Mattias Desmet

Factorial Validity and Measurement Invariance of the 20-Item Toronto Alexithymia Scale in Clinical and Nonclinical Samples

The most widely used instrument to measure alexithymia is the 20-item Toronto Alexithymia Scale (TAS-20). However, different factor structures have been found in different languages. This study tests six published factor models and metric invariance across clinical and nonclinical samples. It also investigated whether there is a method effect of the negatively keyed items. Second-order models with alexithymia as a higher order factor are tested. Confirmatory factor analyses showed that the original factor model with three factors—difficulty identifying feelings (DIF); difficulty describing feelings (DDF) and externally oriented thinking (EOT)—is the best fitting model. Partial measurement invariance across samples was illustrated but requires further study. A weakness of the model is the low internal consistency of the third factor. Because models with a method factor had a better fit, future reconsideration of the negatively formulated items seems necessary. No evidence was found for the second-order models.

The Factorial Structure of the Dutch Translation of the Inventory of Interpersonal Problems: A Test of the Long and Short Versions

In this article, the authors study the factorial structure of 2 versions (64 items and 32 items) of the Dutch translation of the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, L. E. Alden, J. S. Wiggins, & A. L. Pincus, 2000) in both a clinical sample (n = 382) and a student sample (n = 287). First, the authors test whether both inventories are constituted by correlated uni-dimensional subscales, and they conclude that this is true only for the short version. Second, the authors study whether the correlations between the subscales follow a circumplex pattern. This proves to be true for both versions. Coefficients alpha and correlations between the IIP-64 and IIP-32 subscales are discussed.

Relationship Patterns in Alexithymia: A Study Using the Core Conflictual Relationship Theme Method

Background: Alexithymia is a disturbance in regulating affective states. Clinical observations suggest that alexithymic patients relate to others in a specific way. This paper explores whether specific relationship or transference patterns are typical of alexithymia. Sampling and Methods: Relationship patterns were assessed by means of the Core Conflictual Relationship Theme method, standard categories version. This method examines transference patterns and was applied to clinical interview data collected from a sample (n = 31) of mental health outpatients. Alexithymia was assessed by means of a score on the 20-item Toronto Alexithymia Scale corrected for the degree of depression (measured by the Beck Depression Inventory-II). Data were analysed by means of the leaps and bounds regression algorithm for selecting optimal subsets of indicators and by bootstrapping to determine 95% confidence intervals. Results: First, we observed that alexithymia can be meaningfully explained by typical wishes, typical subjective perceptions of how others respond and one’s own typical responses to others. This result indicates that the more marked a patient’s alexithymic traits are, the more probable it is that specific transference themes come to the fore. Second, a set of three core indicators of trait alexithymia was mapped: little concern about being good to others, a strong perception of others as cooperative, and weak levels of reacting to others and to conflict by means of somatic symptoms. Conclusion: Alexithymia is related to a double interpersonal indifference: not much is expected from others, nor is there a personal urge to fulfill the expectations of others. Moreover, in alexithymia somatic symptoms proved to be non-reactive to interpersonal situations. Implications for diagnosis and treatment are highlighted. Limitations of our study are that alexithymia was only assessed with a self-report measure and that conclusions are based only upon data from a heterogeneous mental health sample.

Interpersonal problems in alexithymia: A study in three primary care groups

OBJECTIVES The present study investigated the relation between alexithymia and interpersonal problems in a sample of primary care patients with either chronic fatigue syndrome (CFS); a chronic cardiovascular or auto-immune disease; or a minor medical condition. It was hypothesized that the relation between cold interpersonal functioning would account for the differences in alexithymia scores between the patient groups. DESIGN AND METHODS Participants were 155 primary care patients that were recruited through 52 general practitioners: 52 CFS patients; 52 patients with a chronic cardiovascular or auto-immune disease; 51 patients with a minor medical condition. Interpersonal problems were assessed by means of the Inventory of Interpersonal Problems and alexithymia was assessed by means of the Toronto Alexithymia Scale. RESULTS CFS patients and patients with a chronic cardiovascular or auto-immune disease have substantially higher alexithymia scores than patients with a minor medical condition. Alexithymia is positively related to cold and distant interpersonal functioning; negatively related to self-sacrificing and overly accommodating in relation to others; and positively related to vindictiveness and self-centredness. The relation between alexithymia and these interpersonal problems accounts for the differences in alexithymia scores between the patient groups. CONCLUSIONS Alexithymia and interpersonal problems should be considered together, in terms of one deficient affect regulatory system, and the relation between alexithymia and specific illness conditions is secondary to this. Clinical assessment of patients with problems in naming and discussing affective states should never be isolated from an examination of their interpersonal problems, and vice versa. Mentalization-based therapy is recommended for patients with problems in naming affective states, interpersonal problems, and concomitant CFS or other alexithymia-related diseases.

Alexithymia, social detachment and cognitive processing

Using lexical content analysis (linguistic inquiry and word count), the hypotheses that social detachment and impaired cognitive processing are typical for alexithymia are investigated. Based on clinical interviews with 32 outpatients (mixed diagnoses), we found support for the hypotheses for the externally oriented thinking facet of alexithymia only.

Personality Disorders in a Sample of Paraphilic and Nonparaphilic Child Molesters

This article renders the results of research that investigated personality disorders in a sample of paraphilic and nonparaphilic child molesters. The sample contained 36 paraphilic child molesters and a matched comparison group of 34 nonparaphilic child molesters. The analyses of the research results show that four personality disorders discriminate between both groups. Only the obsessive-compulsive personality disorder contributes significantly to the explanation of paraphilic child molestation. This result also contributes to the development and differentiation of the treatment of paraphilia-related disorders. For several child molesters, psychological approaches to the treatment of sexual offending (e.g., cognitive—behavioral treatment, psychotherapy in general) are limited and cannot be expected to immediately reduce risk. Interest has been expressed in medical approaches to reduce recidivism, in combination with psychotherapy.

The Observer Alexithymia Scale: A Reliable and Valid Alternative for Alexithymia Measurement?

In this study, we evaluated the reliability and validity of the Dutch version of the Observer Alexithymia Scale (OAS; Haviland, Warren, & Riggs, 2000) while addressing shortcomings of earlier research. Internal consistency and test–retest reliability were found to be adequate, whereas interrater reliability was insufficient. The original five-factor model (Distant, Uninsightful, Somatizing, Humorless, Rigid) with item parcels showed excellent fit, indicating adequate translation. Alternative models were tested to overcome problems with the parcel method, and all showed poor fit. OAS total scores correlated .23 with the 20-item Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994; Bagby, Taylor, & Parker, 1994) and .50 with the Toronto Structured Interview for Alexithymia (Bagby, Taylor, Parker, & Dickens, 2006). These problematic results on validity compromise the use of the OAS as an alexithymia measure.

Psychoanalytic Single Cases Published in ISI-Ranked Journals: The Construction of an Online Archive

nique (e.g. music therapy, bodypacking, wilderness therapy, etc. were not included), (3) the case study is either the focus of the article or an illustrative vignette of sufficient size (more than 50% of the publication or longer than five pages), (4) the case study is written in English, French, or German, and (5) the case study presents an original analysis of therapeutic data. Four hundred and fifty-three cases were selected according to these criteria. The full text of 8 cases could not be obtained. The full texts of the remaining 445 articles were screened with the Inventory of Basic Information in Single Cases (IBISC), an ad hoc constructed inventory that assesses the presence of basic information on research method, patient, therapist, and therapy. The IBISC, the IBISC manual, and the full results of the screening are available at www.singlecasearchive.com. What follows is a concise overview of salient results of the screening.

Interpersonal problems and cognitive characteristics of interpersonal representations in Alexithymia: a study using a self-report and interview-based measure of Alexithymia

Abstract In this study, associations between alexithymia, interpersonal problems, and cognitive-structural aspects of internal interpersonal representations were examined. Alexithymia was measured using the Toronto Structured Interview for Alexithymia (TSIA) and the 20-item Toronto Alexithymia Scale (TAS-20). To measure interpersonal problems, the dominance and affiliation dimension scores of the Inventory of Interpersonal Problems were used, and cognitive-structural characteristics of interpersonal representations were measured using the Social Cognition and Object Relations Scale (SCORS). As hypothesized, alexithymia was related to cold and withdrawn, but not to dominant or submissive, interpersonal functioning. In terms of the SCORS, alexithymia was negatively related to complexity of interpersonal representations, both in TAT and in interview narratives, indicating a link between alexithymia and mentalization. However, alexithymia was related only to the dimension of social causality when this dimension was scored on TAT narratives. Overall, the TSIA provides the most consistent and stable results after controlling for negative affectivity.

Alexithymia and core conflictual relationship themes: A study in a chronically fatigued primary care population

Objective: Clinical studies have indicated that concomitant to problems with affect regulation interpersonal problems can be observed in alexithymic patients. We test whether this is the case, and determine a parsimonious set of typical relationship themes. Method: Relationship themes were assessed by means of the Core Conflictual Relationship Theme (CCRT) method. This method examines transference patterns, and was applied to clinical interview data collected from a sample (n = 30) of chronically fatigued primary care patients. Alexithymia was assessed by means of a score on the 20-item Toronto Alexithymia Scale. The data were analyzed by means of the leaps and bounds regression algorithm for selecting optimal subsets of indicators, and by bootstrapping to determine 95% confidence intervals. Results: Alexithymia can be meaningfully explained by typical relationship themes. A set of two wishes and one response of the self to the other that is most representative of alexithymia was mapped. The wishes demonstrate that the more alexithymic someone is, the less likely it is that this person wishes to be helped by others and the less likely it is that he/she interacts with others in order to feel good about him/herself. The selected response of the self indicates that it is typical of alexithymia that interactions with others do not result in good or happy feelings. Conclusion: Linking alexithymia to typical relationship themes is valid. Limitations of the study are indicated.