Perth Alexithymia Questionnaire

The Perth Alexithymia Questionnaire (PAQ) is a 24-item self-report measure of alexithymia. The PAQ is designed to assess all three components of alexithymia across negative and positive emotions.

Taking the PAQ and receiving your score are free, as always.
Once you receive your score, you’ll have the option to purchase a PDF with a personalized interpretation of your overall score and subscales for $3.50.

Take the test here:

This test and your on-screen scores are free. No email sign-up is required to see your scores.

Who the test is designed for

The PAQ was designed for adults and adolescents. The reference ranges below come from an Australian adult community sample, so they should not be treated as adolescent-specific norms. ^[1]PAQ scoring and interpretation manual (Preece; updated December 2023)

What is alexithymia?

Alexithymia involves difficulty noticing, identifying, or describing your own emotions. It does not mean that you have no emotions. You might know that you feel bad without knowing whether you are sad, frightened, or angry.

The PAQ measures three components:

1. Difficulty identifying feelings.
2. Difficulty describing feelings.
3. A tendency not to focus attention on feelings, called externally oriented thinking.

It looks at these experiences across pleasant and unpleasant emotions. For more information, see our Alexithymia & autism guide.

Alexithymia is associated with a range of mental health difficulties. It is relatively stable, but levels can change with distress or treatment. ^[2]PAQ scoring and interpretation manual (Preece; updated December 2023)

Versions & translations

The PAQ has been translated into several other languages. These include the following:

• Afrikaans
• Dutch
• Finnish
• French
• German
• Italian
• Persian (2020)
• Persian Farsi (2023)
• Polish
• Russian
• Spanish
• Turkish

There is also the Perth Alexithymia Questionnaire-Short Form (PAQ-S), which is a 6-item version.

Taking the test

The PAQ consists of 24 statements, giving you 7 choices for each statement ranging from:

• Strongly disagree (1 point), to Strongly agree (7 points)
• Neither agree nor disagree (4 points)

The PAQ comprises 24 statements, broken down into five categories:

• 4 statements on Negative-Difficulty identifying feelings (N-DIF)
• 4 statements on Positive-Difficulty identifying feelings (P-DIF)
• 4 statements on Negative-Difficulty describing feelings (N-DDF)
• 4 statements on Positive-Difficulty describing feelings (P-DDF)
• 8 statements on General-Externally orientated thinking (G-EOT)

Scoring

• Score each answer from 1 to 7. There are no reverse-scored items.
• Add all 24 answers for a total between 24 and 168.
• Higher scores indicate greater difficulty with the aspect of emotional awareness being measured.
• Five subscales and six composites (including the total) can be calculated.

What your score means

• 24–51: Low level of alexithymia.
• 52–112: Average level of alexithymia.
• 113–168: High level of alexithymia.

These ranges compare your score with the authors’ Australian adult community sample of 748 people. Low and high mean at least one standard deviation below or above that sample’s mean; average means between those boundaries. The total mean is 81.97, with a standard deviation of 30.91. Thus, high begins at 112.88, or 113 for a whole-number score. These are reference ranges, not diagnostic cutoffs. ^[3]PAQ scoring and interpretation manual (Preece; updated December 2023)

Look at all five subscales as well as the total. A total can conceal differences between your experiences of positive and negative emotions. The ranges below apply the authors’ rule to their published decimal values; we have not rounded the means or standard deviations before calculating the boundaries.

Interpreting your scores

Alexithymia exists on a continuum. A high score does not establish a separate diagnosis, and this questionnaire does not determine whether you are autistic. “Average” describes a comparison with a sample; it does not mean that your difficulties are unimportant.

The manual also reports female (468 participants) and male (280 participants) subgroup norms, shown below for reference. These are adult general-community norms, not autistic-specific norms. The manual does not provide a non-binary subgroup. The combined-sample ranges offer a comparison that does not require choosing one of these subgroups; averaging the female and male cutoffs would not create validated non-binary norms.

Subscale scores

Below are more comprehensive descriptions of the PAQ subscales, and the test items that are associated with each subscale.

Negative-Difficulty identifying feelings (N-DIF)

• Meaning: Difficulty identifying, understanding, and differentiating between one’s own negative feelings
• N-DIF scoring: Add together items #2, #8, #14, and #20

Positive-Difficulty identifying feelings (P-DIF)

• Meaning: Difficulty identifying, understanding, and differentiating between one’s own positive feelings
• P-DIF scoring: Add together items #5, #11, #17, and #23

Negative-Difficulty describing feelings (N-DDF)

• Meaning: Difficulty describing and communicating one’s own negative feelings
• N-DDF scoring: Add together items #1, #7, #13, and #19

Positive-Difficulty describing feelings (P-DDF)

• Meaning: Difficulty describing and communicating one’s own positive feelings
• P-DDF scoring: Add together items #4, #10, #16, and #22

General-Externally orientated thinking (G-EOT)

• Meaning: Tendency to not focus attention on one’s own emotions (negative and positive). Externally oriented thinking occurs when a person’s thoughts are focused externally (vs. internally). An externally oriented thinker focuses their energy on external events and tends to avoid focusing on internal experiences.
• G-EOT scoring: Add together items #3, #6, #9, #12, #15, #18, #21, and #24

Total scale score

• Meaning: Overall alexithymia; difficulty focusing attention on and appraising one’s own feelings (negative and positive)
• Total scoring: Add together items #1–24 (all of them)

Subscale combination scores

It’s also possible to combine various subscales to get a sense of one’s ability to identify or describe one’s feelings irrespective of the quality of those feelings (i.e., positive or negative). You can see those subscale combinations below.

General-Difficulty identifying feelings (G-DIF)

• Meaning: Difficulty identifying, understanding, and differentiating between one’s own feelings (negative and positive)
• G-DIF scoring: Add together N-DIF and P-DIF subscales

General-Difficulty describing feelings (G-DDF)

• Meaning: Difficulty describing and communicating one’s own feelings (negative and positive)
• G-DDF scoring: Add together N-DDF and P-DDF subscales

Negative-Difficulty appraising feelings (N-DAF)

• Meaning: Difficulty identifying and describing (i.e., appraising) one’s own negative feelings
• N-DAF scoring: Add together N-DIF and N-DDF subscales

Positive-Difficulty appraising feelings (P-DAF)

• Meaning: Difficulty identifying and describing (i.e., appraising) one’s own positive feelings
• P-DAF scoring: Add together P-DIF and P-DDF subscales

General-Difficulty appraising feelings (G-DAF)

• Meaning: Difficulty identifying and describing (i.e., appraising) one’s own feelings (negative and positive)
• G-DAF scoring: Add together N-DIF, P-DIF, N-DDF and P-DDF subscales

G-DIF note: The manual’s combined-sample G-DIF mean is internally inconsistent: it gives 23.68, while its N-DIF and P-DIF means sum to 24.68. We have therefore not assigned combined-sample G-DIF interpretation bands here pending clarification. Its raw score is still calculated by adding N-DIF and P-DIF.

Validity

The original development studies supported the PAQ’s five-subscale structure, internal consistency, and validity. In the 748-person study, internal consistency coefficients were approximately 0.89–0.96 across its subscales and composites. These findings support its use as a measure of alexithymia; they do not establish a diagnostic accuracy percentage or guarantee that every person’s score captures their experience perfectly.^[4]Preece et al. (2018): Development and validation of the PAQ

PAQ vs. TAS-20

Both the PAQ and the Toronto Alexithymia Scale (TAS-20) assess alexithymia.

• TAS-20: Does not provide separate scores for positive and negative emotions. Its identifying/describing items tend to emphasise distress or leave emotional valence unspecified.
• PAQ: Explicitly separates difficulties identifying and describing positive emotions from those involving negative emotions.

The PAQ can therefore help show whether these difficulties differ between pleasant and unpleasant emotions. It is too strong to say that the TAS-20 only measures negative emotions.^[5]Preece et al. (2018)

Discussion

The PAQ took me 6.5 minutes, making it the longest test per question time. The main problem I was having was difficulty with each question. I have considerable alexithymia, so much so that it makes it difficult to answer the questions. For example: “When I’m feeling bad, I can’t tell whether I’m sad, angry, or scared.” I had to think about this and remember that when I feel depressed, I am instead feeling anxious. When I am feeling agitated, that is also usually anxiety. Primarily, I feel good, very good, anxious, or very anxious. I have some anger, but that does not really come up; it’s more of an agitation when I get overwhelmed that comes across like anger. This sort of process I had to go through with each question, which increased my timing. However, when I’m feeling good, I can tell whether I’m happy, excited, or amused; positive emotions are easier for me to identify and communicate.

Unlike Kendall’s description of emotions, my emotions are more solid; they are pretty intense. Nevertheless, I can’t identify or name them because what I think I am feeling differs from what I am feeling.

The table below uses my five listed subscale scores. The composite scores and total have been recalculated from those values; they have not been verified against my original item responses. Interpretations use the combined-sample ranges above.

Scores:

Kendall:

The test took me 6 minutes. I finally beat Ember!

There is a pattern of repetition to the questions, whose purpose eludes me. Though asked seven different ways, the question still seems the same. This sameness makes me wonder whether there is a subtle shade of meaning I’m not understanding. Would those questions have seven different responses?

So, the 24 questions, when seen as a series of permutations, can be distilled into 3. If I ignore the words good and bad, it’s two questions. I know creators of tests have reasons for such things, but the tactic typically creates confusion and doubt for me. I assume the scoring key reveals the strategy of these variations, but as a test taker, it’s puzzling.

I have always felt I can’t isolate my emotions long enough to describe them. It is like trying to grab onto mercury—I can’t freeze them in place and tell you their shape. All the little shades are too complex to tease apart. They are a kaleidoscopic image, flickering and changing all the time. If asked how I feel about something, more often than not, I’ll answer, “I don’t know.” People find that strange and have said so.

It was when first researching autism that I came across the term alexithymia, and I was thunderstruck — Holy smokes! Unable to describe my emotions—this is what it is—it has a name. And that made me feel like I was not crazy. I am not the only person with this problem—it’s a thing.

Kendall’s scores:

These calculations use the five subscale scores listed in the original account. The composites and total have been recalculated; the original item responses would be needed to confirm them. Interpretations use the combined-sample ranges.

Eva

The test took me a bit over 3 minutes to complete, although it was the second time I did it, as I inadvertently refreshed the page after my first attempt, thus losing my results. The statements are pretty straightforward, so I don’t need to take that long to think. Someone with high alexithymia will probably have a harder time with the test. My alexithymia used to be very high, but I’ve practiced identifying and describing my feelings, so I score relatively low now.

Despite the statements being pretty straightforward though, I did notice a few biases. For instance, item #5 states “I can’t tell whether I’m happy, excited, or amused.” While I think listing examples is a good idea to clarify what is being asked, I chose mildly agree, because in many contexts happiness and excitement either seem to be the same to me, or they tend to show up as a pair which makes it difficult to distinguish between them. If the statement had listed different emotions as examples, I may have chosen disagree. Whereas the negative emotions that are listed in #2 seem way more distinct to me.

Also, item #7 states, “When I’m feeling bad, I can’t talk about those feelings in much depth or detail.” I feel this is quite an ambiguous statement. What is almost certainly meant is how much difficulty one experiences when reporting on negative emotions. However, it’s easy enough to interpret the sentence to mean you can’t talk about it for emotional reasons; you might feel too overwhelmed in the moment and regulate yourself before you can discuss it, or you feel bad because of a triggering situation that prevents you from talking about it. I think it should have been made clearer that the item deals with the inability to identify and report, as opposed to situational reasons for not being able to talk.

Eva’s scores:

These calculations use the five subscale scores listed in the original account. The composites and total have been recalculated; the original item responses would be needed to confirm them. Interpretations use the combined-sample ranges.

Permission to use the PAQ

The copyright holders, Preece et al. (2018), permit unlimited use and reproduction of the PAQ, including online administration. Their manual requires additional permission before translating or modifying its content. ^[6]PAQ scoring and interpretation manual (Preece; updated December 2023)

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