The authors developed a relatively brief observer alexithymia measure that can be used by patients’ acquaintances and relatives. Items corresponding to the defining features of alexithymia (California Q-Set Alexithymia Prototype) were written, and the new instrument's psychometric properties were evaluated in 3 lay-rater samples. The 33-item Observer Alexithymia Scale (OAS) is internally consistent (coefficient alphas = 0.88 and 0.89) and stable (2-week test-retest reliability = 0.87). Moreover, it has an interpretable five-factor structure (based on exploratory and confirmatory factor analyses): distant, uninsightful, somatizing, humorless, and rigid. The OAS is a reliable instrument with a stable factor structure and good conceptual coverage and thus, it appears to be a useful tool for collecting observer data on the clinically relevant expressions of alexithymia that receive minimal attention.
Alexithymia is a term used most commonly to describe people who have difficulties recognizing, processing, and regulating emotions.1 It is a unique personality trait2,3 that places individuals at great risk for several medical and psychiatric disorders (e.g., substance related, panic, posttraumatic stress, somatoform, and eating) and reduces the likelihood that these individuals will respond to conventional treatments for these disorders.1 Therefore, alexithymia assessment is important, given the prevalence, severity, intractability, and costliness of these problems; the association of alexithymia with these disorders; and the need for modified treatment plans with alexithymic patients.
The most widely used method to measure alexithymia is self-report, and the most popular instrument is the selfreport 20-item Toronto Alexithymia Scale (TAS-20).4 The test authors recommend that TAS-20 scores be evaluated in the context of other relevant information, such as clinical observations and reports from people who know the patient well (e.g., acquaintances and family members).1 Despite this recommendation and the availability of observer alexithymia tools [e.g., the 12-item modified Beth Israel Hospital Psychosomatic Questionnaire (modified BIQ)1 and the California Q-Set Alexithymia Prototype (CAQ-AP)],3 observer methods are not in widespread use. The modified BIQ requires a professional rater, and typically, it is completed after a clinical interview. The CAQ-AP, on the other hand, can be used by lay or professional raters, but the procedure takes 45–60 minutes to complete.
A patient's acquaintances’ and relatives’ viewpoints are important for two reasons. First, acquaintances and relatives are in a position to see a wide range of the patient's behaviors in real-life contexts beyond those ordinarily available to a therapist or other professional. Second, one of the primary factors that makes alexithymia important is its potential effect on the patient's interpersonal relationships. The impression of an alexithymic person formed by acquaintances and relatives may be a useful characterization of his or her social environment.
Therefore, the purpose of our research is to develop a relatively brief observer-based alexithymia scale phrased in terms of ordinary language accessible to acquaintances and relatives. The scale offers the potential to tap into an unexplored source of data about the alexithymic patient, derived from the patient's daily interpersonal world and depictive of the nature of the patient's “social stimulus values” upon the individuals with whom the patient comes into contact.
