4 Exploring the mediating role of alexithymia in BPP 121 3.1 Instruments Borderline Personality Pathology (BPP) The 23-item Borderline Symptom List (BSL-23, Dutch version) [1] was used as a measure of the level of BPP. The BSL-23 is a shortened version of the BSL-95. It consists of 23 items from the BSL-95 that were found to have the highest levels of sensitivity to change and that discriminate best between BPD and other disorders. The items do not directly represent the criteria of borderline personality disorder in the DSM 5. The items of the BSL-23 are rated from 0 (not at all) to 4 (very much so) that yield a sum score. Higher BSL-23 total scores indicate more borderline symptoms. In our sample, the Dutch version of the BSL-23 showed excellent internal consistency (Cronbach’s = .95). Alexithymia The Dutch versions of Toronto Alexithymia Scale-20 (TAS-20) [36, 69] and the Toronto Structured Clinical Interview (TSIA) [37] were used to assess alexithymia. The TAS-20 is a 20-item self-report questionnaire [36, 69]. The TAS-20 is the most used instrument in research and clinical practice for assessing alexithymia. The items of the TAS-20 are rated from 0 (not at all) to 4 (very much so) that yield a sum score. Items assess alexithymia according to three facets: Difficulties identifying and distinguishing among feelings [DIF], difficulties describing or communicating feelings [DDF], and externally oriented thinking [EOT]. In our sample, the Dutch TAS-20 showed internal consistencies similar to those found in previous studies: DIF: Cronbach’s = .74, DDF: Cronbach’s = .79, EOT: Cronbach’s = .53 and total score: Cronbach’s = .85 [36, 69, 106]. The TSIA is clinician administered interview to assess the level of alexithymia [37]. It is composed of 24 questions addressing four facets of alexithymia. Three of these facets are the same as those assessed in the TAS-20 (i.e., DIF, DDF, EOT). The fourth facet is difficulties in fantasizing (DFAN). Participants’ answers are scored by the interviewer on a three-point Likert scale. Total scores range from 0 to 48, with higher scores indicating a higher level of alexithymia. Factorial validity of the TSIA was established in a combined community and clinical sample; internal consistency and inter-rater reliability were adequate to good [23, 37]. In our sample, internal consistencies were as follows: DIF: Cronbach’s = .86, DDF: Cronbach’s = .74, EOT: Cronbach’s = .68 DFAN: Cronbach’s = .76, and total score: Cronbach’s = .88. Depressive symptoms The Dutch version of the Beck Depression Inventory-II (BDI-II-NL) [107] was used to measure the depressive symptoms. The BDI-II consists of 21 items inquiring about the level of depressive symptoms experienced by the participant. Items probe for
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