Is Alexithymia Related to Individual Cultural Orientation? A Preliminary Study on Horizontal-Vertical Individualism-Collectivism in an Italian Sample
DOI:
https://doi.org/10.13129/2282-1619/mjcp-5361Keywords:
Alexithymia, Collectivism, Independence, Individualism, InterdependenceAbstract
Introduction: Alexithymia, characterized by difficulties in identifying and describing feelings and externally oriented thinking, is conceptualized as a multidimensional construct of personal functioning and a transdiagnostic construct. There is a paucity of research on the link between cultural context, alexithymia, and health. Most studies were conducted in Western individualistic countries. The scientific community generally considers that a more Eastern and/or more collectivist cultural orientation (interdependence) explains higher levels of alexithymia. More specifically, higher interdependent self-construal has been associated with higher alexithymia, while higher independent self-construal has been associated with lower alexithymia. No study has investigated this topic in the Italian context or assessed individual cultural orientation distinguishing horizontal-vertical individualism-collectivism. This preliminary study aimed to fill this gap by exploring the relationship between alexithymia and individual cultural orientation in an Italian community sample. Moreover, anxious and depressive symptoms, psychological well-being, and quality of life were taken into account.
Methods: Participants (N = 80) were recruited from a region in southern Italy, with ages ranging from 18 to 79 years (M = 42.82; SD = 17.18). Participants completed the Toronto Alexithymia Scale (TAS-20), the Horizontal-Vertical Individualism-Collectivism Scale (INDCOL), and measures of emotional distress (depression [EDD] and anxiety [EDA]), psychological well-being (PWB), and quality of life (WHOQOL-BRIEF).
Results: No significant sex differences emerged for any measured variables. All alexithymia dimensions showed positive associations with anxious and depressive symptoms and negative associations with psychological well-being and quality of life. Contrary to findings in individualist cultures, no associations emerged between alexithymia and individualist orientation. Moreover, negative correlations were found between collectivist orientation (horizontal and vertical) and alexithymic traits, particularly difficulty identifying feelings.
Conclusion: Findings suggest the relationship between cultural orientation and alexithymia might depend on person-environment fit, whereby alignment between individual orientation and cultural values might promote emotional awareness. Given southern Italy's collectivistic culture, results support the "person-environment fit" and "personality-culture clash" concepts, highlighting the need to distinguish cultural and individual levels when examining cultural influences on emotional functioning. Limitations include cross-sectional design, small sample size, and gender imbalance. Future research should employ larger, gender-balanced, cross-cultural samples.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994a). The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23-32. https://doi.org/10.1016/0022-3999(94)90005-1
Bagby, R. M., Taylor, G. J., & Parker, J. D. (1994b). The twenty-item Toronto Alexithymia Scale—II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38(1), 33-40. https://doi.org/10.1016/0022-3999(94)90006-X
Bagby, R. M., Parker, J. D., & Taylor, G. J. (2020). Twenty-five years with the 20-item Toronto Alexithymia Scale. Journal of Psychosomatic Research, 131, 109940. https://doi.org/10.1016/j.jpsychores.2020.109940
Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., Allegranti, I., Bongiorno, A., Giberti, F., Bucca, M., Todarello, O., Callegari, C., Vender, S., Gala, C., & Invernizzi, G. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study. Journal of Psychosomatic Research, 41(6), 551-559. https://doi.org/10.1016/S0022-3999(96)00228-0
Burton, L., Delvecchio, E., Germani, A., & Mazzeschi, C. (2021). Individualism/collectivism and personality in Italian and American groups. Current Psychology, 40(1), 29-34. https://doi.org/10.1007/s12144-019-00584-4
Caldwell-Harris, C. L., & Ayçiçegi, A. (2006). When personality and culture clash: The psychological distress of allocentrics in an individualist culture and idiocentrics in a collectivist culture. Transcultural Psychiatry, 43(3), 331-361. https://doi.org/10.1177/1363461506066982
Cheng, C., Cheung, M.-W.-L., Montasem, A., & 44 Members of the International Network of Well-Being Studies. (2016). Explaining differences in subjective well-being across 33 nations using multilevel models: Universal personality, cultural relativity, and national income. Journal of Personality, 84(1), 46-61. https://doi.org/10.1111/jopy.12136
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159. https://doi.org/10.1037/0033-2909.112.1.155
De Berardis, D., Fornaro, M., Orsolini, L., Valchera, A., Carano, A., Vellante, F., Perna, G., Serafini, G., Gonda, X., Pompili, M., Martinotti, G., & Di Giannantonio, M. (2017). Alexithymia and suicide risk in psychiatric disorders: A mini-review. Frontiers in Psychiatry, 8, 148. https://doi.org/10.3389/fpsyt.2017.00148
De Girolamo, G., Rucci, P., Scocco, P., Becchi, A., Coppa, F., D’Addario, A., Daru, E., De Leo, D., Galassi, L., Mangelli, L., Marson, C., Neri, G., & Soldani, L. (2000). Quality of life assessment: Validation of the Italian version of the WHOQOL-Brief. Epidemiologia e Psichiatria Sociale, 9(1), 45-55. https://doi.org/10.1017/S1121189X00007740
Dere, J., Falk, C. F., & Ryder, A. G. (2012). Unpacking cultural differences in alexithymia: The role of cultural values among Euro-Canadian and Chinese-Canadian students. Journal of Cross-Cultural Psychology, 43(8), 1297-1312. https://doi.org/10.1177/0022022111430254
Dere, J., Tang, Q., Zhu, X., Cai, L., Yao, S., & Ryder, A. G. (2013). The cultural shaping of alexithymia: Values and externally oriented thinking in a Chinese clinical sample. Comprehensive Psychiatry, 54(4), 362-368. https://doi.org/10.1016/j.comppsych.2012.10.013
Di Giuseppe, M., & Conversano, C. (2022). Psychological components of chronic diseases: the link between defense mechanisms and alexithymia. Mediterranean Journal of Clinical Psychology, 10(3). https://doi.org/10.13129/2282-1619/mjcp-3602
Dion, K. L. (1996). Ethnolinguistic correlates of alexithymia: Toward a cultural perspective. Journal of Psychosomatic Research, 41(6), 531-539. https://doi.org/10.1016/S0022-3999(96)00226-7
Di Trani, M., Cocchiaro, T., Renzi, A., Vizzini, M. A. S., Guarino, A., Galanti, F., Corno, R., Pasquinelli, S., Rago, R., & Marcoccia, A. (2025). Exploring the Association of Alexithymia and Romantic Attachment with Quality of Life and Pain Perception in Systemic Sclerosis. Mediterranean Journal of Clinical Psychology, 13(3). https://doi.org/10.13129/2282-1619/mjcp-5067
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods, 41(4), 1149-1160. https://doi.org/10.3758/BRM.41.4.1149
Germani, A., Delvecchio, E., Li, J. B., & Mazzeschi, C. (2020). The horizontal and vertical individualism and collectivism scale: Early evidence on validation in an Italian sample. Journal of Child and Family Studies, 29(3), 904-911. https://doi.org/10.1007/s10826-019-01571-w
Germani, A., Delvecchio, E., Li, J. B., Lis, A., Nartova‐Bochaver, S. K., Vazsonyi, A. T., & Mazzeschi, C. (2021). The link between individualism–collectivism and life satisfaction among emerging adults from four countries. Applied Psychology: Health and Well‐Being, 13(2), 437-453. https://doi.org/10.1111/aphw.12255
Germani, A., Lopez, A., Martini, E., Cicchella, S., De Fortuna, A. M., Dragone, M., ... & De Luca Picione, R. (2023). The relationships between compulsive Internet use, alexithymia, and dissociation: Gender differences among Italian adolescents. International Journal of Environmental Research and Public Health, 20(14), 6431. https://doi.org/10.3390/ijerph20146431
Grynberg, D., Berthoz, S., & Bird, G. (2018). Social and interpersonal implications of alexithymia. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 174-189). Cambridge University Press. https://doi.org/10.1017/9781108241595.011
Gündoğmuş, İ., Ünsal, C., Bozdağ, B., Aydın, M. B., & Bolu, A. (2023). The impact of alexithymia on quality of life in a sample of healthy university students: A structural equation modelling approach. Journal of Cognitive Behavioral Psychotherapies and Research, 12(1), 19-30. https://doi.org/10.5455/JCBPR.60084
Hofstede, G., Hofstede, G. J., & Minkov, M. (2010). Cultures and organizations: Software of the mind (3rd ed.). McGraw-Hill.
Honkalampi, K., De Berardis, D., Vellante, F., & Viinamäki, H. (2018). Relations between alexithymia and depressive and anxiety disorders and personality. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 142-157). Cambridge University Press. https://doi.org/10.1017/9781108241595.009
Huggins, C. F., Williams, J. H. G., & Sato, W. (2023). Cross-cultural differences in self-reported and behavioural emotional self-awareness between Japan and the UK. BMC Research Notes, 16(1), 1-6. https://doi.org/10.1186/s13104-023-06660-0
Karukivi, M., Suominen, A., Scheinin, N. M., Li, R., Ahrnberg, H., Rantavuori, K., Karlsson, H., Karlsson, L., & Lahti, S. (2022). Gender‐specific associations between the dimensions of alexithymia personality trait and dental anxiety in parents of the FinnBrain Birth Cohort Study. European Journal of Oral Sciences, 130(1), e12830. https://doi.org/10.1111/eos.12830
Kayrouz, R., Karin, E., Staples, L., Dear, B., Nielssen, O., & Titov, N. (2025). A review of the 257 meta-analyses of the differences between females and males in prevalence and risk, protective factors, and treatment outcomes for mental disorder. BMC Psychiatry, 25, 677. https://doi.org/10.1186/s12888-025-06848-7
Keefer, K. V., Taylor, G. J., Parker, J. D., & Bagby, R. M. (2019). Taxometric analysis of the Toronto structured interview for alexithymia: Further evidence that alexithymia is a dimensional construct. Assessment, 26(3), 364-374. https://doi.org/10.1177/1073191117698220
Kekkonen, V., Kraav, S.-L., Hintikka, J., Kivimäki, P., Kaarre, O., & Tolmunen, T. (2021). Stability of alexithymia is low from adolescence to young adulthood, and the consistency of alexithymia is associated with symptoms of depression and dissociation. Journal of Psychosomatic Research, 150. https://doi.org/10.1016/j.jpsychores.2021.110629
Konrath, S., Grynberg, D., Corneille, O., Hammig, S., & Luminet, O. (2011). On the social cost of interdependence: Alexithymia is enhanced among socially interdependent people. Personality and Individual Differences, 50(2), 135-141. https://doi.org/10.1016/j.paid.2010.09.001
Le, H. N., Berenbaum, H., & Raghavan, C. (2002). Culture and alexithymia: Mean levels, correlates and the role of parental socialization of emotions. Emotion, 2(4), 341-360. https://doi.org/10.1037/1528-3542.2.4.341
Lo, C. (2014). Cultural values and alexithymia. Sage Open, 4(4), 2158244014555117. https://doi.org/10.1177/2158244014555117
Mahapatra, A., & Sharma, P. (2018). Association of Internet addiction and alexithymia—A scoping review. Addictive Behaviors, 81, 175-182. https://doi.org/10.1016/j.addbeh.2018.02.004
Mattila, A. K., Saarni, S. I., Salminen, J. K., Huhtala, H., Sintonen, H., & Joukamaa, M. (2009). Alexithymia and health-related quality of life in a general population. Psychosomatics, 50(1), 59-68. https://doi.org/10.1176/appi.psy.50.1.59
Matud, M. P., Bethencourt, J. M., & Ibáñez, I. (2019). Gender and psychological well-being. International Journal of Environmental Research and Public Health, 16(19), 3531. https://doi.org/10.3390/ijerph16193531
Mendia, J., Zumeta, L. N., Cusi, O., Pascual, A., Alonso-Arbiol, I., Díaz, V., & Páez, D. (2024). Gender differences in alexithymia: Insights from an updated meta-analysis. Personality and Individual Differences, 227, 112710. https://doi.org/10.1016/j.paid.2024.112710
Minkov, M., & Kaasa, A. (2022). Do dimensions of culture exist objectively? A validation of the revised Minkov-Hofstede model of culture with World Values Survey items and scores for 102 countries. Journal of International Management, 28(4), 100971. https://doi.org/10.1016/j.intman.2022.100971
Minkov, M., Dutt, P., Schachner, M., Morales, O., Sanchez, C., Jandosova, J., Khassenbekov, Y., & Mudd, B. (2017). A revision of Hofstede’s individualism-collectivism dimension. Cross Cultural & Strategic Management, 24(3), 386-404. https://doi.org/10.1108/CCSM-11-2016-0197
Morie, K. P., & Ridout, N. (2018). Alexithymia and maladaptive regulatory behaviors in substance use disorders and eating disorders. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 158-179). Cambridge University Press. https://doi.org/10.1017/9781108241595.010
Oyserman, D., Coon, H. M., & Kemmelmeier, M. (2002). Rethinking individualism and collectivism: Evaluation of theoretical assumptions and meta-analysis. Psychological Bulletin, 128(1), 3-72. https://doi.org/10.1037/0033-2909.128.1.3
Paquet, S. L., & Kline, T. J. B. (2009). Uncovering the psychometric properties of scales measuring individualist and collectivist orientations. International Journal of Testing, 9(4), 260-270. https://doi.org/10.1080/15305050903106859
Parker, J. D., Keefer, K. V., Taylor, G. J., & Bagby, R. M. (2008). Latent structure of the alexithymia construct: A taxometric investigation. Psychological Assessment, 20(4), 385-396. https://doi.org/10.1037/a0014262
Parker, J. D., Taylor, G. J., & Bagby, R. M. (2001). The relationship between emotional intelligence and alexithymia. Personality and Individual Differences, 30(1), 107-115. https://doi.org/10.1016/S0191-8869(00)00014-3
Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D., & PROMIS Cooperative Group. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263-283. https://doi.org/10.1177/1073191111411667
Porcelli, P., & Taylor, G. J. (2018). Alexithymia and physical illness: A psychosomatic approach. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 105-126). Cambridge University Press. https://doi.org/10.1017/9781108241595.007
Preece, D. A., Mehta, A., Petrova, K., Sikka, P., Bjureberg, J., Becerra, R., & Gross, J. J. (2023). Alexithymia and emotion regulation. Journal of Affective Disorders, 324, 232-238. https://doi.org/10.1016/j.jad.2022.12.065
Ruini, C., Ottolini, F., Rafanelli, C., Ryff, C. D., & Fava, G. A. (2003). La validazione italiana delle Psychological Well-Being Scales (PWB). Rivista di Psichiatria, 38(3), 117-130.
Ryder, A. G., Sunohara, M., Dere, J., & Chentsova-Dutton, Y. (2018). The cultural shaping of alexithymia. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 33-48). Cambridge University Press. https://doi.org/10.1017/9781108241595.003
Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117(2), 300-313. https://doi.org/10.1037/0021-843X.117.2.300
Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719-727. https://doi.org/10.1037/0022-3514.69.4.719
Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783-822. https://doi.org/10.1037/bul0000102
Schimmack, U., Oishi, S., & Diener, E. (2005). Individualism: A valid and important dimension of cultural differences between nations. Personality and Social Psychology Review, 9(1), 17-31. https://doi.org/10.1207/s15327957pspr0901_2
Schimmenti, A., & Caretti, V. (2018). Attachment, trauma, and alexithymia. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 127-141). Cambridge University Press. https://doi.org/10.1017/9781108241595.008
Schönbrodt, F. D., & Perugini, M. (2013). At what sample size do correlations stabilize?. Journal of Research in Personality, 47(5), 609-612. https://doi.org/10.1016/j.jrp.2013.05.009
Schroeders, U., Kubera, F., & Gnambs, T. (2022). The structure of the Toronto Alexithymia Scale (TAS-20): A meta-analytic confirmatory factor analysis. Assessment, 29(8), 1806-1823. https://doi.org/10.1177/10731911211033894
Sekely, A., Bagby, R. M., & Porcelli, P. (2018). Assessment of the alexithymia construct. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 17-32). Cambridge University Press. https://doi.org/10.1017/9781108241595.002
Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2-6), 255-262. https://doi.org/10.1159/000286529
Singelis, T. M. (1994). The measurement of independent and interdependent self-construals. Personality and Social Psychology Bulletin, 20(5), 580-591. https://doi.org/10.1177/0146167294205014
Singelis, T. M., Triandis, H. C., Bhawuk, D. P. S., & Gelfand, M. J. (1995). Horizontal and vertical dimensions of individualism and collectivism: A theoretical and measurement refinement. Cross-Cultural Research, 29(3), 240-275. https://doi.org/10.1177/106939719502900302
Skevington, S. M., Schick-Makaroff, K., Rowland, C., Molzahn, A., & WHOQOL Group. (2024). Women’s environmental quality of life is key to their overall quality of life and health: Global evidence from the WHOQOL-100. PLoS One, 19(10), e0310445. https://doi.org/10.1371/journal.pone.0310445
Taylor, G. J., Bagby, R. M., & Parker, J. D. (2003). The 20-item Toronto Alexithymia Scale: IV. Reliability and factorial validity in different languages and cultures. Journal of Psychosomatic Research, 55(3), 277-283. https://doi.org/10.1016/S0022-3999(02)00601-3
The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558. https://doi.org/10.1017/S0033291798006667
Topino, E., Gori, A., & Cacioppo, M. (2021). Alexithymia, dissociation, and family functioning in a sample of online gamblers: A moderated mediation study. International Journal of Environmental Research and Public Health, 18(24), 13291. https://doi.org/10.3390/ijerph182413291
Triandis, H. C. (1995). Individualism and collectivism. Westview Press.
Triandis, H. C. (1996). The psychological measurement of cultural syndromes. American Psychologist, 51(4), 407-415. https://doi.org/10.1037/0003-066X.51.4.407
Triandis, H. C. (2000). Cultural syndromes and subjective well-being. In E. F. Diener & E. M. Suh (Eds.), Subjective well-being across cultures (pp. 87-112). MIT Press.
Triandis, H. C. (2001). Individualism-collectivism and personality. Journal of Personality, 69(6), 907-924. https://doi.org/10.1111/1467-6494.696169
Triandis, H. C., & Gelfand, M. J. (1998). Converging measurement of horizontal and vertical individualism and collectivism. Journal of Personality and Social Psychology, 74(1), 118-128. https://doi.org/10.1037/0022-3514.74.1.118
Vaske, J. J., Beaman, J., & Sponarski, C. C. (2016). Rethinking internal consistency in Cronbach’s alpha. Leisure Sciences, 39(2), 163-173. https://doi.org/10.1080/01490400.2015.1127189
Ziadni, M. S., Jasinski, M. J., Labouvie-Vief, G., & Lumley, M. A. (2017). Alexithymia, defenses, and ego strength: Cross-sectional and longitudinal relationships with psychological well-being and depression. Journal of Happiness Studies, 18(6), 1799-1813. https://doi.org/10.1007/s10902-016-9800-7
Downloads
Published
Issue
Section
License
Articles and conference papers published in Mediterranean Journal of Clinical Psychology are distributed under the terms and conditions of a Creative Commons Attribution 4.0 Unported License. Correspondingly, authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).