R. Michael Bagby | University of Toronto (original) (raw)
Papers by R. Michael Bagby
Journal of Personality Disorders, 2019
Psychological Medicine, 2024
Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line intervention... more Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line interventions for adult depression, but their relative efficacy in the long term and on outcome measures other than depressive symptomatology is unknown. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses. This IPD meta-analysis compared the efficacy of IPT and antidepressants on various outcomes at post-treatment and follow-up (PROSPERO: CRD42020219891). A systematic literature search conducted May 1st, 2023 identified randomized trials comparing IPT and antidepressants in acute-phase treatment of adults with depression. Anonymized IPD were requested and analyzed using mixed-effects models. The prespecified primary outcome was post-treatment depression symptom severity. Secondary outcomes were all post-treatment and follow-up measures assessed in at least two studies. IPD were obtained from 9 of 15 studies identified (N = 1536/1948, 78.9%). No significant comparative treatment effects were found on post-treatment measures of depression (d = 0.088, p = 0.103, N = 1530) and social functioning (d = 0.026, p = 0.624, N = 1213). In smaller samples, antidepressants performed slightly better than IPT on post-treatment measures of general psychopathology (d = 0.276, p = 0.023, N = 307) and dysfunctional attitudes (d = 0.249, p = 0.029, N = 231), but not on any other secondary outcomes, nor at follow-up. This IPD meta-analysis is the first to examine the acute and longer-term efficacy of IPT v. antidepressants on a broad range of outcomes. Depression treatment trials should routinely include multiple outcome measures and follow-up assessments.
Clinical Neuropsychiatry, 2024
Objective: Our goal was to compare the original conceptualization of the alexithymia construct wi... more Objective: Our goal was to compare the original conceptualization of the alexithymia construct with the attention-appraisal model, focusing primarily on the removal of the reduced imaginal activity component, a seminal aspect of the construct in the original model. We also examined associations between alexithymia and emotional distress and emotion regulation, attachment, and trauma, and whether alexithymia is a transdiagnostic risk factor. We discuss differences between the models in the treatment of alexithymia and also differences in measurement.
Method: We conducted a narrative review of the scientific literature validating the original model of alexithymia and examined the comparatively few empirical studies evaluating the attention-appraisal model. Articles describing contemporary theoretical ideas about the relationship between imagination and emotion were reviewed, as well as studies exploring associations between alexithymia and imaginal activity.
Results: The attention-appraisal model of alexithymia is theoretically derived and examined empirically in studies using correlation/measurement-based methods that employed self-report measures with mostly non-clinical samples and conducted primarily by researchers led by developers of the model. The original model of alexithymia is derived from observations of patients in clinical settings; its validity is supported by findings from hundreds of empirical investigations spanning nearly four decades with nonclinical and a variety of clinical samples using both correlation-based and experimental studies and methods of measurement other than self-report, and by independent teams of researchers. The reduced imaginal activity component of the alexithymia construct is mostly supported by these studies.
Conclusions: Because of the dearth of studies with clinical samples, the absence of investigations by independent researchers, and the limited range of methods and measurements to evaluate and assess the model, there is insufficient evidence to warrant removal of the imaginal activity component of the alexithymia construct and for replacing the original conceptualization of the construct with the attention-appraisal model.
Journal of personality assessment, Jan 19, 2015
Valid self-report assessment of psychopathology relies on accurate and credible responses to test... more Valid self-report assessment of psychopathology relies on accurate and credible responses to test questions. There are some individuals who, in certain assessment contexts, cannot or choose not to answer in a manner typically representative of their traits or symptoms. This is referred to, most broadly, as test response bias. In this investigation, we explore the effect of response bias on the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2013 ), a self-report instrument designed to assess the pathological personality traits used to inform diagnosis of the personality disorders in Section III of DSM-5. A set of Minnesota Multiphasic Personality Inventory Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008 / 2011 ) validity scales, which are used to assess and identify response bias, were employed to identify individuals who engaged in either noncredible overreporting (OR) or underreporting (UR), or who were deemed to be reporting or resp...
Comprehensive Psychiatry, 2009
Recently, the Toronto Structured Interview for Alexithymia (TSIA) was developed to supplement the... more Recently, the Toronto Structured Interview for Alexithymia (TSIA) was developed to supplement the self-assessment of alexithymia and/or offer a different method of measuring the alexithymia construct. The aim of this study was to evaluate the psychometric properties of a German language translation of the TSIA in a psychiatric patient sample. Translation and back-translation were performed until a high agreement of cross-language equivalence was obtained between the German and the original English language version of the TSIA. The TSIA and the German language version of the 20-Item Toronto Alexithymia Scale were administered to 237 psychiatric patients at the departments of psychiatry and psychotherapy in Germany and Switzerland. Videotapes of some of the interviews were recorded for the assessment of interrater reliability. The German version of the TSIA and its 4 scales correlated significantly with the German version of the 20-Item Toronto Alexithymia Scale and its 3 factor scales, providing support for concurrent validity of the interview. Confirmatory factor analyses supported the hierarchical, 4-factor structure obtained with the original English version, with 4 lower-order factors nested within 2 higher-order latent factors. Acceptable levels of internal reliability and interrater reliability were also demonstrated. The TSIA is a valid and reliable measure for assessing alexithymia, at least in clinical samples. The TSIA, together with a self-report alexithymia scale, allow for a multimethod approach to assessing alexithymia.
Psychological Medicine, 2010
BackgroundMonoamine oxidase A (MAOA) is an important enzyme that metabolizes monoamines such as s... more BackgroundMonoamine oxidase A (MAOA) is an important enzyme that metabolizes monoamines such as serotonin, norepinephrine and dopamine in the brain. In prefrontal cortex, low MAOA binding is associated with aggression and high binding is associated with major depressive disorder (MDD) and also risk for recurrence of depressive episodes. In rodent models, low MAOA levels are associated with increased aggression and fear conditioning, and decreased social and exploratory investigative behaviors. Our objective was to measure MAOA binding in prefrontal cortex and concurrently evaluate a broad range of validated personality traits. We hypothesized that prefrontal MAOA binding would correlate negatively with angry-hostility, a trait related to aggression/anger, and positively with traits intuitively related to adaptive investigative behavior.MethodParticipants were aged 19–49 years, healthy and non-smoking. MAOA binding was measured with [11C]harmine positron emission tomography (PET) in ...
Psychological Assessment, 2014
Researchers are increasingly administering tests developed and validated in paper format via the ... more Researchers are increasingly administering tests developed and validated in paper format via the Internet. Yet, the equivalence between paper and Internet concerning administration of tests is not typically demonstrated. We evaluated the reliability, factorial and external validity, and measurement equivalency of the Internet version of the 20-item Toronto Alexithymia Scale (TAS-20; Bagby, Parker, & Taylor, 1994; Bagby, Taylor, & Parker, 1994; Lumley et al., 2007) vis-à-vis the paper version. Participants (N = 621) completed the TAS-20 either on the Internet or on paper. Reliability and item-to-scale homogeneity were evaluated for each format. We used confirmatory factor analyses (CFAs) to evaluate factorial validity and used CFA-based factorial invariance procedures to determine measurement equivalency. Alpha coefficients and mean interitem correlations (MICs) were adequate for the full-scale TAS-20 Internet and paper versions and the difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) factor scale test scores; in both formats, alpha and MICs were poorer for externally oriented thinking (EOT) factor test scores compared to scores for the DIF and DDF. The fit of the 3-factor structure of the TAS-20 was adequate for both formats. Factorial invariance across formats was also demonstrated; mean scores for the total scale and each factor scale were not different across formats. Correlations with the domain and facet scales of the Revised NEO Personality Inventory (Costa & McCrae, 1992b) were mostly similar across formats. The Internet and paper versions of the TAS-20 are comparably reliable and valid. An Internet version of the TAS-20 expands opportunities to collect data and permits generalizing of results across studies using the different modes of administration.
Psychotherapy and Psychosomatics, 1992
Journal of Personality Assessment, 1999
Alexithymia and the Five Factor Model of Personality: Facet Analysis Validation
British Journal of Clinical Psychology, 2010
Objectives. We examined the moderating role of depression recurrence on the relationb etween auto... more Objectives. We examined the moderating role of depression recurrence on the relationb etween autonomous and controlled motivation and interpersonal therapy (IPT) treatment outcome.
Many jurisdictions across North America have revised their civil commitment laws. In general, the... more Many jurisdictions across North America have revised their civil commitment laws. In general, these laws have specified more concretely those conditions under which an individual may be involuntarily hospitalized, with the legislative intent of reducing civil commitments. The present study analysed the effects of similar reform on admission rates to Ontario Public Mental Hospitals and Public Psychiatric Hospitals. Results indicate that despite a significant trend toward a decreasing rate of involuntary hospitalization prior to legislative revision, there was a subsequent trend toward an increasing rate of civil commitments in the years following change in law. These results raise serious questions about the ability of lawmakers to legislate the practices of mental health professionals.
Many jurisdictions across North America have revised their statutes pertaining to the criteria fo... more Many jurisdictions across North America have revised their statutes pertaining to the criteria for civil commitment with the legislative intent to either increase or decrease the use of involuntary hospitalization. The impact of these revised statutes has been examined in many jurisdictions, but there has been no consensus regarding their effectiveness in changing the rates of involuntary admissions. The present article reviews the literature from a methodological perspective, comparing the differing analyses, results and interpretations. When the legislative revision has sought to expand medical prerogative, results indicate a sustained increase in civil commitments. When legislation has aimed at limiting medical discretion, there was an immediate decline in civil commitment rates, but a subsequent increase in the period following the initial post-reform declines. These results are discussed in terms of readmission trends, deinstitutionalization, and the possible reaction of mental health professionals who perceive legislation as an unnecessary constraint in the treatment of the mentally ill.
The authors question the clinical status of factitious disorder with psychological symptoms as a ... more The authors question the clinical status of factitious disorder with psychological symptoms as a mental disorder. In particular, they argue that unresolved issues regarding the motivational basis of this disorder and the lack of clearly delineated inclusion, exclusion, and outcome criteria seriously compromise its diagnostic legitimacy. Two case reports are presented to illustrate these difficulties. Future studies should consider these empirical and conceptual difficulties in refining the diagnosis of factitious disorder with psychological symptoms for DSM-IV.
Conflicting results have been reported in studies examining the relationships between alexithymia... more Conflicting results have been reported in studies examining the relationships between alexithymia and the variables of age, gender, social class, and intelligence. Moreover, these results are of dubious validity and generalizability because many of the studies used psychometrically poor scales to measure the alexithymia construct. The present study reexamined the relationships between alexithymia and sociodemographic variables and intelligence in a sample of normal adults using the Toronto Alexithymia Scale (TAS), a recently developed self-report measure with evidence of reliability and validity. The results indicate that alexithymia, as measured by the TAS, is not associated with age, gender, educational level, socioeconomic status, and intelligence.
SI88I8ry-The pilot study examined the relationships between the Toronto AJexithymia Scale (TAS), ... more SI88I8ry-The pilot study examined the relationships between the Toronto AJexithymia Scale (TAS), the scales of the EPQ. and self-report measures of somatic complaints. One hundred and ninety undergraduates completed the T AS, EPQ and two measures of somatic complaints. As expected, the T AS and EPQ Neuroticism scale correlated positively with each other and with somatic complaints; the Extraversion scale correlated negatively with the T AS. The Neuroticism scale was found to be highly correlated with the somatic complaint scales. Directions for future research relating personality variables and somatic complaints are suggested.
The prevalence of alexithymia in a group of newly abstinent male substance abusers (N=44) was 50%... more The prevalence of alexithymia in a group of newly
abstinent male substance abusers (N=44) was 50%.
The alexithymic patients had significantly less ego
strength and repressive defensive behavior and significantly higher levels of somatic complaints and general dysphoria.
Alexithymia is a hypothetical personality construct that has been associated with a variety of me... more Alexithymia is a hypothetical personality construct that has been associated with a variety of medical and psychiatric disorders. This article reviews a program of research evaluating the validity of the construct using a measurement-based, construct validation approach. For this purpose the Toronto Alexithymia Scale (TAS) was developed. In a series of studies the TAS demonstrated internal consistency, good test-retest reliability, and a stable factor structure theoretically congruent with the alexithymia construct. In separate tests of construct validity, the TAS correlated in a theoretically meaningful fashion with measures of other constructs. Criterion validity was supported by a study in which the TAS was able to discriminate between behavioural medicine out-patients designated as alexithymic and those designated as nonalexithymic on the basis of objectively rated structured interviews. In a normal adult sample, TAS scores were not related to sociodemographic variables or intelligence. These results provide considerable empirical support for the validity of the alexithymia construct. In addition, the TAS appears to be a psychometrically sound measure of alexithymia that may prove useful in testing the construct with psychiatric and medical patient populations.
A simulation design was used to test the validity of the SIRS as a structured interview for the a... more A simulation design was used to test the validity of the SIRS as a structured interview for the assessment of malingering. A correctional sample (25 simulators and 26 controls) was compared to previous validation research (Rogers et al., 1989) which had employed clinical and community samples. Results indicated that six of the 13 SIRS scales, as well as overall item endorsement, differed consistently between honest and simulating malingering conditions across correctional, clinical, and community settings. In addition, the suggestion that sociopaths may be more effective malingerers was not supported by the SIRS data.
Ultimate opinion testimony in insanity trials has met with strong moral condemnation with charges... more Ultimate opinion testimony in insanity trials has met with strong moral condemnation with charges that mental health experts have cast off their mantle of expertise and ventured into an arena sanctioned only for law and
philosophy (Bonnie, 1983; Morse, 1978, 1985; Rodriguez, LeWinn, &; Perlin, 1983). Ultimate opinions (i.e., those conclusions which address directly the defendant's sanity/insanity) are inveighed against for subversion of the legal process by "invading the province of the jury" (Arenella, 1982; Halleck, 1980; Shah, 1981). Based on an availability heuristic, "egregious" insanity cases are believed to exist where it is surmised that a docile jury followed uncritically an expert's opinions, apparently unmoved by the judge's admonitions and unswayed by opposing counsel's exhortations (for a more balanced view see Golding &; Roesch, 1988).
Journal of Personality Disorders, 2019
Psychological Medicine, 2024
Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line intervention... more Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line interventions for adult depression, but their relative efficacy in the long term and on outcome measures other than depressive symptomatology is unknown. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses. This IPD meta-analysis compared the efficacy of IPT and antidepressants on various outcomes at post-treatment and follow-up (PROSPERO: CRD42020219891). A systematic literature search conducted May 1st, 2023 identified randomized trials comparing IPT and antidepressants in acute-phase treatment of adults with depression. Anonymized IPD were requested and analyzed using mixed-effects models. The prespecified primary outcome was post-treatment depression symptom severity. Secondary outcomes were all post-treatment and follow-up measures assessed in at least two studies. IPD were obtained from 9 of 15 studies identified (N = 1536/1948, 78.9%). No significant comparative treatment effects were found on post-treatment measures of depression (d = 0.088, p = 0.103, N = 1530) and social functioning (d = 0.026, p = 0.624, N = 1213). In smaller samples, antidepressants performed slightly better than IPT on post-treatment measures of general psychopathology (d = 0.276, p = 0.023, N = 307) and dysfunctional attitudes (d = 0.249, p = 0.029, N = 231), but not on any other secondary outcomes, nor at follow-up. This IPD meta-analysis is the first to examine the acute and longer-term efficacy of IPT v. antidepressants on a broad range of outcomes. Depression treatment trials should routinely include multiple outcome measures and follow-up assessments.
Clinical Neuropsychiatry, 2024
Objective: Our goal was to compare the original conceptualization of the alexithymia construct wi... more Objective: Our goal was to compare the original conceptualization of the alexithymia construct with the attention-appraisal model, focusing primarily on the removal of the reduced imaginal activity component, a seminal aspect of the construct in the original model. We also examined associations between alexithymia and emotional distress and emotion regulation, attachment, and trauma, and whether alexithymia is a transdiagnostic risk factor. We discuss differences between the models in the treatment of alexithymia and also differences in measurement.
Method: We conducted a narrative review of the scientific literature validating the original model of alexithymia and examined the comparatively few empirical studies evaluating the attention-appraisal model. Articles describing contemporary theoretical ideas about the relationship between imagination and emotion were reviewed, as well as studies exploring associations between alexithymia and imaginal activity.
Results: The attention-appraisal model of alexithymia is theoretically derived and examined empirically in studies using correlation/measurement-based methods that employed self-report measures with mostly non-clinical samples and conducted primarily by researchers led by developers of the model. The original model of alexithymia is derived from observations of patients in clinical settings; its validity is supported by findings from hundreds of empirical investigations spanning nearly four decades with nonclinical and a variety of clinical samples using both correlation-based and experimental studies and methods of measurement other than self-report, and by independent teams of researchers. The reduced imaginal activity component of the alexithymia construct is mostly supported by these studies.
Conclusions: Because of the dearth of studies with clinical samples, the absence of investigations by independent researchers, and the limited range of methods and measurements to evaluate and assess the model, there is insufficient evidence to warrant removal of the imaginal activity component of the alexithymia construct and for replacing the original conceptualization of the construct with the attention-appraisal model.
Journal of personality assessment, Jan 19, 2015
Valid self-report assessment of psychopathology relies on accurate and credible responses to test... more Valid self-report assessment of psychopathology relies on accurate and credible responses to test questions. There are some individuals who, in certain assessment contexts, cannot or choose not to answer in a manner typically representative of their traits or symptoms. This is referred to, most broadly, as test response bias. In this investigation, we explore the effect of response bias on the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2013 ), a self-report instrument designed to assess the pathological personality traits used to inform diagnosis of the personality disorders in Section III of DSM-5. A set of Minnesota Multiphasic Personality Inventory Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008 / 2011 ) validity scales, which are used to assess and identify response bias, were employed to identify individuals who engaged in either noncredible overreporting (OR) or underreporting (UR), or who were deemed to be reporting or resp...
Comprehensive Psychiatry, 2009
Recently, the Toronto Structured Interview for Alexithymia (TSIA) was developed to supplement the... more Recently, the Toronto Structured Interview for Alexithymia (TSIA) was developed to supplement the self-assessment of alexithymia and/or offer a different method of measuring the alexithymia construct. The aim of this study was to evaluate the psychometric properties of a German language translation of the TSIA in a psychiatric patient sample. Translation and back-translation were performed until a high agreement of cross-language equivalence was obtained between the German and the original English language version of the TSIA. The TSIA and the German language version of the 20-Item Toronto Alexithymia Scale were administered to 237 psychiatric patients at the departments of psychiatry and psychotherapy in Germany and Switzerland. Videotapes of some of the interviews were recorded for the assessment of interrater reliability. The German version of the TSIA and its 4 scales correlated significantly with the German version of the 20-Item Toronto Alexithymia Scale and its 3 factor scales, providing support for concurrent validity of the interview. Confirmatory factor analyses supported the hierarchical, 4-factor structure obtained with the original English version, with 4 lower-order factors nested within 2 higher-order latent factors. Acceptable levels of internal reliability and interrater reliability were also demonstrated. The TSIA is a valid and reliable measure for assessing alexithymia, at least in clinical samples. The TSIA, together with a self-report alexithymia scale, allow for a multimethod approach to assessing alexithymia.
Psychological Medicine, 2010
BackgroundMonoamine oxidase A (MAOA) is an important enzyme that metabolizes monoamines such as s... more BackgroundMonoamine oxidase A (MAOA) is an important enzyme that metabolizes monoamines such as serotonin, norepinephrine and dopamine in the brain. In prefrontal cortex, low MAOA binding is associated with aggression and high binding is associated with major depressive disorder (MDD) and also risk for recurrence of depressive episodes. In rodent models, low MAOA levels are associated with increased aggression and fear conditioning, and decreased social and exploratory investigative behaviors. Our objective was to measure MAOA binding in prefrontal cortex and concurrently evaluate a broad range of validated personality traits. We hypothesized that prefrontal MAOA binding would correlate negatively with angry-hostility, a trait related to aggression/anger, and positively with traits intuitively related to adaptive investigative behavior.MethodParticipants were aged 19–49 years, healthy and non-smoking. MAOA binding was measured with [11C]harmine positron emission tomography (PET) in ...
Psychological Assessment, 2014
Researchers are increasingly administering tests developed and validated in paper format via the ... more Researchers are increasingly administering tests developed and validated in paper format via the Internet. Yet, the equivalence between paper and Internet concerning administration of tests is not typically demonstrated. We evaluated the reliability, factorial and external validity, and measurement equivalency of the Internet version of the 20-item Toronto Alexithymia Scale (TAS-20; Bagby, Parker, & Taylor, 1994; Bagby, Taylor, & Parker, 1994; Lumley et al., 2007) vis-à-vis the paper version. Participants (N = 621) completed the TAS-20 either on the Internet or on paper. Reliability and item-to-scale homogeneity were evaluated for each format. We used confirmatory factor analyses (CFAs) to evaluate factorial validity and used CFA-based factorial invariance procedures to determine measurement equivalency. Alpha coefficients and mean interitem correlations (MICs) were adequate for the full-scale TAS-20 Internet and paper versions and the difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) factor scale test scores; in both formats, alpha and MICs were poorer for externally oriented thinking (EOT) factor test scores compared to scores for the DIF and DDF. The fit of the 3-factor structure of the TAS-20 was adequate for both formats. Factorial invariance across formats was also demonstrated; mean scores for the total scale and each factor scale were not different across formats. Correlations with the domain and facet scales of the Revised NEO Personality Inventory (Costa & McCrae, 1992b) were mostly similar across formats. The Internet and paper versions of the TAS-20 are comparably reliable and valid. An Internet version of the TAS-20 expands opportunities to collect data and permits generalizing of results across studies using the different modes of administration.
Psychotherapy and Psychosomatics, 1992
Journal of Personality Assessment, 1999
Alexithymia and the Five Factor Model of Personality: Facet Analysis Validation
British Journal of Clinical Psychology, 2010
Objectives. We examined the moderating role of depression recurrence on the relationb etween auto... more Objectives. We examined the moderating role of depression recurrence on the relationb etween autonomous and controlled motivation and interpersonal therapy (IPT) treatment outcome.
Many jurisdictions across North America have revised their civil commitment laws. In general, the... more Many jurisdictions across North America have revised their civil commitment laws. In general, these laws have specified more concretely those conditions under which an individual may be involuntarily hospitalized, with the legislative intent of reducing civil commitments. The present study analysed the effects of similar reform on admission rates to Ontario Public Mental Hospitals and Public Psychiatric Hospitals. Results indicate that despite a significant trend toward a decreasing rate of involuntary hospitalization prior to legislative revision, there was a subsequent trend toward an increasing rate of civil commitments in the years following change in law. These results raise serious questions about the ability of lawmakers to legislate the practices of mental health professionals.
Many jurisdictions across North America have revised their statutes pertaining to the criteria fo... more Many jurisdictions across North America have revised their statutes pertaining to the criteria for civil commitment with the legislative intent to either increase or decrease the use of involuntary hospitalization. The impact of these revised statutes has been examined in many jurisdictions, but there has been no consensus regarding their effectiveness in changing the rates of involuntary admissions. The present article reviews the literature from a methodological perspective, comparing the differing analyses, results and interpretations. When the legislative revision has sought to expand medical prerogative, results indicate a sustained increase in civil commitments. When legislation has aimed at limiting medical discretion, there was an immediate decline in civil commitment rates, but a subsequent increase in the period following the initial post-reform declines. These results are discussed in terms of readmission trends, deinstitutionalization, and the possible reaction of mental health professionals who perceive legislation as an unnecessary constraint in the treatment of the mentally ill.
The authors question the clinical status of factitious disorder with psychological symptoms as a ... more The authors question the clinical status of factitious disorder with psychological symptoms as a mental disorder. In particular, they argue that unresolved issues regarding the motivational basis of this disorder and the lack of clearly delineated inclusion, exclusion, and outcome criteria seriously compromise its diagnostic legitimacy. Two case reports are presented to illustrate these difficulties. Future studies should consider these empirical and conceptual difficulties in refining the diagnosis of factitious disorder with psychological symptoms for DSM-IV.
Conflicting results have been reported in studies examining the relationships between alexithymia... more Conflicting results have been reported in studies examining the relationships between alexithymia and the variables of age, gender, social class, and intelligence. Moreover, these results are of dubious validity and generalizability because many of the studies used psychometrically poor scales to measure the alexithymia construct. The present study reexamined the relationships between alexithymia and sociodemographic variables and intelligence in a sample of normal adults using the Toronto Alexithymia Scale (TAS), a recently developed self-report measure with evidence of reliability and validity. The results indicate that alexithymia, as measured by the TAS, is not associated with age, gender, educational level, socioeconomic status, and intelligence.
SI88I8ry-The pilot study examined the relationships between the Toronto AJexithymia Scale (TAS), ... more SI88I8ry-The pilot study examined the relationships between the Toronto AJexithymia Scale (TAS), the scales of the EPQ. and self-report measures of somatic complaints. One hundred and ninety undergraduates completed the T AS, EPQ and two measures of somatic complaints. As expected, the T AS and EPQ Neuroticism scale correlated positively with each other and with somatic complaints; the Extraversion scale correlated negatively with the T AS. The Neuroticism scale was found to be highly correlated with the somatic complaint scales. Directions for future research relating personality variables and somatic complaints are suggested.
The prevalence of alexithymia in a group of newly abstinent male substance abusers (N=44) was 50%... more The prevalence of alexithymia in a group of newly
abstinent male substance abusers (N=44) was 50%.
The alexithymic patients had significantly less ego
strength and repressive defensive behavior and significantly higher levels of somatic complaints and general dysphoria.
Alexithymia is a hypothetical personality construct that has been associated with a variety of me... more Alexithymia is a hypothetical personality construct that has been associated with a variety of medical and psychiatric disorders. This article reviews a program of research evaluating the validity of the construct using a measurement-based, construct validation approach. For this purpose the Toronto Alexithymia Scale (TAS) was developed. In a series of studies the TAS demonstrated internal consistency, good test-retest reliability, and a stable factor structure theoretically congruent with the alexithymia construct. In separate tests of construct validity, the TAS correlated in a theoretically meaningful fashion with measures of other constructs. Criterion validity was supported by a study in which the TAS was able to discriminate between behavioural medicine out-patients designated as alexithymic and those designated as nonalexithymic on the basis of objectively rated structured interviews. In a normal adult sample, TAS scores were not related to sociodemographic variables or intelligence. These results provide considerable empirical support for the validity of the alexithymia construct. In addition, the TAS appears to be a psychometrically sound measure of alexithymia that may prove useful in testing the construct with psychiatric and medical patient populations.
A simulation design was used to test the validity of the SIRS as a structured interview for the a... more A simulation design was used to test the validity of the SIRS as a structured interview for the assessment of malingering. A correctional sample (25 simulators and 26 controls) was compared to previous validation research (Rogers et al., 1989) which had employed clinical and community samples. Results indicated that six of the 13 SIRS scales, as well as overall item endorsement, differed consistently between honest and simulating malingering conditions across correctional, clinical, and community settings. In addition, the suggestion that sociopaths may be more effective malingerers was not supported by the SIRS data.
Ultimate opinion testimony in insanity trials has met with strong moral condemnation with charges... more Ultimate opinion testimony in insanity trials has met with strong moral condemnation with charges that mental health experts have cast off their mantle of expertise and ventured into an arena sanctioned only for law and
philosophy (Bonnie, 1983; Morse, 1978, 1985; Rodriguez, LeWinn, &; Perlin, 1983). Ultimate opinions (i.e., those conclusions which address directly the defendant's sanity/insanity) are inveighed against for subversion of the legal process by "invading the province of the jury" (Arenella, 1982; Halleck, 1980; Shah, 1981). Based on an availability heuristic, "egregious" insanity cases are believed to exist where it is surmised that a docile jury followed uncritically an expert's opinions, apparently unmoved by the judge's admonitions and unswayed by opposing counsel's exhortations (for a more balanced view see Golding &; Roesch, 1988).
Background: Anxiety disorders are common problems that result in enormous suffering and economic ... more Background: Anxiety disorders are common problems that result in enormous suffering and economic costs. The efficacy of Web-based self-help approaches for anxiety disorders has been demonstrated in a number of controlled trials. However, there is little data regarding the patterns of use and effectiveness of freely available Web-based interventions outside the context of controlled trials. Objective: To examine the use and longitudinal effectiveness of a freely available, 12-session, Web-based, cognitive behavioral therapy (CBT) program for panic disorder and agoraphobia. Methods: Cumulative anonymous data were analyzed from 99695 users of the Panic Center. Usage statistics for the website were examined and a longitudinal survey of self-reported symptoms for people who registered for the CBT program was conducted. The primary outcome measures were self-reported panic-attack frequency and severity at the beginning of each session (sessions 2-12). Results: Between September 1, 2002 and February 1, 2004, there were 484695 visits and 1148097 page views from 99695 users to the Panic Center. In that same time period, 1161 users registered for the CBT program. There was an extremely high attrition rate with only 12 (1.03%) out of 1161 of registered users completing the 12-week program. However, even for those who remained in the program less than 12 weeks we found statistically significant reductions (P<.002) in self-reported panic attack frequency and severity, comparing 2 weeks of data against data after 3, 6, or 8 weeks. For example, the 152 users completing only 3 sessions of the program reduced their average number of attacks per day from 1.03 (week 2) to 0.63 (week 3) (P<.001). Conclusions: Freely available Web-based self-help will likely be associated with high attrition. However, for the highly self-selected group who stayed in the program, significant improvements were observed.
Alexithymia is a personality trait characterised by difficulty identifying and describing subject... more Alexithymia is a personality trait characterised by difficulty identifying and describing subjective emotional feelings, a restricted imagination, and an externally oriented style of thinking. Individuals with high levels of this trait are at risk of developing several common psychiatric disorders. The concept of alexithymia has evolved considerably over the past twenty years, and this important new work responds to the need for a definitive book on the subject. The research, theory and clinical issues surrounding alexithymia are discussed in depth, examining the psychological, biological and social aspects of the construct and their related outcomes. Featuring contributions from researchers and clinicians in the field of emotion processing and regulation, chapters include methods for assessing and reducing alexithymia, and research findings from diverse fields of scientific enquiry including genetics, neuroimaging studies, emotion regulation, attachment and trauma research, and comorbidities with a number of psychiatric and medical disorders. • Discusses the state of the art alexithymia research-there has not been a comprehensive book on the topic for more than twenty years • Demonstrates the relationship between alexithymia and various medical and psychiatric disorders, and offers therapeutic interventions for reducing this personality trait • The book will help to develop more integrative research and interventions in the future