R. Michael Bagby

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.

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 ...

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.

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 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 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.

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 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 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 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).

SIR: Dr. Hoffman's suggestion -- based entirely on his impressions and experiences -- that factitious disorder patients selectively seek out general hospitals (in particular, emergency rooms of teaching hospitals) in the evening or on weekends is an interesting and empirically testable hypothesis. During our literature search, however, we were unable to locate any studies to support or negate this hypothesis. Nevertheless, we would certainly encourage Dr. Hoffman and other researchers to pursue the issue.

During the past decade, the alexithymia construct has undergone theoretical refinements and empirical testings and has evolved into a potential new paradigm for understanding the influence of emotions and personality on physical illness and health.

Research evaluating the relationship of alexithymia to medical and psychiatric disorders has been compromised by the poor psychometric properties of the instruments that have been used to measure alexithymia. This study evaluated the psychometric properties of a recently introduced measure of alexithymio-the revised Schalling-Sifneos Personality Scale (SSPS-R). While the factor structure of the SSPS-R was found to be reasonably congruent with the theoretical domains of the alexithymia construct, the scale lacked homo-geneity and internal reliability. These results are compared with the reliability and' validity of other available measures of alexithymia. Recommendations are offered for the improved assessment of alexithymia in future research studies. alexithymia construct, originally developed by Nemiah and Sifneos, 1.2 is generating increasing interest in the role of emotional processing in illness and health.~ Derived initially. from clinical observations made about patients with classical psychosomatic diseases who were not psychologically minded and who had difficulty describing their emotions, I the construct has since been extended and applied to patients with a variety of medical and psychiatric disorders , in particular somatization disorders,J-7 substance use disorders,4.5.8 and post-traumatic stress disorders.s.9.,o The four components' that jointly form the construct of alexithymia are as follows:

Psychiatrists are being asked more and more often by the courts to determine whether or not criminal defendants are fit to stand trial. However, the Criminal Code provides few statutory guidelines on what constitutes fitness to stand trial.

The utility of the M test (Beaber, Marston, Michelli, & Mills, 1985) as a screening measure for malingering was assessed using simulation-design ( subjects asked to fake mental illness) and natural group ( forensic cases suspected of malingering) approaches.

The Toronto Alexithymia Scale (TAS) is a self-report measure of the alexithymia construct. In previous studies with college students, the TAS demonstrated excellent psychometric properties including a 4-factor structure theoretically congruent with the alexithymia construct. The present study attempted to cross-validate the factor structure of the TAS with samples of normal adults, psychiatric outpatients and college students. Congruence coefficients comparing the similarity of the factor structures for these three samples indicated good congruence for all four factors. The results provide further support for the validity of both the TAS and the alexithymia construct. In addition, the results provide evidence of the applicability of the scale to normal adult and clinical samples.

The Endler Multidimensional Anxiety Scales (EMAS) are derived from an interactional model of personality that proposes that anxiety is a function of the interaction of person and situation variables. The EMAS distinguish between state and trait anxiety and assume that both are multidimensional constructs. The EMAS were adminstered to 2,009 students in a neutral situation. Three factor analyses were performed to clarify the empirical relation between state and trait anxiety and the variables within the 2 domains. Results support the distinction between state and trait anxiety. Factor analysis of the state items provided support for the separate dimensions of cognitive and autonomic state anxiety. Factor analysis of the trait items provided support for trait anxiety multidimensionality. Four congruent factors were associated with increases in state anxiety in 4 general situations: Social Evaluation, Physical Danger, Ambiguous, and Daily Routines.

Legislation in Canada and the United States that was intended to decrease the use of civil commitment has resulted in a paradoxical increase in involuntary hospital admissions. To elucidate the reasons for this increase, this study was designed to assess the relative importance of various factors involved in the decision to commit a patient.

Notes that many community mental health centers in North America have on their staff paraprofessionals (PPs) who are indigenous to the community. Sharing the same cultural background as the community, they can often bridge the wide cultural barriers between the professional and the population served. Despite this, PPs have traditionally held a relatively subservient role in relation to their professional colleagues, with the more crucial decisions left to the professionals—specifically, the involuntary commitment of the potentially dangerous person. Because of their understanding of the community culture, PPs' involvement in civil commitment procedures would seem critical. Although medical-psychological training is adequate for assessing dispositional traits, the very nature of such training prohibits an emphasis on cultural–contextual variables. The use of indigenous PPs in the commitment process would reduce this methodological dilemma and would also attenuate the potential misuse of mental health facilities as agents of social control.

Recently, the alexithymia construct has emerged as a heuristically useful personality construct in the explanation of the pathogenesis of a variety of physical illnesses. Research that has evaluated the alexithymia construct, however has been conducted with little attention to the psychometric properties of the various scales constructed to measure it. The study investigated the underlying dimensions and factor structure stability of the MMPI alexithymia scale.

Addressing methodological problems in the development of existing scales for measuring alexithymia, this study reports the development of a new self-report scale. The Toronto Alexithymia Scale (T AS) was devised with concern for theoretical congruence with the alexithymia construct, independence of social desirability response bias, and internal consistency. Initially, 41 items were administered to 542 college students. Twenty-six items meeting preestablished psychometric guidelines were retained. Factor analysis yielded four interpretable factors, all consistent with the construct. The scale demonstrated adequate split-balfand test-retest reliability, and scores were not significantly associated with age, education, and socioeconomic status. These preliminary results suggest that the T AS may be used as a clinical screening device with psychiatric and general medical patient populations.

Discusses the lack of a clear distinction between confidentiality and privileged communication for Canadian psychologists. Research from the field of experimental ethics provides a framework for determining whether L. Wigmore's (1940) rules, which provide 4 prerequisites for the justification of a claim of privilege, are satisfied

Though never empirically verified, it is the general consensus among social psychologists that cognitive dissonance is no longer an actively researched area. In contrast, attribution theory is currently regarded as continuing to have a major influence in social psychological research. In order to examine this widely held belief, Leon Festinger's Theory of Cognitive Dissonance and Fritz Heider's Psychology of Interpersonal Relations (1958) were used as source indicators for dissonance and attribution theory, respectively, and citations to these two targets were tabulated for the years 1958-1987 using the Science Citation Index and Social Science Citation Index. As expected, the rate of citation to dissonance theory has decreased substantially during the past 15 years, while citations to attribution theory have remained relatively steady. The pattern of differential citation rates is even more evident within subsets of general psychology journals and social psychology journals. The results are discussed in terms of intellectual, methodological, and theoretical differences between the two theories.

This study examines the effectiveness of 3 validity scales from the Millon Clinical Multiaxial Inventory-lI (MCMI-II) to detect fake-good and fake-bad responding. The sample consisted of 150 college students and 75 psychiatric inpatients. The students took the MCMI-II under 1 of 3 instructional sets: fake bad, fake good, and honest responding. Two separate discriminant-function analyses with cross-validation were performed. The overall rate of successful classification was 76.0% for the faking bad group versus inpatient group and 72.0% for the faking good group versus the honest group.

This study investigated the effectiveness of the Millon Clinical Multiaxial Inventory (MCMI-II) Validity Index (VI) to detect random responding. Undergraduate students (n = 58) completed the MCMI-II under instructions to respond randomly to the items. Scores on the VI from this sample were compared with VI scores from a sample of psychiatric inpatients (n = 129). Discriminant function analyses yielded excellent overall correct classification rates. However, the cutoff levels recommended by the test publishers produced a high rate of false positives. Alternative cutoff scores are provided, and the use of additional indexes using different detection strategies are suggested.

This study investigated the effectiveness of two recently developed measures of psychopathology - the Basic
Personality Inventory (BPI) and the Millon Clinical Multiaxial Inventory-II (MCMI-II) in detecting dissimulation (i.e., faking good and faking bad). Both personality measures have developed special 'validity scales' to discern dissimulating responses. Ninety-one undergraduate students completed the two personality scales under one of three instructional sets: fake good, fake bad, and honest. In general, the results indicated that both scales were effective in distinguishing the groups from one another. The MCMI-II was better at detecting fake bad responding, while the BPI appeared to be more effective in detecting fake good responding. These differences in identifying fake good and fake bad response styles can be attributed to the method in which the scales were constructed.

In their excellent article on the competence to consent to
treatment, under the subsection "Competence and Treatment"
(I), Drs. Draper and Dawson cite a study on the effects of
legislation revision on involuntary admission rates that my
colleague and I published in 1987 (2). Unfortunately, the
rendering of the results of this study and the summary of their
, literature review are somewhat misleading.

The theoretical parameters of the 5-factor personality model, which underlie the item domain of the Revised NEO Personality Inventory (NEO-PI-R), were assessed by subjecting the 30 subscales that comprise this scale to confirmatory factor analysis (CFA). Results from the CFA with a normative sample of 1000 adults indicated poor fit between the obtained factor structure and the hypothesized dimensions corresponding to the 5-factor model.

The impulsivity scale from the Personality Research Form (PRF), the control/impulsiveness scale from the Multidimensional Personality questionnaire (MPQ), and the restraint scale from the Guilford-Zimmerman Temperament Survey (GZTS) were each subjected to exploratory factor analysis in a sample of 252 normal adults. The replicability of the derived factor structure for each scale was tested in a sample of 230 undergraduates using confirmatory factor analysis. The relationships among impulsivity dimensions were also examined by subjecting the extracted factors from the three scales to a second order factor analysis. Although developed as unideminsional measures of the impulsivity construct, the MPQ and GZTS scales were found to have a similar multidimensional structure: a cautious versus spontaneous dimension, and a methodical versus disorganized dimension. This multidimensional model is compared with some recently proposed models for the impulsivity construct. The PRF scale was found to be a unidimensional measure that taps only a cautious/spontaneous facet of the impulsivity construct.

Although both lithium and triiodothyronine IT 3) augmentation strategies may be rapid. safe. and effective ways of treating patients who fail to respond to tricyclics. little Is known about the clinical or biochemical correlates of response. We examined clinical and endocrine variables which distinguished T 3 and lithium responders from eact1 other and from non-responders in a post-hoc analysis of two studies involving 51 subjects who had received these augmentation strategies under double-blind conditions. Uthium non~ponders were more severely depressed and had more insomnia and weight loss than responders. T 3 responders could be distinguished from lithium responders by greater weight loss. There were no reliable clinical differences between T 3 responders and non-responders. Thyroid function tests did not differ between any of the treatment or response groups. Our findings suggest that clinical but not endocrine variables may distinguish responders to these two augmentation strategies.

Oinicallore has long supported the subtype of situational or
reactive depression. To date, however, there has been limited
empirical research support for this subtype of major depression.
We examined demographic, clinical and personality features
of situational and nonsituational depression in 89 outpatients
with unipolar nonpsychotic major depressive disorder.
Situational depressives had a less recurrent course of illness
and appeared to respond more completely to the antidepressant
used for their current episode. Demographic and personality
measures did not distinguish situational and nonsituational
depression.

We conducted the first systematic comparison of patients with Factitious Disorders with Predominantly Psychological Symptoms (FDPS). suspected malingerers. and psychiatric inpatients; all the subjects were recruited from a forensic clinic. Through the employment of the Structured Interview of Reported Symptoms (SIRS). we failed to find consistent differences on SIRS scales between nine FDPS patients and 25 suspected malingerers. However. investigation of individual SIRS items was moderately successful in distinguishing groups. Because of these relatively modest results and the absence of other validation. we questioned the diagnostic validity of FDPS and recommended its placement as provisional diagnosis. We also discuss the implications of FDPS for forensic experts consulting to the courts.

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.