Toronto Alexithymia Scales (TAS-26)

Abstract

The Toronto Alexithymia Scale (TAS-26) is a foundational 26-item self-report psychometric instrument designed to assess alexithymia, a multidimensional clinical construct characterized by deficits in emotional processing, verbalization, cognitive fantasizing, and externally focused mentation. Developed by Graeme J. Taylor, Dale Ryan, and R. Michael Bagby in 1985 at the University of Toronto, the TAS-26 addressed severe psychometric shortcomings observed in prior clinician-administered and self-report measures of emotional deficit, such as the Beth Israel Hospital Psychosomatic Questionnaire and the Schalling-Sifneos Personality Scale. The TAS-26 captures four distinct yet interrelated operational dimensions: (1) Difficulty Identifying and Distinguishing between Feelings and Bodily Sensations, (2) Difficulty Describing Feelings to Others, (3) Reduced Daydreaming and Fantasy Activity, and (4) Externally Oriented Thinking. Items are rated on a 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree), generating both total alexithymia composite indices and subscale scores. Empirical investigations establish that the TAS-26 exhibits adequate internal consistency across psychiatric and community cohorts (Cronbach’s alpha spanning .72 to .79 for total scores), solid test-retest reliability across multi-week intervals (ranging from .75 to .83), and strong convergent validity with measures of neuroticism, somatization, affect intensity, and negative emotionality. As the direct historical and empirical precursor to the widely employed 20-item Toronto Alexithymia Scale (TAS-20), the TAS-26 remains an essential assessment tool in clinical psychology, psychosomatic medicine, behavioral neurology, and affective neuroscience for tracing the evolution of emotion regulation diagnostics.

Keywords

alexithymia, Toronto Alexithymia Scale, TAS-26, emotional awareness, affect regulation, psychosomatics, externally oriented thinking, emotional processing, emotional blindness, psychometrics

Authors

The Toronto Alexithymia Scale (TAS-26) was conceptualized, operationalized, and psychometrically validated by a collaborative research team based in the Department of Psychiatry at the University of Toronto and Mount Sinai Hospital in Toronto, Ontario, Canada:

• Graeme J. Taylor, M.D., FRCPC: Emeritus Professor of Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto, and Psychoanalyst at the Toronto Psychoanalytic Society. A leading global authority on psychosomatic medicine, mind-body interactions, and the developmental etiology of affect dysregulation.
• Dale Ryan, Ph.D.: Research Associate and Clinical Methodologist affiliated with the Department of Psychiatry, University of Toronto, who collaborated on the original psychometric construction and statistical refinement of the preliminary item pool.
• R. Michael Bagby, Ph.D., ABAP, FRSC: Full Professor of Psychology and Psychiatry, University of Toronto, and Senior Clinical Scientist at the Centre for Addiction and Mental Health (CAMH). A world-renowned quantitative psychometrician specializing in personality assessment, diagnostic construct validity, and the psychometric modeling of affective phenotypes.

Purpose

The primary purpose of the Toronto Alexithymia Scale (TAS-26) is to provide an empirically grounded, psychometrically standardized, self-report inventory that quantifies the multifaceted features of alexithymia. Coined by psychiatrist Peter Sifneos in the early 1970s from the Greek roots a- (lack), lexis (word), and thymos (emotion)—literally translating to “no words for feelings”—alexithymia delineates a profound disturbance in cognitive-affective processing and interpersonal communicative capacity. Prior to the publication of the TAS-26 in 1985, researchers and clinicians relied on observer-rated protocols, such as the Beth Israel Hospital Psychosomatic Questionnaire (BIQ), or unrefined self-inventories that exhibited unstable factor structures, poor discriminant validity relative to general distress, and unacceptable internal consistency.

In response to these diagnostic limitations, Taylor, Ryan, and Bagby constructed the TAS-26 to systematically identify affective impairments across clinical and non-clinical populations. In clinical settings, the TAS-26 serves as a sensitive diagnostic screener for patients presenting with classical psychosomatic conditions, including functional gastrointestinal disorders (e.g., irritable bowel syndrome), chronic idiopathic pain, hypertension, dermatological conditions, and functional neurological disorder. Individuals displaying elevated alexithymia frequently amplify and misinterpret normal somatic correlates of sympathetic arousal—such as diaphoresis, tachycardia, or muscle tension—as indicators of physical illness rather than somatic expressions of emotional experience.

Beyond psychosomatic medicine, the TAS-26 fulfills an important prognostic purpose in psychiatric evaluation and psychotherapeutic treatment planning. Highly alexithymic individuals exhibit poor response rates to traditional expressive, insight-oriented, and psychoanalytic therapies because such modalities require dynamic introspection, metaphorical reasoning, and verbal affective exploration. Utilizing the TAS-26 permits clinicians to identify affect-processing deficits early in treatment, facilitating a transition toward cognitive-behavioral, somatic-grounding, mentalization-based, or psychoeducational interventions that build foundational emotional literacy before attempting intrapsychic exploration.

In empirical research, the TAS-26 serves as a foundational measurement instrument for testing neurobiological, cognitive, and evolutionary models of affect regulation. It enables researchers to investigate the relationships between emotional awareness and prefrontal-limbic functional connectivity, interoceptive predictive coding, neuroendocrine stress reactivity, attachment insecurity, and substance dependence vulnerabilities.

Psychological Construct

Alexithymia, as operationalized within the TAS-26, is not conceptualized as a categorical psychiatric disorder or a defense mechanism, but rather as a continuous, multifaceted personality trait reflecting a developmental impairment in the cognitive appraisal and cognitive representation of emotions. The construct represents a defect in the trans-modal integration of affective information, situated at the intersection of autonomic neurobiology and conscious awareness. The TAS-26 comprehensively maps this construct across four distinct psychometric subcomponents:

1. Difficulty Identifying and Distinguishing between Feelings and Bodily Sensations

This primary dimension reflects a deficit in affective differentiation and interoceptive awareness. Individuals with elevations in this domain experience subjective emotional states as vague, undifferentiated, and confusing experiences of internal distress. When experiencing intense negative arousal, an individual cannot discern whether the experience represents sadness, fear, or anger (e.g., Item 14: “When I am upset, I don’t know if I am sad, frightened or angry”). Furthermore, individuals experience a fundamental failure to discriminate between the somatic sensations accompanying autonomic arousal and the somatic signals of organic physical pathology (e.g., Item 17: “I am often puzzled by sensations in my body”). Consequently, autonomic manifestations of anxiety or distress are attributed to medical illness, contributing to elevated rates of health anxiety, medical over-utilization, and somatoform presentations.

2. Difficulty Describing Feelings to Others

The second dimension addresses the verbal expressive facet of the construct, capturing a marked deficit in finding semantic symbols and language to communicate internal emotional states to social partners (e.g., Item 8: “It is difficult for me to find the right words for my feelings”; Item 12: “I am able to describe my feelings easily” [reverse-scored]). This deficit does not stem from general language deficits or diminished intellectual functioning; rather, it reflects a selective impairment in translating affective feeling-states into descriptive, relational language. Interpersonally, this manifesting deficit leads to flattened relational interactions, an inability to convey vulnerability, and social friction, as interpersonal partners frequently perceive the individual as emotionally detached, indifferent, or mechanically robotic.

3. Reduced Daydreaming and Fantasy Activity

The third dimension assesses the impoverishment of imaginative mental life, mentalization capacity, and symbolic cognitive processing. Healthy psychological adaptation relies upon an active inner fantasy life and daydreaming to cognitively simulate future scenarios, process unresolved conflicts, regulate emotional tension, and soothe psychological distress. In contrast, alexithymia involves a marked reduction or absence of imaginative activity (e.g., Item 2: “Day dreaming is a waste of time”; Item 15: “I use my imagination a great deal” [reverse-scored]; Item 18: “I daydream rarely”). Individuals scoring high in this domain rarely engage in spontaneous creative daydreams, project minimal symbolic imagery in projective tasks, and report dreams that are bland, realistic, or entirely absent.

4. Externally Oriented Thinking (EOT)

The fourth dimension captures a distinctive cognitive style designated as pensée opératoire (operative thinking) by French psychoanalysts Pierre Marty and Michel de M’Uzan. Externally oriented thinking reflects an intentional and habitual tendency to focus exclusively on external events, empirical facts, pragmatic details, and mechanistic descriptions of concrete reality, while avoiding introspective reflection, psychological causation, and affective meaning (e.g., Item 7: “Knowing the answers to problems is more important than knowing the reasons for the answers”; Item 19: “I prefer to just let things happen rather than to understand why they turned out that way”). Operative thinking prioritizes technical details and situational chronologies over motives, psychological dynamics, or emotional resonance.

Theoretical Framework

The TAS-26 is theoretically grounded in the convergence of psychodynamic psychosomatics, developmental attachment theory, and cognitive-developmental theories of emotion regulation. The foundational architecture of the alexithymia construct emerged from the clinical observations of psychoanalysts in Paris and Boston during the mid-twentieth century. Pierre Marty and Michel de M’Uzan (1963) observed that patients presenting with severe, chronic psychosomatic ailments displayed a peculiar form of mental functioning marked by an absence of neurotic symptom formation, impoverished fantasy, and pragmatic speech patterns focused solely on mechanical objects and events. Simultaneously, John C. Nemiah and Peter E. Sifneos (1970, 1973) at Harvard Medical School corroborated these findings, observing that psychosomatic patients lacked an internal vocabulary for feelings and demonstrated striking somatic amplification alongside affective detachment.

Affect Integration and Neurobiological Substrates

Graeme J. Taylor integrated these psychodynamic clinical observations with contemporary neuroscience and structural-developmental theories. A foundational model underpinning the TAS-26 is Henry Krystal’s (1988) developmental theory of affect, which posits that affect undergoes three major ontogenetic transformations: differentiation (separating distinct emotional qualities from a global somatic sensation), verbalization (translating physiological feelings into symbolic linguistic representations), and desomatization (relying on cognitive meaning rather than somatic discharge to process emotion). Alexithymia represents a developmental arrested state or post-traumatic regression wherein emotions remain undifferentiated, somatic, and pre-verbal.

At the neurobiological level, the TAS-26 was conceptualized around hypothesized structural and functional disconnects within the human central nervous system. Early theoretical frameworks, such as the corpus callosum deficit model advanced by Hoppe and Bogen (1977), posited that alexithymia represents a functional commissurotomy—a functional disconnection between the right cerebral hemisphere, which excels in nonverbal emotional processing and bodily perception, and the left cerebral hemisphere, which governs verbal labeling and syntactic analysis. Modern neuroimaging validates this theoretical formulation, demonstrating that individuals with elevated TAS scores exhibit altered activity and reduced gray matter volume in the anterior cingulate cortex (ACC), anterior insular cortex, and ventromedial prefrontal cortex (vmPFC)—regions vital for interoceptive predictive coding, conscious feeling awareness, and mentalization.

Attachment and Mentalization Deficits

The theoretical framework also draws upon John Bowlby’s attachment theory and Peter Fonagy’s concept of mentalization. The development of emotional awareness requires a primary caregiver to serve as a contingent, attuned external mirror who marks, reflects, and verbalizes the infant’s bodily distress. When early infant-caregiver interactions are characterized by neglect, emotional unpredictability, or parental misattunement, the developing child fails to internalize symbolic representations of internal feeling states. Consequently, affective states remain tied to visceral bodily pathways, leading to the cognitive-emotional deficits indexed by the TAS-26.

Validity

The psychometric validity of the TAS-26 has been rigorously examined across multiple empirical investigations involving clinical psychiatric patients, psychosomatic cohorts, substance-dependent populations, and university undergraduates.

Construct and Factorial Validity

Initial construct validation conducted by Taylor, Ryan, and Bagby (1985) on a non-clinical sample of 542 undergraduate students demonstrated that the scale items clustered into four coherent, theoretically meaningful components via exploratory factor analysis. Subsequent factor-analytic evaluations across international adaptations—such as French, Spanish, German, and Persian versions—confirmed that the TAS-26 tapped the underlying multidimensional construct of alexithymia far more successfully than historical instruments. The scale reliably separates emotional identification difficulties from outward-oriented cognitive styles, confirming the structural independence of its core domains.

Convergent Validity

Convergent validity has been established through statistically significant correlations with validated psychometric measures of personality, distress, and somatic preoccupation:

• Neuroticism and Negative Affectivity: Scores on TAS-26 Total, as well as Factor 1 (Difficulty Identifying Feelings), exhibit moderate-to-high positive correlations with the Neuroticism scale of the NEO Personality Inventory ($r = .35$ to $.52, p < .001$) and the Beck Depression Inventory ($r = .30$ to $.48, p < .001$), reflecting the distressing nature of affective confusion.
• Somatization and Hypochondriasis: Positive correlations are consistently observed between the TAS-26 and the Somatization subscale of the Symptom Checklist-90-R (SCL-90-R; $r = .32$ to $.45, p < .001$), supporting the clinical hypothesis that individuals unable to identify feelings express distress via physical symptoms.
• Affect Intensity and Openness to Experience: Factor 3 (Daydreaming) and Factor 4 (Externally Oriented Thinking) demonstrate significant inverse relationships with the Openness to Experience domain of the Five-Factor Model ($r = -.30$ to $-.44, p < .01$) and Larsen’s Affect Intensity Measure ($r = -.36, p < .01$), verifying that high alexithymia aligns with reduced emotional richness and concrete cognitive framing.
• Mindfulness and Interoception: The TAS-26 demonstrates strong inverse correlations with instruments measuring mindful attention (e.g., Mindful Attention Awareness Scale, $r = -.42, p < .001$) and emotional intelligence scales (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test, $r = -.48, p < .001$).

Discriminant Validity

The discriminant validity of the TAS-26 was a critical advancement over early scales (such as the Schalling-Sifneos Personality Scale), which were criticized for being uncalibrated measures of general psychological distress or low intelligence. Taylor et al. (1985) demonstrated that although Factor 1 correlates with negative mood, the total TAS-26 score remains psychometrically distinct from state anxiety, trait anxiety, and cognitive intelligence (IQ), showing low and non-significant correlations with standard measures of verbal and performance IQ ($r < .10$). Furthermore, longitudinal studies confirm that while depression and anxiety symptoms fluctuate substantially following psychiatric pharmacotherapy, TAS-26 scores remain largely stable, supporting the conceptualization of alexithymia as an enduring, trait-like personality dimension.

Reliability

The reliability of the TAS-26 has been established through internal consistency assessments and temporal stability investigations across diverse demographic cohorts.

Internal Consistency

In the original validation study by Taylor, Ryan, and Bagby (1985), the TAS-26 total score achieved an overall Cronbach’s alpha ($lpha$) coefficient of .79, reflecting acceptable-to-good internal reliability for a multi-faceted construct. Subsequent cross-validation studies in psychiatric outpatient cohorts, substance-dependent populations, and international samples have documented overall alpha values consistently ranging between .72 and .82:

• Total Scale: $\alpha = .72 – .82$ across clinical and non-clinical populations.
• Factor 1 (Difficulty Identifying Feelings and Bodily Sensations): Demonstrates the highest internal consistency, typically exhibiting $\alpha$ coefficients between .78 and .85.
• Factor 2 (Difficulty Describing Feelings): Demonstrates moderate-to-good internal consistency, with $\alpha$ coefficients ranging between .70 and .78.
• Factor 3 (Reduced Daydreaming): Yields $\alpha$ values ranging from .62 to .72, occasionally affected by cultural differences in attitudes toward daydreaming.
• Factor 4 (Externally Oriented Thinking): Shows slightly lower internal consistency ($\alpha = .56 – .67$), a psychometric observation that eventually prompted the item pruning that led to the development of the TAS-20.

Test-Retest Temporal Stability

The temporal stability of the TAS-26 has been confirmed through repeated-measures designs across varying test-retest intervals. Taylor et al. (1985) observed a 1-week test-retest reliability coefficient of $r = .82$ ($p < .001$) in an initial non-clinical cohort. Longitudinal investigations spanning 4- to 12-week test-retest windows in both university student cohorts and stable psychiatric outpatients have yielded Pearson correlation coefficients ranging from $r = .75$ to $r = .84$, demonstrating that the scale measures a stable, trait-like cognitive-affective disposition rather than transient situational distress.

Factor Analysis

The factor structure of the TAS-26 has been evaluated using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), shedding light on the structural composition of the alexithymia construct.

Original Exploratory Factor Analysis (EFA)

During scale construction, Taylor, Ryan, and Bagby (1985) administered an initial pool of 41 potential items to a derivation sample of 542 undergraduate university students. Subjecting the data to principal component analysis followed by orthogonal (Varimax) and oblique (Promax) rotations, items failing to demonstrate primary loadings $ge .35$ or exhibiting high cross-loadings across multiple components were systematically removed. This psychometric refinement yielded a final 26-item instrument defined by a four-factor solution accounting for approximately 35.8% of the total variance:

• Factor 1: Ability to Identify and Distinguish between Feelings and Bodily Sensations (Items 4, 10, 14, 17, 20, 25, 26). Salient loadings on this factor index emotional confusion and somatic misinterpretation, with standardized item loadings ranging from .42 to .71.
• Factor 2: Daydreaming / Fantasy Activity (Items 2, 5, 15, 16, 18). Items loading on this factor capture imaginative capacity and the frequency of daydreaming, with loadings ranging from .45 to .76.
• Factor 3: Externally Oriented Thinking (Items 7, 11, 13, 19, 21, 24). This factor captures a pragmatic, anti-introspective, concrete cognitive stance, with loadings between .36 and .62.
• Factor 4: Ability to Describe Feelings to Others (Items 1, 8, 9, 12, 22, 23). Items reflect difficulties in verbalizing emotion and communicating affective states to relational partners, showing loadings between .38 and .68.
• Note on Items 3 and 6: In initial factor extractions, Items 3 (“I wish I were not as shy”) and 6 (“I seem to make friends as easily as others do”) loaded on a secondary social anxiety/interpersonal factor, which was later deemed peripheral to the core alexithymia construct during subsequent scale revisions.

Confirmatory Factor Analysis (CFA) and the Evolution to TAS-20

Subsequent psychometric investigations utilizing confirmatory factor analysis (CFA) highlighted certain structural limitations in the 26-item version. While the four-factor model exhibited acceptable absolute fit in exploratory samples, cross-validation studies using CFA revealed that several items—most notably Item 3, Item 6, and some daydreaming items (Items 5, 16)—exhibited low factor determinacy, elevated modification indices, and substantial covariance with neuroticism and social anxiety. Furthermore, researchers observed that the Daydreaming factor frequently formed a detached dimension that did not consistently load onto a higher-order alexithymia latent variable.

In 1994, Bagby, Parker, and Taylor conducted an extensive psychometric revision of the TAS-26 using CFA with multiple competitive model evaluations. This research revealed that eliminating the social-interaction items and the problematic daydreaming items yielded a cleaner, three-factor structure with superior goodness-of-fit parameters (CFI > .90, RMSEA < .06). This streamlined model was codified as the 20-item Toronto Alexithymia Scale (TAS-20), which retained three core dimensions: Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking. Despite the TAS-20’s widespread adoption, the TAS-26 remains a widely analyzed psychometric instrument, particularly for researchers investigating fantasy deficit profiles and the cognitive architecture of daydreaming in psychosomatic vulnerability.

Instrument / Measurement Tool

• Test Name: Toronto Alexithymia Scale (TAS-26)
• Alternative Titles: TAS-1985, 26-Item Toronto Alexithymia Scale
• Authors: Graeme J. Taylor, Dale Ryan, and R. Michael Bagby
• Publication Year: 1985
• Instrument Type: Self-report psychometric questionnaire
• Intended Population: Adults and late adolescents (ages 16 and older); adapted versions exist for pediatric and adolescent populations (e.g., Alexithymia Questionnaire for Children)
• Item Count: 26 items
• Administration Format: Paper-and-pencil questionnaire, computerized terminal, or secure web-based electronic survey
• Estimated Completion Time: 5 to 10 minutes
• Response Scale: 5-point Likert scale formatted as follows:
  • (1) Strongly Disagree
  • (2) Moderately Disagree
  • (3) Neither Disagree or Agree
  • (4) Moderately Agree
  • (5) Strongly Agree
• Subscales:
  • Factor 1: Difficulty to Identify and to Distinguish between Feelings and Bodily Sensations (Items 4, 10, 14, 17, 20, 25, 26)
  • Factor 2: Reduced Daydreaming / Fantasy Activity (Items 2, 5, 15, 16, 18)
  • Factor 3: Externally Oriented Thinking (Items 7, 11, 13, 19, 21, 24)
  • Factor 4: Difficulty Describing Feelings (Items 1, 8, 9, 12, 22, 23)
  • Unassigned / Interpersonal Items: Items 3 and 6
• Scoring Procedures:
  • Direct-scored items receive point values identical to the selected numeric response: $1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5$.
  • Reverse-keyed items (where high scores indicate emotional awareness or imaginative engagement) must be inverted prior to calculating subscale and total scores using the transformation formula: $\text{Reversed Score} = 6 – \text{Raw Score}$. The positively phrased items requiring reverse scoring are: Item 1, Item 5, Item 6, Item 9, Item 11, Item 12, Item 13, Item 15, Item 16, Item 21, and Item 24.
  • The Total TAS-26 Score is obtained by summing all 26 recoded items, yielding a theoretical score range of 26 to 130. Higher total scores denote elevated levels of alexithymia.
• Clinical Cutoff Scores (Original Guidelines):
  • Non-Alexithymic: Total scores $le 62$
  • Borderline / Intermediate: Total scores between $63$ and $73$
  • Alexithymic: Total scores $ge 74$

Permissions & Fee and Test Year

The Toronto Alexithymia Scale (TAS-26) was first published in 1985 in the peer-reviewed journal Psychotherapy and Psychosomatics. The copyright to the original scale publication is held by S. Karger AG (Basel) and the original authors (Graeme J. Taylor, Dale Ryan, and R. Michael Bagby). The TAS-26 was placed into the academic public domain for non-commercial, scholarly research and non-profit educational instruction. Researchers and clinicians may utilize, reproduce, and administer the TAS-26 without financial royalty fees, provided that appropriate scholarly attribution is maintained and the instrument is cited accurately in all derived publications.

Commercial reproduction, incorporation into proprietary digital health or electronic medical record (EMR) software platforms, sponsored corporate trials, or fee-for-service diagnostic platforms require explicit formal licensing and written permission from the copyright holders or their institutional representatives. Researchers planning modifications, transcultural adaptations, or formal pediatric translations should contact Professor Graeme J. Taylor or Professor R. Michael Bagby through the Department of Psychiatry at the University of Toronto to ensure adherence to psychometric standards and translation fidelity.

References

The theoretical foundations, construction, psychometric validation, and structural revisions of the Toronto Alexithymia Scales are documented in the following peer-reviewed literature:

• 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(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-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(3), 133–139.
• Hoppe, K. D., & Bogen, J. E. (1977). Alexithymia in twelve commissurotomized patients. Psychotherapy and Psychosomatics, 28(1–4), 148–155. https://doi.org/10.1159/000287057
• Krystal, H. (1988). Integration and healing: Affect, trauma, alexithymia. Analytic Press.
• Marty, P., & de M’Uzan, M. (1963). La “pensée opératoire” [Operative thinking]. Revue Française de Psychanalyse, 27(Suppl.), 345–356.
• Nemiah, J. C., & Sifneos, P. E. (1970). Affect and fantasy in patients with psychosomatic disorders. In O. W. Hill (Ed.), Modern trends in psychosomatic medicine (Vol. 2, pp. 26–34). Butterworths.
• 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.2009.11.011
• Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255–262. https://doi.org/10.1159/000286529
• 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

Items of the Scale