Are alexithymia and schizoid personality disorder synonymous diagnoses? Frederick L. Coolidge ⁎ , Alisa J. Estey, Daniel L. Segal, Peter D. Marle Psychology Department, University of Colorado, Colorado Springs, CO 80918 Abstract Relationships among alexithymia, personality disorders, and higher-order psychopathological and interpersonal dimensions were examined in 199 college students and a close relative of each. Alexithymia, the difficulty to express and identify emotions, was measured by the Observer Alexithymia Scale (OAS; [Haviland, M. G., Warren, W. L., & Riggs, M. L. (2000). An observer scale to measure alexithymia. Psychosomatics, 41, 385–392]), which was completed by each student's relative. Each student completed three self-report measures: the Coolidge Axis II Inventory (CATI; [Coolidge, F. L. (2000). Coolidge Axis II Inventory: Manual. Colorado Springs, CO: Author.), the Five Dimensional Personality Test (5DPT; [van Kampen, D. (2009). Personality and psychopathology: A theory-based revision of Eysenck's PEN model. Clinical Practice and Epidemiology in Mental Health, 5,9–21]), and the Horney-Coolidge Tridimensional Inventory (HCTI; [Coolidge, F. L. (1998). Horney-Coolidge Tridimensional Inventory: Manual. Colorado Springs, CO: Author]). Results indicated that higher levels of alexithymia are associated with personality disorders and their traits, such as schizoid, avoidant, and paranoid. With regard to the issue of the similarity and difference between alexithymia and schizoid personality disorder, there was sufficient evidence across all of the measures to suggest that they are not synonymous entities. Finally, alexithymic traits were associated with concurrent depressive traits even in a non-clinical sample. © 2013 Elsevier Inc. All rights reserved. In his work with psychosomatic patients, Sifneos [1] observed that many had great difficulty communicating during their clinical interviews. He also observed that they particularly had trouble finding appropriate words to describe their feelings. He proposed the use of the term “alexithymia,” which he derived from Greek, a = lack, lexis =word, and thymos = mood or emotion. Sifneos found that psychosomatic patients, when compared to a control group, scored over twice as high on an observer questionnaire measuring alexithymic characteristics, such as a tendency to describe minuscule details instead of feelings, an inability to use appropriate words to describe emotions, a lack of a rich fantasy life, and use of actions to express emotions. Earlier, psychoanalyst Karen Horney [2] may have described a prototype of the alexithymic patient. She postulated that the paucity of inner experiences in an individual leads to externalized living and anxieties not conscious to the person. This condition, she believed, led to several neurotic disturbances, which she classified into two categories: substitute-functions and reactive anxieties. Her category of substitute-functions fit individuals who relied solely on the outside world for guidance of their behaviors because they lacked the ability to experience their emotions and beliefs. Horney thought emotions that should be attributed to oneself were projected onto others, and one's feelings were not truly owned. Horney also described a shift from being to appear- ing; in other words, she thought that a feeling of anxiety might become a concern if that person was aware that his or her hands were perspiring or trembling. Horney believed that ‘externalized living’ was the emphasis of relying on others' expectations and rules instead of one's own. Horney's [2] second category of neurotic disturbances – reactive anxieties – constituted an unawareness of inner experiences, which resulted in a feeling of emptiness of which the person may not be aware. She thought that this emptiness was the source of reactive anxieties that led to neurotic behaviors. Horney emphasized that if unawareness Available online at www.sciencedirect.com Comprehensive Psychiatry 54 (2013) 141 – 148 www.elsevier.com/locate/comppsych Frederick L. Coolidge, Alisa J. Estey, Daniel L. Segal, and Peter D. Marle, Department of Psychology, University of Colorado, Colorado Springs. The CATI, 5DPT, and HCTI are available free for research purposes from the senior author. ⁎ Corresponding author. E-mail address: fcoolidg@uccs.edu (F.L. Coolidge). 0010-440X/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2012.07.005