2 The body as a (muffled) sound box for emotion 55 5. Clinical Implications 5.1 Diagnostics: Challenges, considerations, and points of attention In diagnosing alexithymia, it is preferential to use a combination of instruments that specifically measure alexithymia along with those that measure emotional awareness. The use of various measuring instruments, especially if they are based on different modes of measurement, not only increases reliability and validity [98, 99], but also provides the clinician with better, more extensive information to work with. The majority of the more recently developed diagnostic instruments are either performance-based measures, interviews, or observation scales. In an earlier era, diagnosing alexithymia mainly relied on clinical judgment and self-reporting questionnaires. An advantage of self-reporting questionnaires is the ease of administration and scoring and the relatively little effort by both patient and clinician to complete the test. As such, these two diagnostic tools have their merit particularly as screening instruments. There is substantial debate, however, over the validity of self-reported emotional (awareness) abilities, including those assessed with alexithymia self-reporting questionnaires. It is considered problematic that selfreporting requires that the person completing the test to have adequate insight into their own functioning relative to norms. In the case of alexithymia, the lack of this insight is precisely what characterizes the phenomenon! In addition, none of the currently available self-reporting questionnaires distinguish between different types of alexithymia, for example, between anomia and agnosia. Besides these more generic limitations, there is growing concern that the ‘gold standard’ self-reporting questionnaires might primarily measure negative affect instead of alexithymia. Various studies have shown that relationships between alexithymia, measured by self-reporting, and various other variables are no longer significant when negative affect is taken into account as a variable [62, 100]. The results indicate that some of the available questionnaires measure mood effects rather than alexithymia, which is worrisome. Luckily there are exceptions. A recent study, for example, showed that subscales from the Perth Alexithymia Questionnaire (PAQ) and the Bermond-Vorst Alexithymia Questionnaire (BVAQ), but not the Toronto Alexithymia Questionnaire (TAS), distinguished between psychological distress and alexithymia [62]. An alternative or addition to self-reporting questionnaires can be the use of performance-based tests, observer scales and structured interviews, such as the Level of Emotional Awareness Scale (LEAS), the Observer Alexithymia Scale (OAS) and the Toronto Structured Interview for Alexithymia (TSIA). They both offer more accurate validity and reliability (also with regard to controlling for negative affect [100] but require the clinician (or researcher) to spend considerably more time and
RkJQdWJsaXNoZXIy MjY0ODMw