
Parker, J. D. A., Taylor, G J., & Bagby, R. M. (2003). The 20-Item
Toronto Alexithymia Scale III. Reliability and factorial validity in a
community population. Journal of Psychosomatic Research, 55,
Porcelli, P., Taylor, G. J., Bagby, R. M., & De Carne, M. (1999).
Alexithymia and gastrointestinal disorders. A comparison with in-
flammatory bowel disease. Psychotherapy and Psychosomatics, 68,
Porcelli, P., & De Carne, M. (2001). Criterion-related validity of the
diagnostic criteria for psychosomatic research for alexithymia in pa-
tients with functional gastrointestinal disorders. Psychotherapy &
Psychosomatics, 70, 184-188. doi:10.1159/000056251
Porcelli, P., De Carne, M., & Todarello, O. (2004). Prediction of treat-
ment outcome of patients with functional gastrointestinal disorders
by the diagnostic criteria for psychosomatic research. Psychotherapy
& Psychosomatics, 73, 166-173. doi:10.1159/000076454
Portincasa, P., Moschetta, A., Baldassarre, G., Altomare, D., & Pa-
lasciano, G. (2003). Pan-enteric dysmotility, impaired quality of life
and alexithymia in a large group of patients meeting ROME II crite-
ria for irritable bowel syndrome. World Journal of Gastroenterology,
Rafanelli, C., Roncuzzi, R., Finos, L., Tossani, E., Tomba, E., Mangelli,
L., Urbinati, S., Pinelli, G., & Fava, G. A. (2003). Psychological as-
sessment in cardiac rehabilitation. Psychotherapy and Psychosoma-
Ricci Bitti, P. E., & Codispoti, M. (2002). Alexithymia hedonic capac-
ity and dysphoria. The (non) expression of emotion. In: A. J. J. M.
Vigerhoets, & J. J. van Bussel (Eds.) Health and disease (pp. 32-34).
Tilburg: Bohelhouwer Faculteit Sociale Wetenschappen, Catholieke
Robins, R. W. Hendin, H. M., & Trzesniewski, K. H. (2001). Meas-
uring global self-esteem: construct validation of a single-item meas-
ure and the rosenberg self-esteem scale. Personality and Social Psy-
chology Bulletin, 27, 151-160. doi:10.1177/0146167201272002
Schermelleh-Engel, K., Moosbrugger, H., & Muller H. (2003). Evalu-
ating the fit of structural equation models: Tests of significance and
goodness-of-fit models. Methods of Psychological Research Online,
Sifneos, P. E. (1973). The prevalence of “alexithymic” characteristics
in psychosomatic patients. Psychotherapy and Psychosomatics, 22,
Sifneos, P. E. (1986). The schalling-sifneos personality scale-revised.
Psychotherapy and Psychosomatics, 45, 161-165.
Speranza, M., Corcos, M., Loas, G, Stephan, P., Guilbaud, O., Peretz-
Diaz, F. et al. (2005). Depressive personality dimensions and alexi-
thymia in eating disorders. Psychiatry Research, 135, 153-163.
Spitzer, C., Vogel., M., Barnow, S., Freyberger, H. J., & Grabe, H. J.
(2007). Psychopathology and alexithymia in severe mental illness:
the impact of trauma and posttraumatic stress symptoms. European
Archives of Psychiarty and Cli n c al Neuroscience, 257, 191-196.
Taylor, G. J., Ryan, J. D. A., & Bagby, R. M. (1985). Toward the de-
velopment of a new self-report alexithymia scale. Psychotherapy and
Psychosomatics, 44, 191-199. doi:10.1159/000287912
Taylor, G. J., & Taylor, H. L. (1997). Alexihymia. In M. McCallum &
W. Piper (Ed.). Psychological mindedness. Hillsdale, NJ: Erlbaum.
Taylor, G. J., Bagby, R. M., & Luminet, O. (2000). Assessment of
Alexithymia: self-report and observer-rated measures. In J. D. A.
Parker & R. Bar-On (Eds.), The handbook of emotional intelligence
(pp. 301-319). San Francisco, CA: Jossey Bass.
Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of
affect regulation: Alexithymia in medical and psychiatric illness.
Cambridge University Press: Cambridge.
Vorst H. C. M., & Bermond B. (2001). Validity and reliability of the
bermond-vorst alexithymia questionnaire. Personality and Individual
Differences, 30, 413-434. doi:10.1016/S0191-8869(00)00033-7
Zech, E., Luminet, O., Rimé, B., & Wagner, H (1999). Alexithymia and
its measurement: Confirmatory factor analyses of the 20-item toronto
alexithymia scale and the bermon-vorst alexithymia questionnaire.
European Journal of P e rs o na l i ty , 13 , 511-532.
Zlotnick, C., Mattia, J. I., & Zimmerman, M. (2001). The relationship
between posttraumatic stress disorders, childhood trauma and alex-
ithymia in an outpatient sample. Journal of Traumatic Stress, 14,
Zonneyville-Bender, M. J., van Goozen, S. H. M., Cohen-Kettenis, P.
T., van Elburg, A., & van Engeland, H. (2002). Do adolescent ano-
rexia nervosa patients have deficits in emotional functioning? Euro-
pean Child & Adolescent Psychiatry, 11, 38-42.
Copyright © 2012 SciRes.