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Alexithymia (literally; no words for emotion)

alexithymiaThe alexithymia concept derived from clinical observations that psychosomatic patients were unimaginative and showed difficulties with the verbal and symbolic expression of emotion (Ruesch, 1948). Later, empirical studies demonstrated this phenomenon. For example, Sifneos (1973) found that psychosomatic patients tended to have a relative constriction in emotional functioning, a poverty of fantasy, and an inability to find appropriate words to describe emotions. Psychosomatic patients possessed twice as many alexithymic characteristics when compared to controls.

Recently, Sifneos expanded on the concept, “Alexithymia, a term I introduced for better or worse in 1972, involves a marked difficulty to use appropriate language to express and describe feelings and to differentiate them from bodily sensations, a striking paucity of fantasies and a utilitarian way of thinking which Marty et al [1963] have called penseé opératoire” (Sifneos, 2000).

According to Taylor, Doddy & Newman 1981 ‘alexithymia’ refers to a hypothetical personality construct that is characterised by, “ (1) a difficulty in identifying and communicating feelings, (2) a difficulty in distinguishing between feelings and bodily sensations (3) impaired symbolization, as evidenced by paucity of fantasies and other imaginative activity, and (4) a preference for focussing on external events rather than inner experiences. ” (Taylor & Bagby 1988, p.352).

As a reflection of the increasing interest in this construct, alexithymia was chosen as the main theme of the 11 th European Conference on Psychosomatic Research at Heidelberg, in 1976 (Brautigam & Von Rad, 1977). Indeed, Taylor in 2000 comments that, “While about 120 articles were published on alexithymia by the mid-1980s, a recent search of the PsycInfo database revealed well over 700 journal articles on alexithymia.” (Taylor, 2000, p.134.).

How is it measured?

The Beth Israel Hospital Psychosomatic Questionnaire (BIQ)

This measure of alexithymia is a 17-item forced choice questionnaire that was developed by Sifneos to measure psychosomatic diseases. The items are completed by the interviewer after a structured interview with the patient. Eight of the items here are thought to be directly related to the alexithymia construct, and therefore only these 8 items are used in obtaining an alexithymia score. A cut-off score, arbitrarily chosen, of 6 yields an alexithymic (≥6) and non-alexithymic (<6) categorisation. There have, however, been a number of methodological criticisms of this scale. The forced choice nature of this scale (true, false) may be unsatisfactory as dichotomous scales can be unstable in factor analyses (Taylor & Bagby, 1988). Perhaps the most pertinent criticisms levelled at the BIQ are that it is time-consuming, and subject to experimenter or observer bias (Kleiger & Kinsman, 1980; Lolas, De La Parra, Arohnson & Colin 1980; Taylor, Doddy & Newman 1981).

Schalling-Sifneos Personality Scale (SSPS)

This self-report scale has 20 items and uses a 4-point Likert scale. Lower scores indicate increased levels of alexithymia. Sifneos suggests that a score of 50 or below indicates alexithymia. Unfortunately, this test was not subjected to item analysis during its construction, leaving it psychometrically weak. Other studies have found that its internal consistency is unsatisfactory (Bagby, Taylor & Ryan 1986; Bagby, Taylor & Atkinson 1988; Faryna, Rodenhauser & Torem 1986). Parker, Taylor & Bagby (1991) have strongly criticised a revised version of the SPSS (Sifneos, 1986) on psychometric grounds, and Bagby, Taylor & Atkinson (1988) advise against its further use.

The MMPI (Welsh & Dahlstrom, 1963; Good & Brantner, 1974) is a psychometric instrument that has been used to assess personality traits in a variety of medical and psychiatric syndromes. It contains 566 dichotomous choice (true or false) items that relate to mood, behaviour, self-concept and personal preferences. An alexithymia scale on the MMPI was developed (Kleiger & Kinsman, 1980) in response to a finding that the MMPI did not distinguish between alexithymic and non-alexithymic groups as measured by the BIQ (Kleiger & Jones, 1979). As Parker et al (1991) have pointed out, the alexithymia scale on the MMPI has been criticised for a lack of internal consistency, having a social desirability bias, and not relating well to other constructs. As with the SSPS, Bagby et al (1988) advise against future use of the MMPI-A.

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