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Assessing alexithymia in chronic pain: psychometric properties of the Toronto Alexithymia Scale-20 and Perth Alexithymia Questionnaire

Rachel V. Aaron,David A. Preece,Lauren C. Heathcote,Stephen T. Wegener,Claudia M. Campbell,Chung Jung Mun

Published 2024 in PAIN Reports

ABSTRACT

Supplemental Digital Content is Available in the Text. The Toronto Alexithymia Scale-20 Item and Perth Alexithymia Questionnaire had psychometric strengths for assessing alexithymia in chronic pain; several weaknesses of the Toronto Alexithymia Scale-20 Item were identified. Abstract Introduction: Alexithymia is elevated in chronic pain and relates to poor pain-related outcomes. However, despite concerns from other clinical populations, the psychometric properties of alexithymia measures have not been rigorously established in chronic pain. Objective: This study examined the psychometric properties of the Toronto Alexithymia Scale-20 Item (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) in adults with chronic pain. Methods: An online sample of adults with chronic pain across the United States (N = 1453) completed the TAS-20, PAQ, and related questionnaires at baseline, 3-month follow-up, and 12-month follow-up. Results: Both measures showed good temporal stability, convergent validity (with emotion regulation scores), divergent validity (with depression and anxiety scores), and criterion validity. Some concerns were raised about the TAS-20: the original 3-factor structure showed a poor model fit; the Externally Oriented Thinking subscale of the TAS-20 had poor factor loadings and unacceptable internal consistency; and, we identified several TAS-20 items that may slightly inflate the predictive validity of the TAS-20 on pain-related outcomes. The original 5-factor structure of the PAQ showed a good fit; each PAQ subscale had good factor loadings and excellent internal consistency. Conclusions: Both the TAS-20 and PAQ had psychometric strengths. Our data raised some concern for the use of TAS-20 subscales; the PAQ may be a psychometrically stronger option, particularly for investigators interested in alexithymia subscale analysis in people with chronic pain.

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