Toronto Alexithymia Scale (TAS-20)

1. Abstract

The Toronto Alexithymia Scale (TAS-20) is internationally recognized as the gold standard self-report instrument for the assessment of alexithymia, a multifaceted personality construct characterized by marked deficits in the cognitive processing and regulation of emotional states. Developed by R. Michael Bagby, James D. A. Parker, and Graeme J. Taylor in 1994, the TAS-20 was formulated through rigorous item-selection and cross-validation procedures to refine its predecessor, the 26-item Toronto Alexithymia Scale (TAS-26). The instrument comprises 20 items structured across a robust three-factor latent architecture: Factor 1, Difficulty Identifying Feelings (DIF; 7 items); Factor 2, Difficulty Describing Feelings (DDF; 5 items); and Factor 3, Externally Oriented Thinking (EOT; 8 items). Items are rated on a 5-point Likert scale ranging from 1 (“Strongly Disagree”) to 5 (“Strongly Agree”), yielding a continuous total score from 20 to 100, alongside established empirical cut-off thresholds: non-alexithymia (≤ 51), borderline or possible alexithymia (52–60), and overt alexithymia (≥ 61).

Extensive psychometric investigations conducted across clinical populations (e.g., major depressive disorder, somatoform disorders, substance use disorders, eating disorders, post-traumatic stress disorder) and non-clinical cohorts globally demonstrate exemplary internal consistency, with total scale Cronbach’s alpha coefficients routinely falling between α = .80 and .86, and acceptable-to-high coefficients for the DIF and DDF subscales. Test-retest reliability across intervals spanning weeks to months consistently demonstrates temporal stability (r ≥ .77). Construct, convergent, and discriminant validity have been demonstrated through significant positive correlations with neuroticism, somatic symptom severity, depression, and anxiety, paired with negative correlations with emotional intelligence, psychological mindedness, open cognitive processing, and extraversion. Confirmatory factor analyses (CFA) across dozens of linguistic and cultural adaptations consistently replicate the three-factor structure, establishing the TAS-20 as an indispensable psychometric measure in affective neuroscience, clinical psychology, psychosomatic medicine, and psychiatric diagnostics.

2. Keywords

Toronto Alexithymia Scale, TAS-20, alexithymia, emotion regulation, affective neuroscience, psychosomatic medicine, factor analysis, psychometric assessment, affective processing, externally oriented thinking

3. Authors

The Toronto Alexithymia Scale was conceptualized, operationalized, and psychometrically validated by a collaborative team of clinical psychiatrists and psychological researchers affiliated with the University of Toronto and associated academic medical centers in Ontario, Canada:

• R. Michael Bagby, Ph.D., ABAP, FRSC: Full Professor in the Departments of Psychology and Psychiatry, and the Institute of Medical Science at the University of Toronto. Dr. Bagby is a distinguished clinical psychologist renowned for his pioneering empirical work in psychological assessment, personality psychopathology, and the operationalization of psychiatric constructs.
• James D. A. Parker, Ph.D.: Professor Emeritus in the Department of Psychology at Trent University (Peterborough, Ontario, Canada). Dr. Parker is an international authority on emotional intelligence, affective competencies, and the structural relationship between emotional deficits and psychopathology across developmental lifespans.
• Graeme J. Taylor, M.D., FRCPC: Professor Emeritus in the Department of Psychiatry at the University of Toronto, and psychoanalyst at Mount Sinai Hospital (Toronto). Dr. Taylor is widely regarded as one of the seminal figures in psychosomatic research, having integrated psychodynamic formulations of affect deficit with neurobiological and cognitive frameworks.

4. Purpose

The primary clinical and research purpose of the TAS-20 is to provide a psychometrically sound, standardized, and parsimonious assessment of the presence and severity of alexithymia. Originally introduced into the psychiatric lexicon by psychotherapist Peter Sifneos and psychoanalyst John Nemiah in the early 1970s, the concept of alexithymia (derived from Greek: a- [lack], lexis [word], and thymos [emotion]—literally translating to “no words for emotions”) was formulated based on observations of classic psychosomatic patients who displayed a striking inability to express emotions verbally, impoverished fantasy lives, and a tendency to experience distress exclusively through undifferentiated somatic sensations.

Prior to the introduction of the TAS-20, early measurement tools—including the Beth Israel Hospital Psychosomatic Questionnaire (BIQ), the Schalling-Sifneos Personality Scale (SSPS), and the Minnesota Multiphasic Personality Inventory Alexithymia Scale (MMPI-AS)—suffered from critical psychometric limitations. These limitations included unacceptable inter-rater reliability, confounding overlaps with general psychopathology or somatic distress, and poor factor stability. The development of the 26-item Toronto Alexithymia Scale (TAS-26) in 1985 and its subsequent refinement into the TAS-20 resolved these structural deficiencies, yielding an instrument capable of measuring the cognitive-affective deficit without being confounded by social desirability, acute distress, or neurotic somatic complaints.

In clinical practice, the TAS-20 serves multiple critical diagnostic and therapeutic functions:

• Differential Diagnosis and Profiling: Differentiating primary affective disorders from structural deficits in emotional representation. Individuals with alexithymia frequently present to medical clinics with somatic complaints (e.g., functional dyspepsia, fibromyalgia, tension headaches, irritable bowel syndrome) because they misinterpret the physiological arousal accompanying emotional states as signs of organic physical illness.
• Treatment Selection and Modulation: Identifying patients who may struggle with traditional insight-oriented psychoanalytic or open-ended psychotherapies. Because individuals with high TAS-20 scores lack symbolic mental representations of affect, they typically respond poorly to expressive techniques that require introspective exploration. Instead, they benefit more from structured cognitive-behavioral therapy (CBT), mentalization-based therapy (MBT), or psychoeducational training in affect labeling and somatic relaxation.
• Risk Stratification: Assessing vulnerability to maladaptive coping mechanisms. Alexithymia is an established transdiagnostic risk factor for substance use disorders, eating disorders (such as binge-eating disorder and bulimia nervosa), self-injurious behavior, and impulsive behaviors, often serving as a maladaptive attempt to regulate intense, unnamable inner tension.
• Monitoring Treatment Progress: Providing an empirical index of changes in emotional cognitive processing over the course of targeted clinical interventions.

5. Psychological Construct

Alexithymia is conceptualized not as a categorical psychiatric disorder per se, but as a continuous, multifaceted, transdiagnostic personality trait reflecting a deficit in the cognitive processing and mental representation of emotion. The construct operationalized by the TAS-20 encompasses three distinct, interrelated dimensions:

Factor 1: Difficulty Identifying Feelings (DIF)

This subscale comprises 7 items (Items 1, 3, 6, 7, 9, 13, and 14) evaluating an individual’s inability to accurately identify, differentiate, and understand subjective emotional states. Individuals with elevated DIF scores experience emotional arousal as a diffuse, undifferentiated internal state. When upset, they cannot discern whether they are angry, anxious, terrified, or depressed (e.g., Item 6: “When I am upset, I don’t know if I am sad, frightened, or angry”). Furthermore, this dimension captures a prominent confusion between the somatic sensations of autonomic arousal (e.g., tachycardia, diaphoresis, gastric motility) and the subjective emotional experiences that trigger them (e.g., Item 3: “I have physical sensations that even doctors don’t understand”; Item 7: “I am often puzzled by sensations in my body”).

Factor 2: Difficulty Describing Feelings (DDF)

Comprising 5 items (Items 2, 4, 11, 12, and 17), this subscale evaluates deficits in verbalizing subjective feelings to others. It reflects an impoverished emotional vocabulary (alexisomia/alexithymia proper) and a profound barrier in translating affective experiences into linguistic symbols (e.g., Item 2: “It is difficult for me to find the right words for my feelings”; Item 17: “It’s difficult for me to reveal my innermost feelings, even to close friends”). This dimension directly impacts interpersonal relationships, rendering communication sterile and limiting intimacy, as romantic partners and family members frequently perceive the individual as emotionally detached, indifferent, or cold.

Factor 3: Externally Oriented Thinking (EOT)

Composed of 8 items (Items 5, 8, 10, 15, 16, 18, 19, and 20), this subscale measures a concrete, utilitarian cognitive style characterized by a pervasive tendency to attend to the external, mechanical details of everyday life while actively avoiding introspective psychological exploration (e.g., Item 15: “I prefer talking to people about their daily activities rather than their feelings”; Item 16: “I prefer to watch ‘light’ entertainment shows rather than psychological dramas”). EOT reflects the classic pensée opératoire (operative thinking) described by French psychoanalysts Marty and de M’Uzan, wherein the patient focuses exclusively on external facts, chronological events, and pragmatic logistics rather than fantasies, psychological meanings, or symbolic life.

6. Theoretical Framework

The theoretical architecture of the TAS-20 is rooted in the convergence of psychodynamic psychosomatics, cognitive developmental psychology, and contemporary affective neuroscience.

Cognitive-Developmental Affect Theory: Lane and Schwartz’s Levels of Emotional Awareness

The operationalization of the TAS-20 aligns closely with Richard Lane and Gary Schwartz’s (1987) Cognitive-Developmental Model of Emotional Awareness. Inspired by Jean Piaget’s stages of cognitive development, this model posits that emotional awareness evolves through five hierarchical stages: (1) bodily sensations, (2) action tendencies, (3) individual emotions, (4) blends of emotions, and (5) blends of blends (the capacity to appreciate complex, differentiated, and contradictory emotional states in oneself and others). In this framework, individuals with severe alexithymia remain arrested at the sensorimotor or pre-operational levels of emotional processing (Stages 1 and 2), experiencing affect primarily as somatic perturbations and impulses to act, rather than symbolic mental phenomena.

Bucci’s Multiple Code Theory

Wilma Bucci’s Multiple Code Theory provides another explanatory paradigm for the TAS-20. Bucci posits three basic systems for processing affective information: subsymbolic nonverbal (visceral and motor sensations), symbolic nonverbal (images, sensory metaphors), and symbolic verbal (language). Healthy emotion regulation requires the seamless translation of visceral subsymbolic activations into symbolic verbal language—a process termed the referential process. In alexithymia, a functional decoupling or “referential disconnection” occurs: somatic sensations and emotional arousal cannot be mapped onto words or conscious cognitive representations, directly driving the elevations observed in the DIF and DDF dimensions of the TAS-20.

Neurobiological Substrates

Neuroimaging and neurobiological research have provided strong biological validity for the TAS-20 factor model:

• Anterior Cingulate Cortex (ACC) and Insular Dysfunction: Functional magnetic resonance imaging (fMRI) investigations show that individuals scoring high on the TAS-20 exhibit altered activation in the anterior insula and the dorsal anterior cingulate cortex during emotion-induction tasks. The anterior insula is critical for interoception—the central representation of visceral autonomic states. Blunted or dysregulated insular-ACC signaling impairs the brain’s ability to translate physiological signals into identifiable feeling states.
• Interhemispheric Communication Deficit: Early theorists, including TenHouten and Hoppe, hypothesized that alexithymia represents a functional “commissurotomy” or split-brain phenomenon, wherein the right hemisphere’s non-verbal emotional processing fails to transfer across the corpus callosum to the left hemisphere’s verbal-linguistic centers. Neurophysiological studies utilizing electroencephalography (EEG) and diffusion tensor imaging (DTI) have supported this hypothesis, showing reduced white matter tract integrity within the corpus callosum in individuals with severe alexithymia.
• Amygdala and Prefrontal Attenuation: Structural and functional studies reveal decreased prefrontal (specifically ventromedial and dorsolateral prefrontal cortex) top-down modulation over limbic structures like the amygdala, resulting in poor cognitive regulation of autonomic arousal.

7. Validity

The TAS-20 has undergone extensive empirical validation across multiple clinical and cross-cultural cohorts, establishing robust construct, convergent, discriminant, and predictive validity.

Construct and Factorial Validity

In the seminal validation studies conducted by Bagby, Parker, and Taylor (1994), the three-factor structure was confirmed through confirmatory factor analysis (CFA) across diverse samples, including university undergraduates (N = 965) and psychiatric outpatients (N = 287). The three-factor model consistently demonstrated superior goodness-of-fit compared to alternative unidimensional, two-factor, or four-factor structures. Replication studies across more than 30 languages (e.g., German, French, Spanish, Italian, Persian, Turkish, Chinese, Japanese) have affirmed the invariance of this three-factor model across cultural boundaries.

Convergent Validity

Convergent validity is supported by strong, theoretically coherent relationships with established psychological measures:

• NEO Personality Inventory (NEO-PI-R): TAS-20 total scores and the DIF/DDF subscales correlate positively with the Neuroticism domain (specifically the Depression, Vulnerability, and Anxiety facets; r values typically ranging from .35 to .55). Conversely, the EOT subscale displays significant negative correlations with Openness to Experience (particularly the Openness to Feelings, Fantasy, and Ideas facets; r = -.38 to -.46).
• Emotional Intelligence: Investigations comparing the TAS-20 to the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the Bar-On Emotional Quotient Inventory (EQ-i) demonstrate strong inverse correlations (r = -.50 to -.68), confirming that alexithymia represents the direct clinical antithesis of emotional intelligence.
• Psychological Mindedness: Research using the Psychological Mindedness Scale (PMS) shows substantial negative associations with TAS-20 scores (r = -.45 to -.58), demonstrating that high-alexithymia individuals exhibit minimal interest in the psychological determinants of behavior.

Discriminant Validity

A crucial milestone during the development of the TAS-20 was ensuring that the instrument measured alexithymia rather than acute negative affect or general psychological distress. In their concurrent validity study, Bagby, Taylor, and Parker (1994) demonstrated that while the TAS-20 shares moderate variance with measures of depression (e.g., Beck Depression Inventory, r ≈ .40–.45) and anxiety (e.g., State-Trait Anxiety Inventory, r ≈ .35–.48), the three-factor structure remains statistically distinct in hierarchical regression and structural equation modeling (SEM) when controlling for negative affectivity. Furthermore, longitudinal studies evaluating patients undergoing pharmacotherapy or psychotherapy for depression indicate that while TAS-20 scores may decrease slightly as depressive symptoms remit, absolute stability remains high, proving that the TAS-20 captures an enduring personality trait rather than a temporary state-dependent affective epiphenomenon.

Predictive and Criterion Validity

The predictive validity of the TAS-20 is supported across psychosomatic and psychiatric literature. High TAS-20 scores predict elevated health-care utilization, poorer treatment response in psychotherapy, elevated markers of systemic inflammation (such as C-reactive protein and interleukin-6), altered pain thresholds in chronic pain syndromes, and heightened mortality risk in cardiovascular disease populations.

8. Reliability

The psychometric evaluation of the TAS-20 has demonstrated high reliability across both classical test theory (CTT) and modern item response theory (IRT) frameworks.

Internal Consistency

Across non-clinical student, community, and clinical psychiatric populations, the TAS-20 total score displays strong internal consistency. In the foundational validation studies by Bagby et al. (1994):

• Total Scale: Cronbach’s alpha values typically range from α = .81 to .86.
• Factor 1 (DIF): Displays high internal consistency, with alpha coefficients consistently between α = .78 and .84.
• Factor 2 (DDF): Displays strong internal consistency, with alpha coefficients ranging between α = .75 and .80.
• Factor 3 (EOT): Tends to exhibit slightly lower, though acceptable, internal consistency, with alpha coefficients ranging from α = .64 to .72. This relative attenuation in alpha is well-documented in psychometric literature and is attributed to the breadth and heterogeneity of the externally oriented thinking construct, which includes sociological, behavioral, and introspective facets, as well as the inclusion of multiple reverse-scored items.

Test-Retest Reliability

Temporal stability assessments have confirmed that the TAS-20 measures an enduring trait rather than transient mood fluctuation:

• In the original psychometric evaluation by Bagby, Parker, and Taylor (1994), test-retest reliability across a three-week interval among university students yielded a correlation coefficient of r = .77 (p < .001).
• Subsequent studies over extended intervals, ranging from 3 months to 12 months in clinical samples (including patients undergoing treatment for eating disorders and substance dependence), report test-retest coefficients between r = .70 and .83. Intraclass correlation coefficients (ICC) consistently exceed .75 across the total score and subscales.

9. Factor Analysis

The factor structure of the TAS-20 was derived and validated using rigorous exploratory and confirmatory factor analytic procedures designed to remedy the psychometric weaknesses of the older 26-item instrument.

Exploratory Factor Analysis (EFA)

During scale development, Bagby et al. (1994) administered an initial pool of 43 candidate items to a developmental sample of undergraduate students (N = 442). Using principal axis factoring followed by oblique (Oblimin) rotation, items were retained based on strict statistical criteria: factor loadings ≥ .35 on the primary factor, minimal cross-loadings (≤ .25 on secondary factors), and conceptually coherent factor interpretations. This iterative reduction produced the parsimonious 20-item model.

Confirmatory Factor Analysis (CFA) and Goodness-of-Fit

To confirm the latent architecture, CFA was conducted on an independent validation sample of university students (N = 523) and a clinical sample of psychiatric outpatients (N = 287). The hypothesized three-factor oblique model exhibited excellent model fit compared to competing alternative models:

• Goodness-of-Fit Index (GFI): .91 to .93
• Adjusted Goodness-of-Fit Index (AGFI): .88 to .90
• Root Mean Square Error of Approximation (RMSEA): .045 to .058
• Standardized Root Mean Square Residual (SRMR): .051 to .059
• Comparative Fit Index (CFI): .88 to .92 (frequently exceeding .92 in contemporary multi-group structural equation models)

Factor Loadings and Latent Architecture

Standardized factor loadings from CFA literature for the three factors are summarized below:

• Factor 1 (DIF): Standardized factor loadings are uniformly robust, ranging from .52 to .78 across Items 1, 3, 6, 7, 9, 13, and 14. Item 6 (“When I am upset, I don’t know if I am sad, frightened, or angry”) and Item 9 (“I have feelings that I can’t quite identify”) consistently exhibit the highest loadings (λ > .70).
• Factor 2 (DDF): Standardized loadings range from .48 to .76 across Items 2, 4, 11, 12, and 17. Item 2 (“It is difficult for me to find the right words for my feelings”) reliably demonstrates the strongest loading (λ ≈ .75).
• Factor 3 (EOT): Standardized loadings range from .35 to .62 across Items 5, 8, 10, 15, 16, 18, 19, and 20. Loadings for reverse-scored items (e.g., Items 5, 10, 18, 19) are slightly lower (λ ≈ .35 to .48), reflecting minor method-effect variance related to reverse-wording syntax, whereas forward-scored items (e.g., Item 15, Item 16) demonstrate higher loadings (λ ≈ .55 to .62).

Inter-factor correlations typically show a moderate-to-strong positive correlation between Factor 1 (DIF) and Factor 2 (DDF) (r ≈ .50 to .65), while Factor 3 (EOT) demonstrates weaker, yet statistically significant, correlations with Factor 1 (r ≈ .20 to .35) and Factor 2 (r ≈ .25 to .40). This empirical pattern supports a hierarchical or bifactor model where an overarching general alexithymia construct accounts for common variance, while the three subscales capture unique clinical facets.

10. Instrument / Measurement Tool

• Instrument Name: Toronto Alexithymia Scale (TAS-20)
• Alternative Titles: 20-Item Toronto Alexithymia Scale, Toronto Alexithymia Scale-20
• Instrument Type: Self-report psychometric questionnaire / Psychological rating scale
• Format: Paper-and-pencil or computerized self-administered questionnaire
• Administration Time: Approximately 5 to 10 minutes
• Target Population: Adults and adolescents aged 16 and older (a specialized variant, the Alexithymia Questionnaire for Children [AQC], is utilized for pediatric cohorts)
• Total Item Count: 20 items
• Subscales (3):
  • Difficulty Identifying Feelings (DIF): 7 items (1, 3, 6, 7, 9, 13, 14)
  • Difficulty Describing Feelings (DDF): 5 items (2, 4, 11, 12, 17)
  • Externally Oriented Thinking (EOT): 8 items (5, 8, 10, 15, 16, 18, 19, 20)
• Response Scale: 5-point Likert scale:
  • 1 = Strongly Disagree
  • 2 = Moderately Disagree
  • 3 = Neither Agree Nor Disagree
  • 4 = Moderately Agree
  • 5 = Strongly Agree
• Reverse-Scored Items: 5 items are negatively keyed and must be reverse-scored prior to calculating subscale and total scores (1 becomes 5, 2 becomes 4, 3 remains 3, 4 becomes 2, 5 becomes 1):
  • Item 4: “I am able to describe my feelings easily”
  • Item 5: “I prefer to analyze problems rather than just describe them”
  • Item 10: “Being in touch with emotions is essential”
  • Item 18: “I can feel close to someone, even in moments of silence”
  • Item 19: “I find examination of my feelings useful in solving personal problems”
• Scoring and Cut-off Benchmarks:
  • Total Score Range: 20 to 100 points (summation of all 20 items after reverse-scoring).
  • Non-Alexithymia: Scores ≤ 51 (indicates normal emotional cognitive processing).
  • Borderline / Possible Alexithymia: Scores between 52 and 60 (indicates intermediate or situational emotional processing difficulties).
  • Definite / High Alexithymia: Scores ≥ 61 (indicates severe, clinically significant deficits in affective awareness and verbalization).

11. Permissions & Fee and Test Year

• Year of Publication: 1994 (original English validation published in the Journal of Psychosomatic Research).
• Copyright Holders: R. Michael Bagby, James D. A. Parker, and Graeme J. Taylor.
• Accessibility and Research Permissions: The TAS-20 is widely accessible for academic, non-commercial scientific research and academic clinical education, provided the scale is cited properly and used without alteration. Researchers may administer the scale without licensing fees for independent research studies, master’s theses, and doctoral dissertations. Commercial applications, corporate assessments, sponsored pharmaceutical clinical trials, or redistribution within proprietary commercial digital platforms require formal written authorization from the copyright holders or designated copyright representatives.
• Official Contact and Inquiries: Academic inquiries regarding licensing and standardized translations may be directed to Dr. R. Michael Bagby through the Department of Psychology, University of Toronto, Toronto, Ontario, Canada.

12. References

• Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale (TAS-20): I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32. https://doi.org/10.1016/0022-3999(94)90005-1
• Bagby, R. M., Taylor, G. J., & Parker, J. D. A. (1994). The twenty-item Toronto Alexithymia Scale (TAS-20): II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38(1), 33–40. https://doi.org/10.1016/0022-3999(94)90006-X
• 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(4), 133–139.
• Lane, R. D., & Schwartz, G. E. (1987). Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology. American Journal of Psychiatry, 144(2), 133–143. https://doi.org/10.1176/ajp.144.2.133
• Parker, J. D. A., Taylor, G. J., & Bagby, R. M. (2001). The twenty-item Toronto Alexithymia Scale—III. Reliability and factorial validity in a community population. Journal of Psychosomatic Research, 55(3), 269–275. https://doi.org/10.1016/S0022-3999(02)00578-0
• Parker, J. D. A., Taylor, G. J., & Bagby, R. M. (2003). The Toronto Alexithymia Scale (TAS-20): 20 years after. Journal of Psychosomatic Research, 55(3), 199–207.
• Rieffe, C., Oosterveld, P., Meerum Terwogt, M., Novin, S., Nasiri, H., & Latifian, M. (2010). Relationship between alexithymia, mood and internalizing symptoms in children and young adolescents: Evidence from an Iranian sample. Personality and Individual Differences, 48(4), 425–430. https://doi.org/10.1016/j.paid.2009.11.016
• Taylor, G. J. (1994). Alexithymia: Concept, measurement, and implications for psychopathology. The American Journal of Psychiatry, 151(4), 472–473. https://doi.org/10.1176/ajp.151.4.472
• Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge University Press. https://doi.org/10.1017/CBO9780511526831
• Taylor, G. J., Ryan, D., & Bagby, R. M. (1985). Toward the development of a new self-report alexithymia scale. Psychotherapy and Psychosomatics, 44(4), 191–199. https://doi.org/10.1159/000287912
• Zimmermann, G., Rossier, J., Meyer de Stadelhofen, F., & Gaillard, F. (2005). Alexithymia assessment and relations with dimensions of personality. European Journal of Psychological Assessment, 21(1), 23–33. https://doi.org/10.1027/1015-5759.21.1.23

13. Items of the Scale (Questionnaire)