The dominant
contemporary work in developing the alexithymia construct has been done by the
Toronto groups (Taylor, Bagby, & Parker, 1999). This group developed a
model of alexithymia building on the work of pioneers in the area who used
psychoanalytic concepts to explain their observations (Nemiah, 1977; Sifneos,
1973). For example, it has been proposed by Marty and de M’Uzan (1963) that alexithymia
was the result of the disturbance in the early child-mother relationship which
disrupts childhood development of the ability to use fantasy or experience
feelings to satisfy instinctual drive. Consequently, it was believed that
somatic symptoms will be experienced by individuals with high levels of
alexithymia as they were unable to use psychic elaboration and fantasy to
regulate the energy of their instinctual drives. Thus, alexithymia was
initially described as a characteristic of psychosomatic patients (Nemiah &
Sifneos, 1970). Furthermore, subsequent studies have indicated that alexithymia
is also a correlate of psychological disorders such as depression and anxiety
disorders (Panayiotou, Leonidou, Constantinou, Hart, Rinehart, Sy, &
Björgvinsson, 2015). The Toronto model, specifies that alexithymia is comprised
of four interrelated components: difficulty identifying feelings in the self
(DIF); difficulty describing feelings (DDF); an externally orientated thinking
(EOT) style; and constricted imaginal processes (difficulty fantasizing; DFAN).

The DIF and DDF components are closely linked to form a broader affect
awareness component and the EOT and DFAN components form a broader operative
thinking component (Preece, Becerra, Allan, Robinson, & Dandy, 2017). Within
the literature, this model is presently the most widely used definition of


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