Psychometric Properties of the Bermond-Vorst Alexithymia Questionnaire (BVAQ) in the General Population and a Clinical Population

Lars de Vroege, Wilco H M Emons, Klaas Sijtsma, Christina M van der Feltz-Cornelis, Lars de Vroege, Wilco H M Emons, Klaas Sijtsma, Christina M van der Feltz-Cornelis

Abstract

Introduction: The Bermond-Vorst Alexithymia Questionnaire (BVAQ) has been validated in student samples and small clinical samples, but not in the general population; thus, representative general-population norms are lacking.

Aim: We examined the factor structure of the BVAQ in Longitudinal Internet Studies for the Social Sciences panel data from the Dutch general population (N = 974).

Results: Factor analyses revealed a first-order five-factor model and a second-order two-factor model. However, in the second-order model, the factor interpreted as analyzing ability loaded on both the affective factor and the cognitive factor. Further analyses showed that the first-order test scores are more reliable than the second-order test scores. External and construct validity were addressed by comparing BVAQ scores with a clinical sample of patients suffering from somatic symptom and related disorder (SSRD) (N = 235). BVAQ scores differed significantly between the general population and patients suffering from SSRD, suggesting acceptable construct validity. Age was positively associated with alexithymia. Males showed higher levels of alexithymia.

Discussion: The BVAQ is a reliable alternative measure for measuring alexithymia.

Keywords: Bermond–Vorst Alexithymia Questionnaire; alexithymia; psychometric properties; somatic symptom and related disorders; validation study.

Figures

Figure 1
Figure 1
Overview of sample composition general population.
Figure 2
Figure 2
Second-order factor structure of the Bermond–Vorst Alexithymia Questionnaire based on exploratory factor analyses on the indicative items and on the counter-indicative items (analysis sample).

References

    1. Sifneos PE. The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychother Psychosom (1973) 22(2–6):255–62.10.1159/000286529
    1. Nemiah JC, Sifneos PE. Psychosomatic illness: a problem in communication. Psychother Psychosom (1970) 18(1–6):154–60.10.1159/000286074
    1. MacLean PD. Psychosomatic disease and the “Visceral Brain”: recent developments bearing on the Papez Theory of Emotion. Psychosom Med (1949) 11(6):338–53.10.1097/00006842-194911000-00003
    1. De Timary P, Luts A, Hers D, Luminet O. Absolute and relative stability of alexithymia in alcoholic inpatients undergoing alcohol withdrawal: relationship to depression and anxiety. Psychiatry Res (2008) 157(1):105–13.10.1016/j.psychres.2006.12.008
    1. Luminet O, Rokbani L, Ogez D, Jadoulle V. An evaluation of the absolute and relative stability of alexithymia in women with breast cancer. J Psychosom Res (2007) 62(6):641–8.10.1016/j.jpsychores.2007.01.003
    1. Luminet O, Bagby RM, Taylor GJ. An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychother Psychosom (2001) 70(5):254–60.10.1159/000056263
    1. Kellner R. Somatization: theories and research. J Nerv Ment Dis (1990) 178(3):150–60.10.1097/00005053-199003000-00002
    1. Rief W, Broadbent E. Explaining medically unexplained symptoms-models and mechanisms. Clin Psychol Rev (2007) 27(7):821–41.10.1016/j.cpr.2007.07.005
    1. Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: a development perspective. Int Rev Psychiatry (2006) 18(1):13–24.10.1080/09540260500466774
    1. Taylor GJ, Bagby RM, Parker JD. Disorders of Affective Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge, UK: Cambridge University Press; (1999).
    1. Honkalampi K, Koivumaa-Honkanen H, Lehto SM, Hintikka J, Haatainen K, Rissanen T, et al. Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study. J Psychosom Res (2010) 68(3):269–73.10.1016/j.jpsychores.2009.05.010
    1. Van’t Wout M, Aleman A, Bermond B, Kahn RS. No words for feelings: alexithymia in schizophrenia patients and first-degree relatives. Compr Psychiatry (2007) 48(1):27–33.10.1016/j.comppsych.2006.07.003
    1. Van der Velde J, Swart M, van Rijn S, van der Meer L, Wunderink L, Wiersma D, et al. Cognitive alexithymia is associated with the degree of risk for psychosis. PLoS One (2015) 10(6):e0124803.10.1371/journal.pone.0124803
    1. Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K. Alexithymia in eating disorders: systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res (2017) 99:66–81.10.1016/j.jpsychores.2017.06.007
    1. Lumley MA, Neely LC, Burger AJ. The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Assess (2007) 89(3):230–46.10.1080/00223890701629698
    1. De Berardis D, Fornaro M, Orsolini L, Valchera A, Carano A, Vellante F, et al. Alexithymia and suicide risk in psychiatric disorders: a mini-review. Front Psychiatry (2017) 8:148.10.3389/fpsyt.2017.00148
    1. Vorst HC, Bermond B. Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire. Pers Individ Dif (2001) 30:413–34.10.1016/S0191-8869(00)00033-7
    1. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale – I. Item selection and cross-validation of the factor structure. J Psychosom Res (1994) 38(1):23–32.10.1016/0022-3999(94)90005-1
    1. Bermond B, Oosterveld P, Vorst HCM. Measures of alexithymia. In: Boyle GJ, Saklofske DH, Matthews G, editors. Measures of Personality and Social Psychological Construct. London, UK: Academic Press; (2015). p. 227–56.
    1. Bagby RM, Quilty LC, Taylor GJ, Grabe HJ, Luminet O, Verissimo R, et al. Are there subtypes of alexithymia? Pers Individ Dif (2009) 47(5):413–8.10.1016/j.paid.2009.04.012
    1. Bagby RM, Taylor GJ, Parker JD, Dickens SE. The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity. Psychother Psychosom (2006) 75(1):25–39.10.1159/000089224
    1. Caretti V, Porcelli P, Solano L, Schimmenti A, Bagby RM, Taylor GJ. Reliability and validity of the Toronto Structured Interview for Alexithymia in a mixed clinical and nonclinical sample from Italy. Psychiatry Res (2011) 187(3):432–6.10.1016/j.psychres.2011.02.015
    1. Bagby RM, Taylor GJ, Quilty LC, Parker JD. Reexamining the factor structure of the 20-item Toronto Alexithymia Scale: commentary on Gignac, Palmer, and Stough. J Pers Assess (2007) 89(3):258–64.10.1080/00223890701629771
    1. Bekker MH, Bachrach N, Croon MA. The relationships of antisocial behavior with attachment styles, autonomy-connectedness, and alexithymia. J Clin Psychol (2007) 63(6):507–27.10.1002/jclp.20363
    1. Bermond B, Clayton K, Liberova A, Luminet O, Maruszewski T, Ricci Bitti PE, et al. A cognitive and an affective dimension of alexithymia in six languages and seven populations. Cogn Emot (2007) 21(5):1125–36.10.1080/02699930601056989
    1. Deborde A-S, Berthoz S, Wallier J, Fermanian J, Falissard B, Jeammet P, et al. The Bermond-Vorst Alexithymia Questionnaire cutoff scores: a study in eating-disordered and control subjects. Psychopathology (2007) 41(1):43–9.10.1159/000109955
    1. Hornsveld R, Kraaimaat F. Alexithymia in Dutch violent forensic psychiatric outpatients. Psychol Crime Law (2012) 18(9):833–46.10.1080/1068316X.2011.568416
    1. Bermond B, Vorst HC, Moormann PP. Cognitive neuropsychology of alexithymia: implications for personality typology. Cogn Neuropsychiatry (2006) 11(3):332–60.10.1080/13546800500368607
    1. Pett MA, Lackey NR, Sullivan JJ. Making Sense of Factor Analysis: the USD of Factor Analysis for Instrument Development in Health Care Research. Thousand Oaks, CA: SAGE; (2003).
    1. Meijer RR, Sijtsma K. Methodology review: evaluating person fit. Appl Psychol Meas (2001) 25(2):107–35.10.1177/01466210122031957
    1. Reise SP, Waller NG. Traitedness and the assessment of response pattern scalability. J Pers Soc Psychol (1993) 65(1):143.10.1037/0022-3514.65.1.143
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Association; (2013).
    1. American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. Washington, DC: American Psychiatric Association; (2000).
    1. Ogrodniczuk JS, Piper WE, Joyce AS. Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Res (2011) 190(1):43–8.10.1016/j.psychres.2010.04.026
    1. Vigneau F, Cormier S. The factor structure of the State-Trait Anxiety Inventory: an alternative view. J Pers Assess (2008) 90(3):280–5.10.1080/00223890701885027
    1. Reise SP, Bonifay WE, Haviland MG. Scoring and modeling psychological measures in the presence of multidimensionality. J Pers Assess (2013) 95(2):129–40.10.1080/00223891.2012.725437
    1. Salminen JK, Saarijärvi S, Äärelä E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosom Res (1999) 46(1):75–82.10.1016/S0022-3999(98)00053-1
    1. Scherpenzeel A, Das M. True longitudinal and probability-based internet panels: evidence from the Netherlands. In: Das M, Ester P, Kaczmirek L, editors. Social and Behavorial Research and the Internet: Advances in Applied Methods and New Research Strategies. Boca Raton, FL: Taylor & Franics; (2011) p. 77–103.
    1. Verhage F. Intelligence and Age: Study with Dutch People Aged 12-77. Assen: Van Gorcum; (1964).
    1. Emons WH. Nonparametric person-fit analysis of polytomous item scores. Appl Psychol Meas (2008) 32(3):224–47.10.1177/0146621607302479
    1. Emons WH, Sijtsma K, Meijer RR. Global, local, and graphical person-fit analysis using person-response functions. Psychol Methods (2005) 10(1):101–19.10.1037/1082-989X.10.1.101
    1. Horn JL. A rationale and test for the number of factors in factor analysis. Psychometrika (1965) 30(2):179–85.10.1007/BF02289447
    1. Ten Berge JM, Kiers HA. A numerical approach to the approximate and the exact minimum rank of a covariance matrix. Psychometrika (1991) 56(2):309–15.10.1007/BF02294464
    1. Timmerman ME, Lorenzo-Seva U. Dimensionality assessment of ordered polytomous items with parallel analysis. Psychol Methods (2011) 16(2):209.10.1037/a0023353
    1. Ferrando PJ, Lorenzo-Seva U. Unrestricted Item Factor Analysis and Some Relations with Item Response Theory. Tarragona: Department of Psychology, Universitat Rovira i Virgili; (2013). Technical Report. Available from: (Accessed: August 25, 2015).
    1. Muthen B, Kaplan D. A comparison of some methodologies for the factor analysis of non-normal Likert variables: a note on the size of the model. Br J Math Stat Psychol (1992) 45(1):19–30.10.1111/j.2044-8317.1992.tb00975.x
    1. Lorenzo-Seva U, Ferrando PJ. FACTOR: a computer program to fit the exploratory factor analysis model. Behav Res Methods (2006) 38(1):88–91.10.3758/BF03192753
    1. Gorsuch R. Factor Analysis. 2nd ed Hillsdale, NJ: LEA; (1983).
    1. Muthén LK, Muthén BO. Mplus User’s Guide. 6th ed. Los Angeles, CA: Muthén & Muthén; (1998–2011).
    1. Revelle W. psych: Procedures for Personality and Psychological Research (R-Package, Version 1.7.5) [Computer Program]. (2015). Available from: (2015) (Accessed: August 25, 2015).
    1. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika (1951) 16(3):297–334.10.1007/BF02310555
    1. Feldt LS, Woodruff DJ, Salih FA. Statistical inference for coefficient alpha. Appl Psychol Meas (1987) 11(1):93–103.10.1177/014662168701100107
    1. Diedenhofen B. cocron: Statistical Comparisons of Two or More Alpha Coefficients (R-package, Version 1.0-1) [Computer Program]. (2016). Available from: (Accessed: November 18, 2016).
    1. Team R. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; (2014).
    1. Haberman SJ. When can subscores have value? J Educ Behav Stat (2008) 33:204–29.10.3102/1076998607302636
    1. Robitzsch A. sirt: Supplemantory Item Response Theory Models (R-package, Version 1.10-0) [Computer Program]. (2016). Available from: (Accessed: December 5, 2016).
    1. Oosterhuis HE, van der Ark LA, Sijtsma K. Sample size requirements for traditional and regression-based norms. Assessment (2016) 23(2):191–202.10.1177/1073191115580638
    1. IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. New York, NY: IBM Corp Armonk; (2011).
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Earlbaum Associates; (1988). p. 20–6.
    1. Franz M, Popp K, Schaefer R, Sitte W, Schneider C, Hardt J, et al. Alexithymia in the German general population. Soc Psychiatry Psychiatr Epidemiol (2008) 43(1):54–62.10.1007/s00127-007-0265-1
    1. Joukamaa M, Saarijärvi S, Muuriaisniemi M-L, Salokangas RK. Alexithymia in a normal elderly population. Compr Psychiatry (1996) 37(2):144–7.10.1016/S0010-440X(96)90576-3
    1. Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, et al. Alexithymia and somatization in general population. Psychosom Med (2008) 70(6):716–22.10.1097/PSY.0b013e31816ffc39
    1. Pasini A, Delle Chiaie R, Seripa S, Ciani N. Alexithymia as related to sex, age, and educational level: results of the Toronto Alexithymia Scale in 417 normal subjects. Compr Psychiatry (1992) 33(1):42–6.10.1016/0010-440X(92)90078-5
    1. Barbosa F, Mota C, Patrício P, Alcântara C, Ferreira C, Barbosa A. The relationship between 754 alexithymia and psychological factors in systemic lupus erythematosus. Compr Psychiatry (2011) 52(6):754–62.10.1016/j.comppsych.2010.11.004
    1. Castelli L, Tesio V, Colonna F, Molinaro S, Leombruni P, Bruzzone M, et al. Alexithymia and psychological distress in fibromyalgia: prevalence and relation with quality of life. Clin Exp Rheumatol (2012) 30(6 Suppl 74):70–7.
    1. Evren B, Evren C, Guler MH. Clinical correlates of alexithymia in patients with fibromyalgia. Pain Clin (2006) 18(1):1–9.10.1163/156856906775249857
    1. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol (2011) 67(9):942–68.10.1002/jclp.20816
    1. Malt EA, Olafsson S, Lund A, Ursin H. Factors explaining variance in perceived pain in women with fibromyalgia. BMC Musculoskelet Disord (2002) 3(1):12.10.1186/1471-2474-3-12
    1. Van Middendorp H, Lumley MA, Jacobs JW, van Doornen LJ, Bijlsma JW, Geenen R. Emotions and emotional approach and avoidance strategies in fibromyalgia. J Psychosom Res (2008) 64(2):159–67.10.1016/j.jpsychores.2007.08.009
    1. Margalit D, Har LB, Brill S, Vatine J-J. Complex regional pain syndrome, alexithymia, and psychological distress. J Psychosom Res (2014) 77(4):273–7.10.1016/j.jpsychores.2014.07.005
    1. Tominaga T, Choi H, Nagoshi Y, Wada Y, Fukui K. Relationship between alexithymia and coping strategies in patients with somatoform disorder. Neuropsychiatr Dis Treat (2014) 10:55–62.10.2147/ndt.s55956
    1. Haviland MG, Shaw DG, Cummings MA, MacMurray JP. Alexithymia: subscales and relationship to depression. Psychother Psychosom (1988) 50(3):164–70.10.1159/000288115
    1. Honkalampi K, Hintikka J, Saarinen P, Lehtonen J, Viinamäki H. Is alexithymia a permanent feature in depressed patients? Psychother Psychosom (2000) 69(6):303–8.10.1159/000012412
    1. Craparo G, Faraci P, Gori A. Psychometric properties of the 20-item Toronto Alexithymia Scale in a group of Italian younger adolescents. Psychiatry Investig (2015) 12(4):500–7.10.4306/pi.2015.12.4.500
    1. Bagby RM, Ayearst LE, Morariu RA, Watters C, Taylor GJ. The internet administration version of the 20-item Toronto Alexithymia Scale. Psychol Assess (2014) 26(1):16.10.1037/a0034316
    1. Samur D, Tops M, Schlinkert C, Quirin M, Cuijpers P, Koole SL. Four decades of research on alexithymia: moving toward clinical applications. Front Psychol (2013) 4:861.10.3389/fpsyg.2013.00861

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