August 15, 2020

Toronto Alexithymia Scale

Last updated on December 7, 2021

The Toronto Alexithymia Scale (TAS-20) is a 20-item, self-administered questionnaire that measures difficulty in identifying and describing emotions, which is a big part of alexithymia.

Dr. Natalie’s rating: 5 stars for appropriate and respectful wording, 2 stars for clarity & lack of ambiguity, and 5 stars for testing accuracy.


Scroll down below discussion to take the test:

Who the test is designed for

  • Adults (age 16+) of average or higher intelligence.

Versions & translations

Taking the test

The Toronto Alexithymia Scale consists of 20 items, giving you 5 choices for each item:

  1. Strongly disagree.
  2. Disagree.
  3. Neither agree nor disagree.
  4. Agree.
  5. Strongly agree.


  • Total scores can range from 20–100, with higher scores indicating greater impairment/challenges.
  • Each item is scored on a 5-point Likert-type scale (1 = strongly disagree; 5 = strongly agree).
  • Five of the items are reverse-scored: 4, 5, 10, 18, and 19.

The total alexithymia score is the sum of responses to all 20 items, while the score for each subscale factor is the sum of the responses to that subscale.

The TAS-20 uses cutoff scoring:

  • Scores equal to or less than 51 = no alexithymia.
  • Scores of 52–60 = possible alexithymia.
  • Scores equal to or greater than 61 = alexithymia.

The TAS-20 has 3 subscales:

  • Difficulty Describing Feelings: 5 items (2, 4, 11, 12, 17).
  • Difficulty Identifying Feelings: 7 items (1, 3, 6, 7, 9, 13, 14).
  • Externally-Oriented Thinking: 8 items (5, 8, 10, 15, 16, 18, 19, 20).

Your highest average score on the subtypes shows what part of alexithymia you have the greatest challenge with.


The TAS-20 is one of the most commonly used measures of alexithymia.

  • Reliability: Demonstrates good internal consistency and test-retest reliability.
  • Validity: Research using the TAS-20 demonstrates adequate levels of convergent and concurrent validity. The 3-factor structure was found to be theoretically congruent with the alexithymia construct.

In addition, it has been found to be stable and replicable across clinical and non-clinical populations.


Dr. Natalie Engelbrecht:

I score 48, which means I do not have alexithymia. I used to have severe alexithymia, but have worked very hard through therapy to overcome it. Why? Well, because many of the challenges we have as autistic individuals come from alexithymia, not autism.

  • Empathy: Alexithymia, not autism, causes reduced affective empathy. As autistic people, our intrinsic empathetic accuracy is superior.
  • Eye contact: Autistic people avoid eye contact when overstimulated, while alexithymic people avoid eye contact due to negative emotions.
  • Emotion recognition: Autism was unrelated to facial expression recognition ability, regardless of the extent of autistic traits. Problems with identifying facial expressions are seen only in alexithymia.
  • Affect display: Reduced facial expressions in alexithymia constitute a defense mechanism against negative affect.

I would say that many of the challenges associated with my alexithymia have reduced, making my life much better. I am happier.

In terms of the TAS-20, I like that it is short and quick to take. However, I wish that a 7-point Likert scale was used instead of a 5-point scale. Going from agree or disagree to neither agree nor disagree is too significant a jump for myself. I would like to see slightly agree and slightly disagree included.


The statements in the TAS-20 are clear and easily understood, though a few are difficult for me to answer. For example, number 10—Being in touch with emotions is essential. I agree intellectually and see the importance, but in practice, I don’t rely on the connection. So, how do I answer? The only way possible is (3) neither agree nor disagree, but it’s not altogether correct. Others are difficult because—I’m unsure how I feel about the statement! Some, I have no experience on which to base a response. That seems to be a lot of issues in only 20 statements, but the total Alexithymia score does appear to be accurate, in that it reflects the challenges I deal with.

Toronto Alexithymia Scale (TAS-20)

Choose one response that best describes how each item applies to you:

Recommended next steps

After the TAS-20, consider taking one of the tests below.

Online Alexithymia Questionnaire

Like the TAS-20, it measures difficulty in identifying
and describing emotions and feelings.

Toronto Empathy Questionnaire

Measures your emotional ability to
understand and respond to others.


Measures camouflaging, and can account
for lower scores on other autism tests.

Online autism tests can play an essential role in the process of self-discovery, and may inform your decision to pursue a formal diagnosis. For a formal assessment, please see a knowledgeable medical professional trained in assessing autism.

An illustration of a clipboard with a checklist or assessment.

If you are looking for an autism assessment,
Dr. Natalie Engelbrecht can offer help!
You can find more information here:

Online autism assessments
This article
was written by:
I’m a dually licensed registered psychotherapist and naturopathic doctor, and a Canadian leader in trauma, PTSD, and integrative medicine strictly informed by scientific research.And not only do I happen to be autistic, but my autism plays a significant role in who I am as a doctor and how I interact with and care for my patients and clients.


Although our content is generally well-researched
and substantiated, or based on personal experience,
note that it does not constitute medical advice.


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