Factorial Validity of the Toronto Alexithymia Scale (TAS-20) in Clinical Samples: A Critical Examination of the Literature and a Psychometric Study in Anorexia Nervosa

  • Sandra TorresEmail author
  • Marina P. Guerra
  • Kylee Miller
  • Patrício Costa
  • Inês Cruz
  • Filipa M. Vieira
  • Isabel Brandão
  • António Roma-Torres
  • Magda Rocha


There is extensive use of the 20-item Toronto Alexithymia Scale (TAS-20) in research and clinical practice in anorexia nervosa (AN), though it is not empirically established in this population. This study aims to examine the factorial validity of the TAS-20 in a Portuguese AN sample (N = 125), testing four different models (ranging from 1 to 4 factors) that were identified in critical examination of existing factor analytic studies. Results of confirmatory factor analysis (CFA) suggested that the three-factor solution, measuring difficulty identifying (DIF) and describing feelings (DDF), and externally oriented thinking (EOT), was the best fitting model. The quality of measurement improves if two EOT items (16 and 18) are eliminated. Internal consistency of EOT was low and decreased with age. The results provide support for the factorial validity of the TAS-20 in AN. Nevertheless, the measurement of EOT requires some caution and may be problematic in AN adolescents.


Alexithymia Factor structure Clinical samples Anorexia nervosa Confirmatory factor analysis 



This work was funded by the Center for Psychology at the University of Porto, Portuguese Science Foundation (FCT UID/PSI/00050/2013) and EU FEDER through COMPETE 2020 program (POCI-01-0145-FEDER-007294).

Compliance with Ethical Standards

Conflict of interest

The authors Sandra Torres, Marina Prista Guerra, Kylee Miller, Patrício Costa, Inês Cruz, Filipa M. Vieira, Isabel Brandão, António Roma-Torres, and Magda Rocha declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Supplementary material

10880_2018_9562_MOESM1_ESM.docx (42 kb)
Supplementary material 1 (DOCX 42 KB)


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Authors and Affiliations

  1. 1.Faculty of Psychology and Education SciencesUniversity of PortoPortoPortugal
  2. 2.Center for Psychology at University of PortoPortoPortugal
  3. 3.Carolina Institute for Developmental Disabilities, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Life and Health Sciences Research Institute, School of MedicineUniversity of MinhoBragaPortugal
  5. 5.ICVS/3B’s, PT Government Associate LaboratoryBraga/GuimarãesPortugal
  6. 6.Psychiatry DepartmentHospital S. JoãoPortoPortugal
  7. 7.Faculty of MedicineUniversity of PortoPortoPortugal
  8. 8.Center for Research in Health Technologies and Services - CINTESISPortoPortugal

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