Alexithymia, Interoceptive Awareness, and Hypochondriasis

All participants completed three questionnaires assessing: (i) IA, (ii) the ability to identify and describe emotions, and (iii) attitudes associated with hypochondriasis. To assess IA, and to specifically investigate how and how frequently subjects feel signals arising from their own body, we used an extended version of the “How do you feel questionnaire” (Grossi et al., 2014 (link)). The questionnaire included 35 items (Appendix 1) to be rated on a 5-point Likert scale (0 = never; 1 = sometimes; 2 = often; 3 = very often; 4 = always). The total score ranges 0–140, with higher scores meaning higher IA. In a preliminary study on an independent sample of 50 healthy students, we required participants to rate whether each item was clearly comprehensible and whether it assessed common physical sensations. All items were considered simple to comprehend, and suitable to address bodily sensations; all 35 items were thus included in the SAQ.
To assess the ability to identify and describe emotions, we used the Toronto Alexithymia Scale-20 items (TAS-20; Bagby et al., 1994 (link)), the most widely used self-report tool to assess the Alexithymia construct. The 20 items explore three factors reflecting the main aspects of the alexithymia: difficulty in identifying feelings; difficulty in describing feelings; externally oriented thinking. Each item has to be rated on a 5-point Likert scale (from 1 = “completely agree” to 5 = “strongly disagree”). The total score ranges 20–100, with higher scores indicating higher levels of alexithymia. The Italian version of TAS-20 has been demonstrated to show good test-retest reliability (0.86) and adequate internal consistency (Cronbach's alpha: 0.75) in a wide sample of healthy adults and of medical and psychiatric outpatients (Bressi et al., 1996 (link)).
The Illness Attitude Scale (IAS; Kellner, 1987 ) investigates attitude, fear and beliefs associated with hypochondriac behavior, and includes 27 items rated on a 5-point Likert scale (from 0 = “no” to 4 = “most of the time”). The total score ranges 0–108, with higher scores indicating more severe hypochondriac symptoms. The IAS is a reliable instrument, distinguishing hypochondriac patients from psychiatric patients and healthy individuals (Kellner, 1987 ). The IAS has been translated in several languages and its psychometric properties are well established (Sirri et al., 2008 (link)); an Italian version of the scale has been used in studies on clinical samples (e.g., Fava et al., 2000 (link)), but its psychometric properties have not been assessed specifically.
The study was approved by the Local Ethics Committees.