August 15, 2020
Category:

Toronto Alexithymia Scale

Last updated on November 9, 2022

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.

Basic information
Statements: 20
Duration: 5–10 minutes
Type: screening tool
Authors: Michael Bagby, James D. A. Parker, Graeme J. Taylor
Publishing year: 1994
Seminal paper: The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure (Bagby, Parker & Taylor, 1994)

 

Take the test here:


Dr. Natalie Engelbrecht’s rating: 4 stars for appropriate and respectful wording, 2 stars for clarity & lack of ambiguity, and 5 stars for testing accuracy.Dr. Natalie Engelbrecht’s rating: 4 stars for appropriate and respectful wording, 2 stars for clarity & lack of ambiguity, and 5 stars for testing accuracy.


Who the test is designed for

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

What it measures

The TAS-20 is one of the most commonly used measures of alexithymia.[1]Toronto Alexithymia Scale (TAS-20) | ACBS It measures the following three factors:

FactorDescriptionAssociated test items
Factor IDifficulty identifying feelings 1, 3, 6, 7, 9, 13, 14
Factor IIDifficulty describing feelings 2, 4, 11, 12, 17
Factor IIIExternally-oriented thinking5, 8, 10, 15, 16, 18, 19, 20

Versions & translations

The English version of TAS-20 has been translated into 30+ different languages,[2]Twenty-five years with the 20-item Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 2020) and there are many papers on the validity of translated versions of the test.[3]Psychometric Properties of the 20-Item Toronto Alexithymia Scale in the Chilean Population (González-Arias et al., 2018) Yet the test isn’t readily available online. Here are the few translations we have been able to find (in PDF-form, so not auto-scored):

LanguageTest
DutchTAS-20
FrenchQuestionnaire TAS-20

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.

Scoring

Basics

  • Scoring range: 20–100 (higher scores indicate 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.

Subscales

The TAS-20 has 3 subscales:

FactorDescriptionAssociated test items
Factor IDifficulty identifying feelings 1, 3, 6, 7, 9, 13, 14
Factor IIDifficulty describing feelings 2, 4, 11, 12, 17
Factor IIIExternally-oriented thinking5, 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.

Interpretation

The TAS-20 uses cutoff scoring:

ScoreInterpretation
0–51No alexithymia
52–60Possible alexithymia
61–100Alexithymia present

Validity

The 3-factor structure of the TAS-20 was found to be theoretically congruent with the alexithymia construct, and research using the TAS-20 demonstrates adequate levels of convergent and concurrent validity. The TAS-20 also demonstrates good internal consistency and test-retest reliability.[4]The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure (Bagby, Parker & Taylor, 1994)

LanguageTest
DutchTAS-20
FrenchQuestionnaire TAS-20

In addition, the TAS-20 has been found to be stable and replicable across clinical and non-clinical populations. However, there was a small but statistically significant difference between the mean TAS-20 scores for men (51.14) and women (48.99).[5]The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure (Bagby, Parker & Taylor, 1994)


Limitations

Some question whether self-report scales such as the TAS-20 can adequately assess alexithymia in individuals where alexithymia is high, as they may be unable to evaluate their awareness of emotional feelings accurately.[6]Are alexithymia, ambivalence over emotional expression, and social insecurity overlapping constructs? (Müller, Bühner, & Şahinc, 2008)[7]Sociodemographic correlates of alexithymia (Lane, Sechrest, & Riedel, 1998) This limitation was also acknowledged by the authors in 1997.[8]Disorders of affect regulation: Alexithymia in medical and psychiatric illness (Taylor, Bagby, & Parker, 1997)

Based on the idea that a multimethod approach may be able to assess alexithymia more accurately, the authors of the TAS-20 also developed a structured interview method based on the TAS-20, called the Toronto Structured Interview for Alexithymia (TSIA).[9]The Development of the Toronto Structured Interview for Alexithymia: Item Selection, Factor Structure, Reliability and Concurrent Validity (Bagby, Taylor, Parker, & Dickens, 2006)[10]Twenty-five years with the 20-item Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 2020)


Discussion

Dr. Natalie Engelbrecht pointing to the title ‘Discussion’.
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.

Kendall:

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.


Dr. Natalie Engelbrecht pointing at a psychometric test.

TAS-20

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

1. I am often confused about what emotion I am feeling.
2. It is difficult for me to find the right words for my feelings.
3. I have physical sensations that even doctors don’t understand.
4. I am able to describe my feelings easily.
5. I prefer to analyze problems rather than just describe them.
6. When I am upset, I don’t know if I am sad, frightened, or angry.
7. I am often puzzled by sensations in my body.
8. I prefer to just let things happen rather than to understand why they turned out that way.
9. I have feelings that I can’t quite identify.
10. Being in touch with emotions is essential.
11. I find it hard to describe how I feel about people.
12. People tell me to describe my feelings more.
13. I don’t know what’s going on inside me.
14. I often don’t know why I am angry.
15. I prefer talking to people about their daily activities rather than their feelings.
16. I prefer to watch “light” entertainment shows rather than psychological dramas.
17. It is difficult for me to reveal my innermost feelings, even to close friends.
18. I can feel close to someone, even in moments of silence.
19. I find examination of my feelings useful in solving personal problems.
20. I look for hidden meanings in movies or plays.


What does my score mean?

Interpretation

The TAS-20 uses cutoff scoring, with scores of 52–60 indicating possible alexithymia, and scores above 60 indicating alexithymia.

ScoreInterpretation
0–51No alexithymia
52–60Possible alexithymia
61–100Alexithymia present

In other words, the higher your score, the more alexithymic traits are present, and the more certainty there is that you clinically qualify for alexithymia.

Subscores

Also, pay attention to which of the subscales you score highest in.

FactorDescriptionAssociated test items
Factor IDifficulty identifying feelings 1, 3, 6, 7, 9, 13, 14
Factor IIDifficulty describing feelings 2, 4, 11, 12, 17
Factor IIIExternally-oriented thinking5, 8, 10, 15, 16, 18, 19, 20

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.

CAT-Q

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.


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

Online autism assessments

References

This article
was written by:
dr-natalie-engelbrecht
Dr. Natalie Engelbrecht ND RP is a dually licensed naturopathic doctor and registered psychotherapist, 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.

Disclaimer

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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