Prevalence of alexithymia and its association with sociodemographic variables in the general population of finland

doi:10.1016/S0022-3999(98)00053-1

Journal of Psychosomatic Research

Volume 46, Issue 1, January 1999, Pages 75-82

https://doi.org/10.1016/S0022-3999(98)00053-1 Get rights and content

Abstract

The prevalence of alexithymia and its association with sociodemographic variables were studied in a sample of 1285 subjects representing the general population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). Alexithymia was normally distributed in the population in both genders, confirming that it is a personality dimension. The prevalence of alexithymia was 13%. Men were alexithymic almost twice (17%) as often as women (10%). Multivariate analysis showed that alexithymia was associated with male gender, advanced age, low educational level, and low socioeconomic status. As to the three factors of the TAS-20, men scored higher in factors 2 (difficulty in describing feelings) and 3 (externally oriented thinking), but there was no gender difference in factor 1 (difficulty in identifying feelings). Comparative population studies in other countries are needed to find out whether there are any differences in the prevalence of alexithymia between cultures.

Introduction

Alexithymia was originally defined by Sifneos in the 1970s as a constellation of personality features characterized by difficulties in the verbalization and expression of affects and elaboration of fantasies, and use of action to express emotions [1]. These features were first assumed to be typical of patients with “classical” psychosomatic diseases. Later, Taylor and coworkers proposed that alexithymia reflects a deficit in the cognitive processing of emotions or, more generally, a disturbance in the regulation of emotions [2]. There is accumulating evidence that these features are prevalent both in medically and mentally ill persons 3, 4. Alexithymia may also be present in healthy populations 5, 6, 7. It has been suggested that alexithymia is a personality trait that is normally distributed in the general population [4]. Consequently, alexithymia should be treated as a dimensional construct rather than a categorical phenomenon. However, to facilitate comparisons between diverse populations, alexithymia is often treated as a categorical entity as well. The prevalence and distribution of alexithymia have been widely studied in various clinical populations, but few attempts have been made to study the association between alexithymia with sociodemographic variables in the general population.

Epidemiological studies in nonclinical populations have mostly involved limited and selected samples. A Finnish study with 266 subjects, drawn from the general population and using the observer-rated Beth Israel Hospital Questionnaire (BIQ) [1], showed that the prevalence of distinct alexithymia was rather low (4.1%), whereas 21.8% of the subjects showed mild alexithymic features [8]. There was a clear gender difference; men were more often alexithymic than women. Alexithymia and alexithymic features were also associated with advanced age, lower social status, and singleness [8]. Being an observer-rated instrument, the BIQ is not easily applicable in large population studies, especially in nonclinical circumstances.

The Toronto Alexithymia Scale (TAS-26), published in the mid-1980s was the first psychometrically valid and reliable instrument for the assessment of alexithymia [9]. This self-report questionnaire was developed further, resulting in the 20-item Toronto Alexithymia Scale (TAS-20) published in 1994 10, 11. This is currently the best and most frequently used method in the measurement of alexithymia. The TAS-20 contains three factors which reflect distinct facets of alexithymia and that have been empirically validated 10, 11, 12. The factors are: (1) difficulty in identifying feelings; (2) difficulty in describing feelings; and (3) externally-oriented thinking.

Using the TAS-26, Pasini and coworkers found that in 417 normal subjects, aged 21–64 years, the total TAS-26 scores correlated positively with age and negatively with education, but no gender difference was found [6]. No prevalence data were presented. The largest epidemiological study so far has been the one carried out by Kauhanen and coworkers [13]. They studied four cohorts of 2682 Finnish middle-aged men drawn from the general population and found that income level and occupational status were inversely related to the degree of alexithymia measured by the TAS-26. Furthermore, men in the highest alexithymia quartile were almost four times as likely to be unmarried as men in the lowest quartile. No prevalence data could be presented due to a minor modification of the TAS-26 used in this study. In a nonclinical elderly population (mean age 72 years), Joukamaa et al. found the prevalence of alexithymia, measured by the TAS-26, to be 34%. Alexithymia was associated with poor perceived somatic health, but not with gender, marital status, social status, or residential area [7]. In sum, the few studies on alexithymia in normal populations and on its association with sociodemographic variables are controversial.

In this study we investigate the prevalence of alexithymia in the general population of Finland and its association with sociodemographic variables.

Section snippets

Subjects

The population comprised 2000 persons of working age (18–64 years), randomly sampled from the population register of the Social Insurance Institution in Finland. The sample was stratified according to the five social insurance districts over all of Finland, and the sample sizes were proportional to the size of the population in each district. One subject died before the data collection.

The TAS-20 used in this study had been translated into Finnish and retranslated into English by J. Julkunen

Results

The sociodemographic characteristics of the study group are presented in Table I. There was no difference between men and women in age (p=0.32) or in marital status (p=0.31). There were more secondary school graduates among women than among men (p<0.001). In regard to socioeconomic status, there was a difference between genders (p<0.001), with men more often being private enterpreneurs or blue-collar workers than women, and women being more often white-collar workers than men.

Discussion

This is the first study on the prevalence of alexithymia in the general population using the TAS-20 in a representative sample. The response rate of 67% is acceptable. There were proportionally more women and less young men among the responders than in the nonresponders. In spite of these limitations the sample represents fairly well the Finnish general population. Our study confirmed that alexithymia, measured by the TAS-20, is normally distributed in the population in both genders. This

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Original ArticlePrevalence of alexithymia and its association with sociodemographic variables in the general population of finland

Abstract

Introduction

Section snippets

Subjects

Results

Discussion

Psychosomatics

J Psychosom Res

Compr Psychiatry

Compr Psychiatry

Compreh Psychiatry

J Psychosom Res

J Psychosom Res

Compr Psychiatry

J Psychosom Res

Compr Psychiatry

Original Article
Prevalence of alexithymia and its association with sociodemographic variables in the general population of finland