Validation of a Greek adaptation of the 20-item Toronto Alexithymia Scale Ioannis Tsaousis a, ⁎ , Graeme Taylor b,c , Lena Quilty b,d , Stelios Georgiades e , Marios Stavrogiannopoulos f , R. Michael Bagby b,d a Department of Psychology, University of Crete, Crete 74100, Greece b Department of Psychiatry, University of Toronto, Toronto, Canada M5T 1R8 c Department of Psychiatry, Mount Sinai Hospital, Toronto, Canada M5T 1R8 d Center for Addiction and Mental Health, Toronto, Canada M5T 1R8 e Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada L8N 3K7 f Scientific Association for Regional Development and Mental Health (EPAPSY), Athens 15124, Greece Abstract Background: The purpose of the current investigation was (1) to test whether the 3-factor structure of the 20-item Toronto Alexithymia Scale (TAS-20) corresponding to the theoretical conceptualization of the alexithymia construct could be recovered in a Greek translation of the scale (the TAS-20-G), (2) to assess if a 3-factor structure provides a better fit to the TAS-20-G compared with the recently proposed alternative factor structures, and (3) to evaluate the internal reliability of the TAS-20-G. Methods: The English version of the TAS-20 was translated into Greek and then back-translated and modified until cross-language equivalence was established. The Greek version was then administered to 340 university students. Confirmatory factor analyses were conducted, and 4 different factor structure models were compared. Internal consistency and item-to-scale homogeneity of the TAS-20-G and its factor scales were also evaluated. Results: The 3-factor model provided a good fit to the data and proved superior to alternative 1-, 2-, and 4-factor models. Apart from a coefficient α below the recommended range for the externally oriented thinking factor, the TAS-20-G and its factor scales demonstrated adequate internal consistency and homogeneity. Conclusion: The TAS-20-G is a valid and reliable measure of alexithymia in university students and may be suitable for investigations of alexithymia in other Greek-speaking population samples. © 2010 Elsevier Inc. All rights reserved. 1. Introduction The term “alexithymia” has its linguistic roots in the Greek language; coined by Sifneos [1], this synthetic Greek term literally means having no words for emotions. The construct of alexithymia was formulated by Nemiah and Sifneos [2,3] to encompass difficulties some people have in identifying and describing their own feelings and emotions as well as an impoverished fantasy life and an externally oriented mode of thinking. Rather than being a psychiatric diagnosis or a categorical phenomenon, alexithymia is conceptualized as a dimensional personality trait [4];a taxometric investigation has provided support for this dimensional view of the construct [5]. A number of investigators have reported associations between alexithymia and a variety of medical and psychiatric disorders, including substance use disorders, eating dis- orders, posttraumatic stress disorder, functional gastrointes- tinal disorders, and essential hypertension [4,6]. There is also accumulating evidence that alexithymia influences patients' responses to some medical and psychotherapeutic treatments and may even predict treatment response. Porcelli et al [7], for example, reported that alexithymia was a significant predictor of treatment outcome for patients with functional gastrointestinal disorder. Clinical researchers have also found alexithymia to be associated with a less favorable Available online at www.sciencedirect.com Comprehensive Psychiatry 51 (2010) 443 – 448 www.elsevier.com/locate/comppsych ⁎ Corresponding author. Tel.: +30 210 8062110; fax: +30 210 6143435. E-mail address: tsaousis@psy.soc.uoc.gr (I. Tsaousis). 0010-440X/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2009.09.005