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Updated: Aug 1, 2026

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Alexithymia according to Bucci's multiple code theory: A preliminary investigation with healthy and hypertensive
Michela Di Trani1, Rachele Mariani2, Alessia Renzi1
1Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy.
Objective:
To evaluate the relation between alexithymia and Referential Activity (RA), a linguistic measure of the process by which non-verbal emotional experience is connected to language.
Methods:
The 20-Item Toronto Alexithymia Scale (TAS-20) and the Toronto Structured Interview for Alexithymia (TSIA) were administered to 20 postgraduate students and 15 outpatients with hypertension. The Weighted Referential Activity Dictionary (WRAD) and other linguistic measures (Reflection, Disfluency, and Somatic Sense) were applied to texts derived from the TSIA using the Discourse Attributes Analysis Program (DAAP).
Results:
Multiple linear regressions performed in the whole sample showed a relation between TSIA scores and Somatic Sense. Comparing the two groups, hypertensive subjects yielded higher scores on the TSIA than the young adult sample; no differences in DAAP measures emerged. A significant negative correlation was found between the TAS-20 Difficulty Describing Feelings score and the DAAP measure of references to body activations (Somatic Sense) both in the young adult sample and in hypertensives. In the young adult sample, negative relations emerged between different TSIA factors, WRAD score, and Somatic Sense; a positive relation with fragmented speech (Disfluency) and use of rationalization (Reflection) was also found. In hypertensive subjects, using the TSIA, a negative correlation between alexithymia and Somatic Sense and a positive correlation between alexithymia and the Mean High WRAD (a measure of intensity of engagement during the speech) were found.
Conclusion:
The TSIA seems to be a more adequate instrument than the TAS-20 to explore relations between alexithymia and RA. Results appear to suggest a complex, nonlinear relation between alexithymia and RA, presumably influenced by subject-specific characteristics.
Practitioner Points:
A relation between alexithymia and RA has been proposed on theoretical grounds, but there has been minimal empirical investigation. This was the first study to employ both a self-report measure and a structured interview for measuring alexithymia in relation to RA. The results of this study suggest a complex, nonlinear relation between alexithymia and RA; this finding is essentially obtained with the structured interview measure of alexithymia. This relation is presumably influenced by subject-specific characteristics.
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