Advertisement

Factorial Validity of the Toronto Alexithymia Scale (TAS-20) in Clinical Samples: A Critical Examination of the Literature and a Psychometric Study in Anorexia Nervosa

  • Sandra Torres
  • Marina P. Guerra
  • Kylee Miller
  • Patrício Costa
  • Inês Cruz
  • Filipa M. Vieira
  • Isabel Brandão
  • António Roma-Torres
  • Magda Rocha
Article
First Online:

Abstract

There is extensive use of the 20-item Toronto Alexithymia Scale (TAS-20) in research and clinical practice in anorexia nervosa (AN), though it is not empirically established in this population. This study aims to examine the factorial validity of the TAS-20 in a Portuguese AN sample (N = 125), testing four different models (ranging from 1 to 4 factors) that were identified in critical examination of existing factor analytic studies. Results of confirmatory factor analysis (CFA) suggested that the three-factor solution, measuring difficulty identifying (DIF) and describing feelings (DDF), and externally oriented thinking (EOT), was the best fitting model. The quality of measurement improves if two EOT items (16 and 18) are eliminated. Internal consistency of EOT was low and decreased with age. The results provide support for the factorial validity of the TAS-20 in AN. Nevertheless, the measurement of EOT requires some caution and may be problematic in AN adolescents.

Keywords

Alexithymia Factor structure Clinical samples Anorexia nervosa Confirmatory factor analysis 
This is a preview of subscription content, log in to check access.

Notes

Funding

This work was funded by the Center for Psychology at the University of Porto, Portuguese Science Foundation (FCT UID/PSI/00050/2013) and EU FEDER through COMPETE 2020 program (POCI-01-0145-FEDER-007294).

Compliance with Ethical Standards

Conflict of interest

The authors Sandra Torres, Marina Prista Guerra, Kylee Miller, Patrício Costa, Inês Cruz, Filipa M. Vieira, Isabel Brandão, António Roma-Torres, and Magda Rocha declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures were in accordance with the ethical standards of the institutional research committees 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.

Supplementary material

10880_2018_9562_MOESM1_ESM.docx (42 kb)
Supplementary material 1 (DOCX 42 KB)

References

  1. Acquash, H. D. (2013). On the comparison of Akaike information criterion and consistent Akaike information criterion in selection of asymmetric price relationships: Bootstrap simulation results. Agris On-line Papers in Economics and Informatics, 5, 3–9.Google Scholar
  2. Akaike, H. (1987). Factor analysis and AIC. Psychometrika, 52, 317–332.  https://doi.org/10.1007/bf02294359.CrossRefGoogle Scholar
  3. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed., text revision Washington, DC: Author.Google Scholar
  4. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRefGoogle Scholar
  5. Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.  https://doi.org/10.1016/0022-3999(94)90005-1.CrossRefPubMedGoogle Scholar
  6. Balottin, L., Nacinovich, R., Bomba, M., & Mannarini, S. (2014). Alexithymia in parents and adolescent anorexic daughters: Comparing the responses to TSIA and TAS-20 scales. Neuropsychiatric Disease and Treatment, 10, 1941–1951.  https://doi.org/10.2147/NDT.S67642.PubMedPubMedCentralGoogle Scholar
  7. Barrett, P. (2007). Structural equation modelling: Adjudging model fit. Personality and Individual Differences, 42, 815–824.  https://doi.org/10.1016/j.paid.2006.09.018.CrossRefGoogle Scholar
  8. Beadle, J. N., Paradiso, S., Salerno, A., & McCormick, L. M. (2013). Alexithymia, emotional empathy, and self-regulation in anorexia aervosa. Annals of Clinical Psychiatry, 25, 107–120.PubMedPubMedCentralGoogle Scholar
  9. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246.PubMedCrossRefGoogle Scholar
  10. Bentler, P. M. (1995). EQS structural equations program manual. Encino, CA: Multivariate Software.Google Scholar
  11. Besharat, M. A., Rostami, R., Pourhosein, R., & Mirzamani, M. (2006). Assessing reliability and validity of Farsi version of the Toronto Alexithymia Scale-20 in a sample of opioid substance use disordered patients. Iranian Journal of Psychiatry, 1, 133–139.Google Scholar
  12. Bourke, M. P., Taylor, G. J., Parker, J. D. A., & Bagby, R. M. (1992). Alexithymia in women with anorexia nervosa: A preliminary investigation. British Journal of Psychiatry, 161, 240–243.PubMedCrossRefGoogle Scholar
  13. Bozdogan, H. (1987). Model selection and Akaike’s information criterion (AIC): The general theory and its analytical extensions. Psychometrika, 52, 345–370.CrossRefGoogle Scholar
  14. Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., … Invernizzi, G. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study. Journal of Psychosomatic Research, 41, 551–559.  https://doi.org/10.1016/S0022-3999(96)00228-0.CrossRefPubMedGoogle Scholar
  15. Briggs, S. R., & Cheek, J. M. (1986). The role of factor analysis in the development and evaluation of personality scales. Journal of Personality, 54, 106–148.  https://doi.org/10.1111/j.1467-6494.1986.tb00391.x.CrossRefGoogle Scholar
  16. Brockmeyer, T., Holtforth, M. G., Bents, H., Kämmerer, A., Herzog, W., & Friederich, H.-C. (2012). Starvation and emotion regulation in anorexia nervosa. Comprehensive Psychiatry, 53, 496–501.  https://doi.org/10.1016/j.comppsych.2011.09.003.CrossRefPubMedGoogle Scholar
  17. Brown, T. A., Holland, L. A., & Keel, P. K. (2014). Comparing operational definitions of DSM-5 anorexia nervosa for research contexts. International Journal of Eating Disorders, 47, 76–84.  https://doi.org/10.1002/eat.22184.CrossRefPubMedGoogle Scholar
  18. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Beverly Hills, CA: Sage.Google Scholar
  19. Byrne, B. M. (2010). Structural equation modelling with AMOS: Basic concepts, applications, and programming (2nd ed.). New York: Routledge.Google Scholar
  20. Caglar-Nazali, H. P., Corfield, F., Cardi, V., Ambwani, S., Leppanen, J., Olabintan, O., … Treasure, J. (2014). A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders. Neuroscience and Biobehavioral Reviews, 42, 55–92.  https://doi.org/10.1016/j.neubiorev.2013.12.002.CrossRefPubMedGoogle Scholar
  21. Cleland, C., Magura, S., Foote, J., Rosenblum, A., & Kosanke, N. (2005). Psychometric properties of the Toronto Alexithymia Scale (TAS-20) for substance users. Journal of Psychosomatic Research, 58, 299–306.  https://doi.org/10.1016/j.jpsychores.2004.11.002.CrossRefPubMedGoogle Scholar
  22. Clinton, D. (2006). Affect regulation, object relations and the central symptoms of eating disorders. European Eating Disorders Review, 14, 203–211.  https://doi.org/10.1002/erv.710.CrossRefGoogle Scholar
  23. Costello, A. B., & Osborne, J. W. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment Research & Evaluation, 10, 1–9.Google Scholar
  24. Courty, A., Godart, N., Lalanne, C., & Berthoz, S. (2015). Alexithymia, a compounding factor for eating and social avoidance symptoms in anorexia nervosa. Comprehensive Psychiatry, 56, 217–228.  https://doi.org/10.1016/j.comppsych.2014.09.011.CrossRefPubMedGoogle Scholar
  25. Dahl, R. E. (2004). Adolescent brain development: A period of vulnerabilities and opportunities. Keynote address. Annals of the New York Academy of Sciences, 1021, 1–22.  https://doi.org/10.1196/annals.1308.001.CrossRefPubMedGoogle Scholar
  26. Dahlgren, C. L., & Wisting, L. (2016). Transitioning from DSM-IV to DSM-5: A systematic review of eating disorder prevalence assessment. International Journal of Eating Disorders, 49, 975–997.  https://doi.org/10.1002/eat.22596.CrossRefGoogle Scholar
  27. Dayton, C. M. (2003). Model comparisons using information measures. Journal of Modern Applied Statistical Models, 2, 281–292.CrossRefGoogle Scholar
  28. De Gucht, V., & Heiser, W. (2003). Alexithymia and somatisation: A quantitative review of the literature. Journal of Psychosomatic Research, 54, 425–434.  https://doi.org/10.1016/S0022-3999(02)00467-1.CrossRefPubMedGoogle Scholar
  29. Erni, T., Lötscher, K., & Modestin, J. (1997). Two-factor solution of the 20-item Toronto Alexithymia Scale confirmed. Psychopathology, 30, 335–340.  https://doi.org/10.1159/000285079.CrossRefPubMedGoogle Scholar
  30. Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.  https://doi.org/10.1016/S0005-7967(02)00088-8.CrossRefPubMedGoogle Scholar
  31. Fernández-Jiménez, E., Pérez-San-Gregorio, M., Taylor, G. J., Bagby, R. M., Ayears, L. E., & Izquierdo, G. (2013). Psychometric properties of a revised Spanish 20-item Toronto Alexithymia Scale adaptation in multiple sclerosis patients. International Journal of Clinical Health & Psychology, 13, 226–234.  https://doi.org/10.1016/S1697-2600(13)70027-9.CrossRefGoogle Scholar
  32. Fox, J. R. E., & Power, M. J. (2009). Eating disorders and multi-level models of emotion: An integrated model. Clinical Psychology and Psychotherapy, 16, 240–267.  https://doi.org/10.1002/cpp.626.CrossRefPubMedGoogle Scholar
  33. Gilboa-Schechtman, E., Avnon, L., Zubery, E., & Jeczmien, P. (2006). Emotional processing in eating disorders: Specific impairment or general distress related deficiency? Depression and Anxiety, 23, 331–339.  https://doi.org/10.1002/da.20163.CrossRefPubMedGoogle Scholar
  34. Gramaglia, C., Ressico, F., Gambaro, E., Palazzolo, A., Mazzarino, M., Bert, F., … Zeppegno, P. (2016). Alexithymia, empathy, emotion identification and social inference in anorexia nervosa: A case-control study. Eating Behaviors, 22, 46–50.  https://doi.org/10.1016/j.eatbeh.2016.03.028.CrossRefPubMedGoogle Scholar
  35. Guillén, V., Santos, B., Muñoz, P., Fernández de Corres, B., Fernández, E., Pérez, I., … González-Pinto, A. (2014). Toronto Alexithymia Scale for patients with eating disorder: Of performance using the non-parametric item response theory. Comprehensive Psychiatry, 55, 1285–1291.  https://doi.org/10.1016/j.comppsych.2014.03.020.CrossRefPubMedGoogle Scholar
  36. Hamilton, J., Gagne, P. E., & Hancock, G. R. (2003). The effect of sample size on latent growth models. Paper presented at the Annual Meeting of the American Educational Research Association, Chicago.Google Scholar
  37. Hatch, A., Madden, S., Kohn, M., Clarke, S., Touyz, S., & Williams, L. M. (2010). Anorexia nervosa: Towards an integrative neuroscience model. European Eating Disorders Review, 18, 165–179.  https://doi.org/10.1002/erv.974.CrossRefPubMedGoogle Scholar
  38. Haviland, M. G., & Reise, S. P. (1996). Structure of the twenty-item Toronto Alexithymia Scale. Journal of Personality Assessment, 66, 116.PubMedCrossRefGoogle Scholar
  39. Haynos, A. F., & Fruzzetti, A. E. (2011). Anorexia nervosa as a disorder of emotion dysregulation: Evidence and treatment implications. Clinical Psychology: Science and Practice, 18, 183–202.  https://doi.org/10.1111/j.1468-2850.2011.01250.x.Google Scholar
  40. Hu, L. t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55.  https://doi.org/10.1080/10705519909540118.CrossRefGoogle Scholar
  41. Jackson, D. L., Gillaspy, J. A. Jr., & Purc-Stephenson, R. (2009). Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods, 14, 6–23.  https://doi.org/10.1037/a0014694.CrossRefPubMedGoogle Scholar
  42. Koch, A. S., Kleiman, A., Wegener, I., Zur, B., Imbierowicz, K., Geiser, F., & Conrad, R. (2015). Factorial structure of the 20-item Toronto Alexithymia Scale in a large sample of somatoform patients. Psychiatry Research, 225, 355–363.  https://doi.org/10.1016/j.psychres.2014.12.013.CrossRefPubMedGoogle Scholar
  43. Kojima, M., Frasure-Smith, N., & Lespérance, F. (2001). Alexithymia following myocardial infarction: Psychometric properties and correlates of the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 51, 487–495.  https://doi.org/10.1016/S0022-3999(01)00253-7.CrossRefPubMedGoogle Scholar
  44. Kooiman, C. G., Spinhoven, P., & Trijsburg, R. W. (2002). The assessment of alexithymia: A critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20. Journal of Psychosomatic Research, 53, 1083–1090.  https://doi.org/10.1016/S0022-3999(02)00348-3.CrossRefPubMedGoogle Scholar
  45. Kutlesic, V., Williamson, D. A., Gleaves, D. H., Barbin, J. M., & Murphy-Eberenz, K. P. (1998). The Interview for the Diagnosis of Eating Disorders—IV: Application to DSM-IV diagnostic criteria. Psychological Assessment, 10, 41–48.  https://doi.org/10.1037/1040-3590.10.1.41.CrossRefGoogle Scholar
  46. Lambert, M. C., Samms-Vaughan, M. E., Lyubansky, M., Rose, D., Grandison, T., Holness, A., … Durst, J. (1999). Emotions and psychopathology. The West Indian Medical Journal, 48, 203–207.PubMedGoogle Scholar
  47. Li, S., Zhang, B., Guo, Y., & Zhang, J. (2015). The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry Research, 227, 1–9.  https://doi.org/10.1016/j.psychres.2015.02.006.CrossRefPubMedGoogle Scholar
  48. Ling, Y., Zeng, Y., Yuan, H., & Zhong, M. (2016). Cross-cultural validation of the 20-item Toronto Alexithymia Scale in Chinese adolescents. Journal of Psychiatric and Mental Health Nursing, 23, 179–187.  https://doi.org/10.1111/jpm.12298.CrossRefPubMedGoogle Scholar
  49. Loas, G., Braun, S., Delhaye, M., & Linkowski, P. (2017). The measurement of alexithymia in children and adolescents: Psychometric properties of the Alexithymia Questionnaire for Children and the twenty-item Toronto Alexithymia Scale in different non-clinical and clinical samples of children and adolescents. PLoS ONE, 12, 1–17.  https://doi.org/10.1371/journal.pone.0177982.CrossRefGoogle Scholar
  50. Loas, G., Corcos, M., Stephan, P., Pellet, J., Bizouard, P., Venisse, J. L., … Jeammet, P. (2001). Factorial structure of the 20-item Toronto Alexithymia Scale: Confirmatory factorial analyses in nonclinical and clinical samples. Journal of Psychosomatic Research, 50, 255–261.  https://doi.org/10.1016/S0022-3999(01)00197-0.CrossRefPubMedGoogle Scholar
  51. Loas, G., Otmani, O., Verrier, A., Fremaux, D., & Marchand, M. P. (1996). Factor analysis of the French version of the 20-Item Toronto Alexithymia Scale (TAS-20). Psychopathology, 29, 139–144.PubMedCrossRefGoogle Scholar
  52. Lulé, D., Schulze, U. M. E., Bauer, K., Schöll, F., Müller, S., Fladung, A.-K., & Uttner, I. (2014). Anorexia nervosa and its relation to depression, anxiety, alexithymia and emotional processing deficits. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 19, 209–216.  https://doi.org/10.1007/s40519-014-0101-z.CrossRefGoogle Scholar
  53. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  54. MacCallum, R. C., Roznowski, M., & Necowitz, L. B. (1992). Model modifications in covariance structure analysis: The problem of capitalization on chance. Psychological Bulletin, 111, 490–504.PubMedCrossRefGoogle Scholar
  55. Maggini, C., & Raballo, A. (2004). Alexithymia and schizophrenic psychopathology. Acta Bio-Medica: Atenei Parmensis, 75, 40–49.Google Scholar
  56. Mallorquí-Bagué, N., Vintró-Alcaraz, C., Sánchez, I., Riesco, N., Agüera, Z., Granero, R., … Fernández-Aranda, F. (2017). Emotion regulation as a transdiagnostic feature among eating disorders: Cross-sectional and longitudinal approach. European Eating Disorders Review.  https://doi.org/10.1002/erv.2570.PubMedGoogle Scholar
  57. Marsh, H. W., Scalas, L. F., & Nagengast, B. (2010). Longitudinal tests of competing factor structures for the Rosenberg Self-Esteem Scale: Traits, ephemeral artifacts, and stable response styles. Psychological Assessment, 22, 366–381.  https://doi.org/10.1037/a0019225.CrossRefPubMedGoogle Scholar
  58. 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.CrossRefPubMedGoogle Scholar
  59. Miyake, Y., Okamoto, Y., Onoda, K., Shirao, N., Mantani, T., & Yamawaki, S. (2009). Neural correlates of alexithymia in response to emotional stimuli: A study of anorexia nervosa patients. Hiroshima Journal of Medical Sciences, 58, 1–8.PubMedGoogle Scholar
  60. Miyake, Y., Okamoto, Y., Onoda, K., Shirao, N., Okamoto, Y., & Yamawaki, S. (2012). Brain activation during the perception of stressful word stimuli concerning interpersonal relationships in anorexia nervosa patients with high degrees of alexithymia in an fMRI paradigm. Psychiatry Research: Neuroimaging, 201, 113–119.  https://doi.org/10.1016/j.pscychresns.2011.07.014.CrossRefPubMedGoogle Scholar
  61. Moriguchi, Y., Maeda, M., Igarashi, T., Ishikawa, T., Shoji, M., Kubo, C., & Komaki, G. (2007). Age and gender effect on alexithymia in large, Japanese community and clinical samples: A cross-validation study of the Toronto Alexithymia Scale (TAS-20). Biopsychosocial Medicine, 1, 7.  https://doi.org/10.1186/1751-0759-1-7.CrossRefPubMedPubMedCentralGoogle Scholar
  62. Müller, J., Bühner, M., & Ellgring, H. (2003). Is there a reliable factorial structure in the 20-item Toronto Alexithymia Scale?: A comparison of factor models in clinical and normal adult samples. Journal of Psychosomatic Research, 55, 561–568.  https://doi.org/10.1016/S0022-3999(03)00033-3.CrossRefPubMedGoogle Scholar
  63. Mustelin, L., Silén, Y., Raevuori, A., Hoek, H. W., Kaprio, J., & Keski-Rahkonen, A. (2016). The DSM-5 diagnostic criteria for anorexia nervosa may change its population prevalence and prognostic value. Journal of Psychiatric Research, 77, 85–91.  https://doi.org/10.1016/j.jpsychires.2016.03.003.CrossRefPubMedGoogle Scholar
  64. Myers, T. A., & Crowther, J. H. (2008). Is self-objectification related to interoceptive awareness? An examination of potential mediating pathways to disordered eating attitudes. Psychology of Women Quarterly, 32, 172–180.  https://doi.org/10.1111/j.1471-6402.2008.00421.x.CrossRefGoogle Scholar
  65. Nowakowski, M. E., McFarlane, T., & Cassin, S. (2013). Alexithymia and eating disorders: A critical review of the literature. Journal of Eating Disorders, 1, 1–14.  https://doi.org/10.1186/2050-2974-1-21.CrossRefGoogle Scholar
  66. Oldershaw, A., Lavender, T., Sallis, H., Stahl, D., & Schmidt, U. (2015). Emotion generation and regulation in anorexia nervosa: A systematic review and meta-analysis of self-report data. Clinical Psychology Review, 39, 83–95.  https://doi.org/10.1016/j.cpr.2015.04.005.CrossRefPubMedGoogle Scholar
  67. Parker, J. D. A., Eastabrook, J. M., Keefer, K. V., & Wood, L. M. (2010). Can alexithymia be assessed in adolescents? Psychometric properties of the 20-item Toronto Alexithymia Scale in younger, middle, and older adolescents. Psychological Assessment, 22, 798–808.  https://doi.org/10.1037/a0020256.CrossRefPubMedGoogle Scholar
  68. Parker, J. D. A., Shaughnessy, P. A., Wood, L. M., Majeski, S. A., & Eastabrook, J. M. (2005). Cross-cultural alexithymia: Validity of the 20-item Toronto Alexithymia Scale in North American aboriginal populations. Journal of Psychosomatic Research, 58, 83–88.PubMedCrossRefGoogle Scholar
  69. Parling, T., Mortazavi, M., & Ghaderi, A. (2010). Alexithymia and emotional awareness in anorexia nervosa: Time for a shift in the measurement of the concept? Eating Behaviors, 11, 205–210.  https://doi.org/10.1016/j.eatbeh.2010.04.001.CrossRefPubMedGoogle Scholar
  70. Pascual, A., Etxebarria, I., & Cruz, M. S. (2011). Emotional differences between women with different types of eating disorders. International Journal of Psychology and Psychological Therapy, 11, 1–11.Google Scholar
  71. Pinaquy, S., Chabrol, H., & Barbe, P. (2002). Alexithymie et obésité: Étude de la structure factorielle et de la consistance interne de la version française de la Toronto Alexithymia Scale (TAS 20) chez les femmes obèses [Factorial analysis and internal consistency of the French version of the Toronto Alexithymia Scale (TAS 20), in obese women]. L’Encéphale: Revue de psychiatrie clinique biologique et thérapeutique, 28, 277–282.Google Scholar
  72. Powell, D. A., & Schafer, W. D. (2001). The robustness of the likelihood ratio chi-square test for structural equation models: A meta-analysis. Journal of Educational and Behavioral Statistics, 26, 105–132.CrossRefGoogle Scholar
  73. Prazeres, N., Parker, J., & Taylor, G. (2000). Adaptação Portuguesa da Escala de Alexitimia de Toronto de 20 Itens (TAS-20) [Portuguese adaptation of the 20-item Toronto Alexithymia Scale (TAS-20)]. Revista Iberoamericana de Diagnóstico y Evaluación Psicológica (RIDEP), 9, 9–21.Google Scholar
  74. Richards, H. L., Fortune, D. G., Griffiths, C. E. M., & Main, C. J. (2005). Alexithymia in patients with psoriasis: Clinical correlates and psychometric properties of the Toronto Alexithymia Scale-20. Journal of Psychosomatic Research, 58, 89–96.  https://doi.org/10.1016/j.jpsychores.2004.03.009.CrossRefPubMedGoogle Scholar
  75. Salerno, L., Ingoglia, S., & Lo Coco, G. (2017). Competing factor structures of the Rosenberg Self-Esteem Scale (RSES) and its measurement invariance across clinical and non-clinical samples. Personality and Individual Differences, 113, 13–19.  https://doi.org/10.1016/j.paid.2017.02.063.CrossRefGoogle Scholar
  76. Satorra, A., & Bentler, P. M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66, 507–514.CrossRefGoogle Scholar
  77. Schumacker, R. E., & Lomax, R. G. (2016). A beginner’s guide to structural equation modeling (4th ed.). New York: Taylor & Francis.Google Scholar
  78. Sexton, M. C., Sunday, S. R., Hurt, S., & Halmi, K. A. (1998). The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients. International Journal of Eating Disorders, 23, 277–286.PubMedCrossRefGoogle Scholar
  79. Simonsson-Sarnecki, M., Lundh, L. G., Törestad, B., Bagby, R. M., Taylor, G. J., & Parker, J. D. (2000). A Swedish translation of the 20-item Toronto Alexithymia Scale: Cross-validation of the factor structure. Scandinavian Journal of Psychology, 41, 25–30.PubMedCrossRefGoogle Scholar
  80. Southgate, L., Tchanturia, K., & Treasure, J. (2005). Building a model of the aetiology of eating disorders by translating experimental neuroscience into clinical practice. Journal of Mental Health, 14, 553–566.  https://doi.org/10.1080/09638230500347541.CrossRefGoogle Scholar
  81. Speranza, M., Loas, G., Guilbaud, O., & Corcos, M. (2011). Are treatment options related to alexithymia in eating disorders? Results from a three-year naturalistic longitudinal study. Biomedicine and Pharmacotherapy, 65, 585–589.  https://doi.org/10.1016/j.biopha.2010.01.009.CrossRefPubMedGoogle Scholar
  82. Speranza, M., Loas, G., Wallier, J., & Corcos, M. (2007). Predictive value of alexithymia in patients with eating disorders: A 3-year prospective study. Journal of Psychosomatic Research, 63, 365–371.  https://doi.org/10.1016/j.jpsychores.2007.03.008.CrossRefPubMedGoogle Scholar
  83. Swift, L., Stephenson, R., & Royce, J. (2006). The 20-item Toronto Alexithymia Scale: Validation of factor solutions using confirmatory factor analysis on physiotherapy out-patients. Psychology and Psychotherapy: Theory, Research and Practice, 79, 83–88.  https://doi.org/10.1348/147608305x42875.CrossRefGoogle Scholar
  84. Tanaka, J. S. (1987). “How big is big enough?”: Sample size and goodness of fit in structural equation models with latent variables. Child Development, 58, 134–146.CrossRefGoogle Scholar
  85. Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  86. Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (2003). The 20-Item Toronto Alexithymia Scale: IV. Reliability and factorial validity in different languages and cultures. Journal of Psychosomatic Research, 55, 277–283.  https://doi.org/10.1016/S0022-3999(02)00601-3.CrossRefPubMedGoogle Scholar
  87. Taylor, G. J., Ryan, D., & Bagby, M. R. (1985). Toward the development of a new self-report alexithymia scale. Psychotherapy and Psychosomatics, 44, 191–199.PubMedCrossRefGoogle Scholar
  88. Thorberg, F. A., Young, R. M., Sullivan, K. A., Lyvers, M., Hurst, C., Connor, J. P., & Feeney, G. F. X. (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.CrossRefPubMedGoogle Scholar
  89. Torres, S., Guerra, M. P., Lencastre, L., Miller, K., Vieira, F. M., Roma-Torres, A., … Costa, P. (2015). Alexithymia in anorexia nervosa: The mediating role of depression. Psychiatry Research, 225, 99–107.  https://doi.org/10.1016/j.psychres.2014.10.023.CrossRefPubMedGoogle Scholar
  90. Torres, S., Guerra, M. P., Lencastre, L., Roma-Torres, A., Brandão, I., Queirós, C., & Vieira, F. (2011). Cognitive processing of emotions in anorexia nervosa. European Eating Disorders Review, 19, 100–111.  https://doi.org/10.1002/erv.1046.CrossRefPubMedGoogle Scholar
  91. Torres, S., Guerra, M. P., Lencastre, L., Vieira, F., Roma-Torres, A., & Brandão, I. (2011). Prevalência da alexitimia na anorexia nervosa e sua associação com variáveis clínicas e sociodemográficas [Prevalence of alexithymia in anorexia nervosa and its association with clinical and sociodemographic variables]. Jornal Brasileiro de Psiquiatria, 60, 182–189.  https://doi.org/10.1590/S0047.CrossRefGoogle Scholar
  92. Torres, S., Guerra, M. P., Lencastre, L., Williamson, D. A., Roma-Torres, A., & Vieira, F. (2008). Contribuição para o estudo da adaptação portuguesa da Entrevista de Diagnóstico das Perturbações do Comportamento Alimentar - IV (IDED-IV) específica para a Anorexia Nervosa [Contribution to the Portuguese adaptation of the Interview for the Diagnosis of Eating Disorders-IV (IDED-IV) specifically for Anorexia Nervosa]. Arquivos de Medicina, 22, 113–119.Google Scholar
  93. Treasure, J., Corfield, F., & Cardi, V. (2012). A three-phase model of the social emotional functioning in eating disorders. European Eating Disorders Review, 20, 431–438.  https://doi.org/10.1002/erv.2181.CrossRefPubMedGoogle Scholar
  94. Troop, N. A., Schmidt, U. H., & Treasure, J. L. (1995). Feelings and fantasy in eating disorders: A factor analysis of the Toronto Alexithymia Scale. International Journal of Eating Disorders, 18, 151–157.PubMedCrossRefGoogle Scholar
  95. Tsaousis, I., Taylor, G., Quilty, L., Georgiades, S., Stavrogiannopoulos, M., & Bagby, R. M. (2010). Validation of a Greek adaptation of the 20-item Toronto Alexithymia Scale. Comprehensive Psychiatry, 51, 443–448.  https://doi.org/10.1016/j.comppsych.2009.09.005.CrossRefPubMedGoogle Scholar
  96. Ullman, J. B. (2006). Structural equation modeling: Reviewing the basics and moving forward. Journal of Personality Assessment, 87, 35–50.  https://doi.org/10.1207/s15327752jpa8701_03.CrossRefPubMedGoogle Scholar
  97. Veríssimo, R. (2001). A versão Portuguesa da Escala de Alexitimia de Toronto de 20 itens - I. Adaptação linguística, validação semântica, e estudo de fiabilidade [The Portuguese version of the 20-item Toronto Alexithymia Scale - I. Linguistic adaptation, semantic validation, and reliability study]. Acta Medica Portuguesa, 14, 529–536.PubMedGoogle Scholar
  98. Veríssimo, R. (2003). Inteligência emocional: Da alexitimia ao controlo emocional [Emotional intelligence: From alexithymia to emotional control]. Acta Medica Portuguesa, 16, 407–411.PubMedGoogle Scholar
  99. Weinbach, N., Sher, H., & Bohon, C. (2017). Differences in emotion regulation difficulties across types of eating disorders during adolescence. Journal of Abnormal Child Psychology.  https://doi.org/10.1007/s10802-017-0365-7.PubMedGoogle Scholar
  100. Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (2017). Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66–81.  https://doi.org/10.1016/j.jpsychores.2017.06.007.CrossRefPubMedGoogle Scholar
  101. Wheaton, B. (1987). Assessment of fit in overidentified models with latent variables. Sociological Methods & Research, 16, 118–154.  https://doi.org/10.1177/0049124187016001005.CrossRefGoogle Scholar
  102. WHO. (1995). Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee (WHO Technical Report Series 854). Geneva: World Health Organization.Google Scholar
  103. Wildes, J. E., Ringham, R. M., & Marcus, M. D. (2010). Emotion avoidance in patients with anorexia nervosa: Initial test of a functional model. International Journal of Eating Disorders, 43, 398–404.  https://doi.org/10.1002/eat.20730.PubMedPubMedCentralGoogle Scholar
  104. 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 Bermond–Vorst Alexithymia Questionnaire. European Journal of Personality, 13, 511–532.CrossRefGoogle Scholar
  105. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of Psychology and Education SciencesUniversity of PortoPortoPortugal
  2. 2.Center for Psychology at University of PortoPortoPortugal
  3. 3.Carolina Institute for Developmental Disabilities, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Life and Health Sciences Research Institute, School of MedicineUniversity of MinhoBragaPortugal
  5. 5.ICVS/3B’s, PT Government Associate LaboratoryBraga/GuimarãesPortugal
  6. 6.Psychiatry DepartmentHospital S. JoãoPortoPortugal
  7. 7.Faculty of MedicineUniversity of PortoPortoPortugal
  8. 8.Center for Research in Health Technologies and Services - CINTESISPortoPortugal

Personalised recommendations

Cite article

Buy options