Non-Suicidal Self-Injury (NSSI) and risky drinking have a shared emotion regulatory function. Alexithymia is an important risk factor for both behaviors. However, it is conceivable that the emotional processing difficulties thought to underlie both behaviors may contribute to differences between people who self-injure or drink in a risky fashion, and those who do not, when interpreting alexithymia items on self-report questionnaires. Therefore, measurement invariance should be established before attributing scale score differences between groups to true differences in alexithymia. We examined the validity, factor structure, and measurement invariance of the Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) among 640 university students (Mage = 20.39, SD = 1.86) with and without histories of NSSI and risky drinking. The original factor structure of the TAS-20 was not supported; however, the addition of a reverse-scored item method factor improved fit. The intended five-factor model of the PAQ was supported. We found configural, full metric, and full scalar invariance for the PAQ and a revised-TAS-20. Both the PAQ and TAS-20 demonstrated good concurrent, convergent, and discriminate validity. Our results suggest that all subscales of the PAQ and the difficulties identifying feelings and difficulties describing feelings subscales of the TAS-20 can be used confidently to discern differences in alexithymia in the context of NSSI and risky drinking. However, the externally orientated thinking subscale of the TAS-20 had poor internal consistency and several inadequate factor loadings. We discuss the utility of the externally orientated thinking subscale (TAS-20).
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Early theoretical models included a fourth component of alexithymia, difficulty fantasising, whereby the individual has limited imagination and a lack of ability fantasise (Sifneos 1973). However, there is continuing debate about the inclusion of this component in the construct (Watters et al. 2016), and most measures of alexithymia do not measure it.
The authors of the PAQ (Preece et al. 2018b) give the following explanation for having a general externally orientated thinking scale rather than a valence-specific scale: “Emotional valence is of most relevance when attempting to assess functioning at the appraisal stage of emotional valuation (i.e., DIF and DDF) because, theoretically speaking, it is not until the appraisal stage of emotion valuation that a valence judgement is made (Gross 2015; Ochsner and Gross 2014; Preece et al. 2017). It is, hence, less appropriate to include valence when attempting to isolate the earlier attention stage (i.e., EOT)” (Preece et al. 2018b, p. 34).
Allemand, M., Steiger, A. E., & Hill, P. L. (2013). Stability of personality traits in adulthood. Geriatric Psychiatry, 26, 5–13. https://doi.org/10.1024/1662-9647/a000080.
Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., & Cuijpers, P. (2018). WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127, 623–628. https://doi.org/10.1037/abn0000362.
Australian Institute of Health and Welfare. (2016). National Drug Strategy Household Survey detailed report 2016. Drug statistics series no. 31. Cat. No. PHE 214. Canberra: AIHW.
Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). Twenty-item Toronto alexithymia scale: II. Convergent, discriminant, and concurrent validity. Journal of Psychometric Research, 38, 33–40. https://doi.org/10.1037/t01318-000.
Bagby, R. M., Taylor, G. J., Parker, J. D., & Dickens, S. E. (2006). The development of the Toronto structured interview for alexithymia: Item selection, factor structure, reliability and concurrent validity. Psychotherapy and Psychosomatics, 75, 25–39. https://doi.org/10.1159/000089224.
Becerra, R., Preece, D., Campitelli, G., & Scott-Pillow, G. (2017). The assessment of emotional reactivity across negative and positive emotions: Development and validation of the Perth emotional reactivity scale (PERS). Assessment, 26, 1–13. https://doi.org/10.7319/1117694455.
Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). New York: Guildford Press.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371–394. https://doi.org/10.1016/j.brat.2005.03.005.
Chen, F. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14, 464–504. https://doi.org/10.1080/10705510701301834.
Cohen, J. (1977). Statistical power analysis for the social sciences. New York: Academic Press.
Cox, W. M., & Klinger, E. (1988). Motivational determinants of alcohol use. Journal of Abnormal Psychology, 97, 168–180. https://doi.org/10.1016/0091-3057(90)90431-g.
Degenhardt, L. J., Conigrave, K. M., Wutzke, S. E., & Saunders, J. B. (2001). The validity of an Australian modification of the AUDIT questionnaire. Drug and Alcohol Review, 20, 143–154. https://doi.org/10.1080/09595230124592.
George, D., & Mallery, M. (2010). SPSS for Windows step by step: A simple guide and reference, 17.0 update (10th ed.). Boston: Pearson.
Gignac, G. E., Palmer, B. R., & Stough, C. (2007). A confirmatory factor analytic investigation of the TAS–20: Corroboration of a five-factor model and suggestions for improvement. Journal of Personality Assessment, 89, 247–257. https://doi.org/10.1080/00223890701629730.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. https://doi.org/10.1023/b:joba.0000007455.08539.94.
Greene, D., Boyes, M., & Hasking, P. (2020). The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis. Journal of Affective Disorders, in press., 260, 140–166. https://doi.org/10.1016/j.jad.2019.08.088.
Gross, J. J. (2015). The extended process model of emotion regulation: Elaborations, applications, and future directions. Psychological Inquiry, 26, 130–137. https://doi.org/10.1080/1047840x.2015.989751.
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362. https://doi.org/10.1037/0022-3522.214.171.1248.
Groth-Marnat, G. (2009). Handbook of psychological assessment. Hoboken: Wiley.
Haviland, M. G., & Reise, S. P. (1996). Structure of the twenty-item Toronto alexithymia scale. Journal of Personality Assessment, 66, 116–125.
Haviland, M. G., Warren, W. L., & Riggs, M. L. (2000). An observer scale to measure alexithymia. Psychosomatics, 41, 385–392. https://doi.org/10.1176/appi.psy.41.5.385.
Hays, R. D., Merz, J. F., & Nicholas, R. (1995). Response burden, reliability, and validity of the CAGE, short MAST, and AUDIT alcohol screening measures. Behavior Research Methods, Instruments, & Computers, 27, 277–280. https://doi.org/10.3758/bf03204745.
International Society for the Study of Self-injury. (2018). What is self-injury? Retrieved from: https://itriples.org/about-self-injury/what-is-self-injury.
Kiekens, G., Hasking, P., & Boyes, M. (2018a). Measurement invariance of three brief emotion regulation questionnaires in people with and without a history of non-suicidal self-injury. European Journal of Psychological Assessment, 35, 1–7. https://doi.org/10.1027/1015-5759/a000464.
Kiekens, G., Hasking, P., Claes, L., Mortier, P., Auerbach, R., Boyes, M., et al. (2018b). The DSM-5 non-suicidal self-injury disorder among incoming college freshmen: Prevalence and association with mental disorders and suicidal thoughts and behaviours. Depression and Anxiety, 35, 629–637. https://doi.org/10.1002/da.22754.
Klonsky, E. D., & Glenn, C. R. (2008). Assessing the functions of non-suicidal self-injury: Psychometric properties of the inventory of statements about self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31, 215–219. https://doi.org/10.1007/s10862-008-9107-z.
Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis. Journal of Consulting and Clinical Psychology, 76, 22–27. https://doi.org/10.1037/0022-006x.76.1.22.
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959–976.
Jungmann, S. M., Vollmer, N., Selby, E. A., & Witthöft, M. (2016). Understanding dysregulated behaviors and compulsions: An extension of the emotional cascade model and the mediating role of intrusive thoughts. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.00994.
Lumley, 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, 230–246. https://doi.org/10.1080/00223890701629698.
Martins, J. S., Bartholow, B. D., Cooper, M. L., Von Gunten, C. D., & Wood, P. K. (2018). Associations between executive functioning, affect-regulation drinking motives, and alcohol use and problems. Psychology of Addictive Behaviors, 32, 16–28. https://doi.org/10.1037/adb0000324.
Meganck, R., Vanheule, S., & Desmet, M. (2008). Factorial validity and measurement invariance of the 20-item Toronto alexithymia scale in clinical and nonclinical samples. Assessment, 15, 36–47. https://doi.org/10.1177/1073191107306140.
Muthen, L. K., & Muthen, B. O. (2017). Mplus version 8 user’s guide. Los Angeles: Muthen & Muthen.
Netemeyer, R. G., Bearden, W. O., & Sharma, S. (2003). Scaling procedures: Issues and applications. Thousand Oaks: SAGE.
Ochsner, K. N., & Gross, J. J. (2014). The neural bases of emotion and emotion regulation: A valuation perspective. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 23–42). Guilford Press.
Pandey, R., Saxena, P., & Dubey, A. (2011). Emotion regulation difficulties in alexithymia and mental health. Europe’s Journal of Psychology, 7, 604–623. https://doi.org/10.5964/ejop.v7i4.155.
Preece, D., Becerra, R., Allan, A., Robinson, K., & Dandy, J. (2017). Establishing the theoretical components of alexithymia via factor analysis: Introduction and validation of the attention-appraisal model of alexithymia. Personality and Individual Differences, 119, 341–352.
Preece, D. A., Becerra, R., Boyes, M. E., Northcott, C., McGillivray, L., & Hasking, P. A. (2019). Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples. Personality and Individual Differences, 155, 109721. https://doi.org/10.1016/j.paid.2019.109721.
Preece, D., Becerra, R., Robinson, K., & Dandy, J. (2018a). Assessing alexithymia: Psychometric properties and factorial invariance of the 20-item Toronto alexithymia scale in nonclinical and psychiatric samples. Journal of Psychopathology and Behavioral Assessment, 40, 276–287. https://doi.org/10.1007/s10862-017-9634-6.
Preece, D., Becerra, R., Robinson, K., Dandy, J., & Allan, A. (2018b). The psychometric assessment of alexithymia: Development and validation of the Perth alexithymia questionnaire. Personality and Individual Differences, 132, 32–44. https://doi.org/10.1016/j.paid.2018.05.011.
Preece, D. A., Becerra, R., Boyes, M. E., Northcott, C., McGillivray, L., & Hasking, P. A. (2020). Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples. Personality and Individual Differences, 155, 109721.
Ripper, C. A., Boyes, M. E., Clarke, P. J., & Hasking, P. A. (2018). Emotional reactivity, intensity, and perseveration: Independent dimensions of trait affect and associations with depression, anxiety, and stress symptoms. Personality and Individual Differences, 121, 93–99. https://doi.org/10.1016/j.paid.2017.09.032.
Roche, A. M., & Watt, A. M. (1999). Drinking and university students: from celebration to inebriation. Drug and Alcohol Review, 18, 389–399. https://doi.org/10.1080/09595239996257.
Rufer, M., Albrecht, R., Zaum, J., Schnyder, U., Mueller-Pfeiffer, C., Hand, I., & Schmidt, O. (2010). Impact of alexithymia on treatment outcome: A naturalistic study of short-term cognitive-behavioral group therapy for panic disorder. Psychopathology, 43, 170–179. https://doi.org/10.1159/000288639.
Sass, D. (2011). Testing measurement invariance and comparing latent factor means within a confirmatory factor analysis framework. Journal of Psychoeducational Assessment, 29, 347–363.
Selby, E. A., & Joiner, T. E. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13, 219–229. https://doi.org/10.1037/a0015687.
Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262.
Stevens, J. P. (1992). Applied multivariate statistics for social sciences. Hillsdale: Erlbaum.
Suárez-Alvarez, J., Pedrosa, I., Lozano, L., García-Cueto, E., Cuesta, M., & Muñiz, J. (2018). Using reversed items in Likert scales: A questionable practice. Psicothema, 30(2), 149–158. https://doi.org/10.7334/psicothema2018.33.
Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-threatening Behavior, 44, 273–303. https://doi.org/10.1111/sltb.12070.
Swart, M., Kortekaas, R., & Aleman, A. (2009). Dealing with feelings: Characterization of trait alexithymia on emotion regulation strategies and cognitive-emotional processing. Public Library of Science ONE, 4, e5751. https://doi.org/10.1371/journal.pone.0005751.
Taylor, G. J. (1994). The alexithymia construct: Conceptualization, validation, and relationship with basic dimensions of personality. New Trends in Experimental & Clinical Psychiatry, 10, 61–74.
Taylor, G. J. (2000). Recent developments in alexithymia theory and research. The Canadian Journal of Psychiatry, 45, 134–142. https://doi.org/10.1177/070674370004500203.
Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759–769. https://doi.org/10.1016/j.jad.2017.11.073.
Thorberg, F. A., Young, R. M., Sullivan, K. A., Lyvers, M., Hurst, C., Connor, J. P., & Feeney, G. F. (2010). A confirmatory factor analysis of the Toronto alexithymia scale (TAS-20) in an alcohol-dependent sample. Psychiatry Research, 178, 565–567. https://doi.org/10.1016/j.psychres.2009.09.015.
Tuliao, A. P., Klanecky, A. K., Landoy, B. V., & McChargue, D. E. (2019). Toronto alexithymia scale–20: Examining 18 competing factor structure solutions in a U.S. sample and a Philippines sample. Assessment. https://doi.org/10.1177/1073191118824030.
Vandenberg, R. J., & Lance, C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3, 4–70. https://doi.org/10.1177/109442810031002.
van der Velde, J., Servaas, M. N., Goerlich, K. S., Bruggeman, R., Horton, P., Costafreda, S. G., & Aleman, A. (2013). Neural correlates of alexithymia: A meta-analysis of emotion processing studies. Neuroscience & Biobehavioral Reviews, 37, 1774–1785. https://doi.org/10.1016/j.neubiorev.2013.07.008.
Vorst, H. C., & Bermond, B. (2001). Validity and reliability of the Bermond–Vorst alexithymia questionnaire. Personality and Individual Differences, 30(3), 413–434. https://doi.org/10.1016/S0191-8869(00)00033-7.
Watters, C., Taylor, G. J., Ayearst, L., & Bagby, R. M. (2016). Measurement invariance of the English and French language versions of the 20-item Toronto alexithymia scale. European Journal of Psychological Assessment, 1–8. https://doi.org/10.1027/1015- 5759/a000365.
Weiss, N. H., Gratz, K. L., & Lavender, J. M. (2015). Factor structure and initial validation of a multidimensional measure of difficulties in the regulation of positive emotions: The DERS-positive. Behavior Modification, 39, 431–453. https://doi.org/10.1177/0145445514566504.
Wolff, J. C., Thompson, E., Thomas, S. A., Nesi, J., Bettis, A. H., Ransford, B., Scopelliti, K., Frazier, E. A., & Liu, R. T. (2019). Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. European Psychiatry, 59, 25–36. https://doi.org/10.1016/j.eurpsy.2019.03.004.
World Health Organization. (2014). Global status report on alcohol and health, 2014. Geneva: WHO.
Zhu, X., Yi, J., Yao, S., Ryder, A. G., Taylor, G. J., & Bagby, R. M. (2007). Cross-cultural validation of a Chinese translation of the 20-item Toronto alexithymia scale. Comprehensive Psychiatry, 48, 489–496. https://doi.org/10.1016/j.comppsych.2007.04.007.
Zou, C., Plaks, J. E., & Peterson, J. B. (2017). Don’t get too excited: Assessing individual differences in the down-regulation of positive emotions. Journal of Personality Assessment, 101, 1–11. https://doi.org/10.1080/00223891.2017.1339711.
Danyelle Greene acknowledges support from the Australian Government Research Training Programme (RTP).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Conflict of Interest
Danyelle Greene, Penelope Hasking, Mark Boyes and David Preece declare that they have no conflicts of interest.
This study was approved by the Curtin University Human Research Ethics Committee (HREC). Informed consent was obtained from all participants.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Greene, D., Hasking, P., Boyes, M. et al. Measurement Invariance of Two Measures of Alexithymia in Students Who Do and Who Do Not Engage in Non-suicidal Self-Injury and Risky Drinking. J Psychopathol Behav Assess 42, 808–825 (2020). https://doi.org/10.1007/s10862-020-09806-7
- Non-suicidal self-injury
- Risky drinking
- Measurement invariance
- Emotion regulation