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Strongly
disagree ---- ----
Neither
agree
nor
disagree
---- ---- Strongly
agree
1
When I’m feeling bad (feeling an unpleasant
emotion), I can’t find the right words to
describe those feelings.
1 2 3 4 5 6 7
2 When I’m feeling bad, I can’t tell whether
I’m sad, angry, or scared. 1 2 3 4 5 6 7
3 I tend to ignore how I feel. 1 2 3 4 5 6 7
4
When I’m feeling good (feeling a pleasant
emotion), I can’t find the right words to
describe those feelings.
1 2 3 4 5 6 7
5 When I’m feeling good, I can’t tell whether
I’m happy, excited, or amused. 1 2 3 4 5 6 7
6 I prefer to just let my feelings happen in the
background, rather than focus on them. 1 2 3 4 5 6 7
7 When I’m feeling bad, I can’t talk about
those feelings in much depth or detail. 1 2 3 4 5 6 7
8 When I’m feeling bad, I can’t make sense of
those feelings. 1 2 3 4 5 6 7
9 I don’t pay attention to my emotions. 1 2 3 4 5 6 7
10 When I’m feeling good, I can’t talk about
those feelings in much depth or detail. 1 2 3 4 5 6 7
11 When I’m feeling good, I can’t make sense
of those feelings. 1 2 3 4 5 6 7
12 Usually, I try to avoid thinking about what
I’m feeling. 1 2 3 4 5 6 7
PAQ
This questionnaire asks about how you perceive and experience your emotions. Please score
the following statements according to how much you agree or disagree that the statement
is true of you. Circle one answer for each statement.
Some questions mention bad or unpleasant emotions, this means emotions like sadness,
anger, or fear. Some questions mention good or pleasant emotions, this means emotions like
happiness, amusement, or excitement.
Name: Date:
Strongly
disagree ---- ----
Neither
agree
nor
disagree
---- ---- Strongly
agree
13 When something bad happens, it’s hard for
me to put into words how I’m feeling. 1 2 3 4 5 6 7
14 When I’m feeling bad, I get confused about
what emotion it is. 1 2 3 4 5 6 7
15 I prefer to focus on things I can actually see
or touch, rather than my emotions. 1 2 3 4 5 6 7
16 When something good happens, it’s hard
for me to put into words how I’m feeling. 1 2 3 4 5 6 7
17 When I’m feeling good, I get confused
about what emotion it is. 1 2 3 4 5 6 7
18 I don’t try to be ‘in touch’ with my
emotions. 1 2 3 4 5 6 7
19 When I’m feeling bad, if I try to describe
how I’m feeling I don’t know what to say. 1 2 3 4 5 6 7
20 When I’m feeling bad, I’m puzzled by those
feelings. 1 2 3 4 5 6 7
21 It’s not important for me to know what I’m
feeling. 1 2 3 4 5 6 7
22 When I’m feeling good, if I try to describe
how I’m feeling I don’t know what to say. 1 2 3 4 5 6 7
23 When I’m feeling good, I’m puzzled by
those feelings. 1 2 3 4 5 6 7
24 It’s strange for me to think about my
emotions. 1 2 3 4 5 6 7
© Preece et al. (2018)
Scoring and Interpretation Manual
What is Alexithymia?
Alexithymia is a multidimensional construct comprised of three components: difficulty identifying one’s own
feelings (DIF); difficulty describing feelings (DDF); and an externally orientated thinking style (EOT) whereby one
tends to not focus their attention on their emotions. In other words, people with high levels of alexithymia have
difficulty focusing attention on their emotional states (EOT), and difficulty accurately appraising what those states
are (DIF, DDF) (Preece et al., 2017; Sifneos, 1973). As specified in the attention-appraisal model of alexithymia
(Preece et al., 2017; Preece & Gross, 2023), people’s overall level of alexithymia reflects the developmental level
of their emotion schemas (i.e., those cognitive structures used to interpret emotional information) and the extent
to which they avoid focusing on their emotional states. There is good evidence that alexithymia is a relatively
stable trait, though levels of alexithymia can still fluctuate over time, such as when people are going through
periods of increased distress or in response to targeted treatment (e.g., Luminet et al., 2001).
The Perth Alexithymia Questionnaire (PAQ)
The PAQ (Preece et al., 2018) is a 24-item self-report measure of alexithymia (note: there is also a 6-item short
form for those wanting a brief measure, which can be downloaded here: PAQ-S). It was designed for use with
adults and adolescents. The PAQ is designed to assess all components of alexithymia, and do so across negative
and positive emotions. Five subscale scores and six composite scores can be derived from the measure (each
listed in the table below), with higher scores indicating higher levels of alexithymia.
In practice, we most frequently use and report the 5 subscale scores and the total scale score, as this combination
provides a nice balance of comprehensiveness and brevity that is suitable for most research and clinical purposes.
Subscale /composite scores
How to
calculate
Content measured
Subscale scores
Negative-Difficulty identifying
feelings (N-DIF)
Sum items 2, 8,
14, 20
Difficulty identifying, understanding, and differentiating between
one’s own negative feelings.
Positive-Difficulty identifying
feelings (P-DIF)
Sum items 5, 11,
17, 23
Difficulty identifying, understanding, and differentiating between
one’s own positive feelings.
Negative-Difficulty describing
feelings (N-DDF)
Sum items 1, 7,
13, 19
Difficulty describing and communicating one’s own negative feelings.
Positive-Difficulty describing
feelings (P-DDF)
Sum items 4, 10,
16, 22
Difficulty describing and communicating one’s own positive feelings.
General-Externally orientated
thinking (G-EOT)
Sum items 3, 6,
9, 12, 15, 18, 21,
24
Tendency to not focus attention on one’s own emotions (negative and
positive).
Composite scores
Total scale score
Sum all items
Overall alexithymia; difficulty focusing attention on and appraising
one’s own feelings (negative and positive).
General-Difficulty identifying
feelings (G-DIF)
Sum N-DIF and
P-DIF subscales
Difficulty identifying, understanding, and differentiating between
one’s own feelings (negative and positive).
General-Difficulty describing
feelings (G-DDF)
Sum N-DDF and
P-DDF subscales
Difficulty describing and communicating one’s own feelings (negative
and positive).
Negative-Difficulty appraising
feelings (N-DAF)
Sum N-DIF and
N-DDF subscales
Difficulty identifying and describing (i.e., appraising) one’s own
negative feelings
Positive-Difficulty appraising
feelings (P-DAF)
Sum P-DIF and
P-DDF subscales
Difficulty identifying and describing (i.e., appraising) one’s own
positive feelings
General-Difficulty appraising
feelings (G-DAF)
Sum N-DIF, P-
DIF, N-DDF and
P-DDF subscales
Difficulty identifying and describing (i.e., appraising) one’s own
feelings (negative and positive)
Excel Auto-Scorer
To facilitate ease of use in scoring and interpretation, we have created a programmed Excel spreadsheet (called
the Lloyd & Preece Psychometric Auto-Scorer) that auto-scores the PAQ and several other common psychological
questionnaires. A copy of this Excel auto-scorer can be freely downloaded here:
https://psychologywa.com/psychometric/
Psychometric Properties and Descriptive Statistics for the PAQ
The PAQ has demonstrated strong psychometric properties across a variety of sample types, including general
community, student, clinical, adult, and adolescent samples. For example, factor analyses have consistently
supported the PAQ’s intended 5-factor (subscale) structure, with all items loading well on their intended subscale
factor (i.e., all items being statistically a good indicator of their intended construct). All subscale and composite
scores have demonstrated high levels of internal consistency reliability, surpassing accepted thresholds for
confident use in research and clinical settings. Correlations with measures of other theoretically relevant
constructs (e.g., emotion regulation, psychopathology symptoms) have also supported that the PAQ has good
criterion/concurrent validity and discriminant validity as a measure of alexithymia, tapping a construct with high
clinical relevance. For more information about the psychometric properties of the PAQ, see for example, Preece
et al. (2018, 2020a, 2020b, 2020c, 2022), Becerra et al. (2021), Chan et al. (2022), Greene et al. (2020a, 2020b),
Fynn et al. (2022), Lashkari et al., (2021), Larionow et al. (2022), Bilge and Bilge (2020), and Mousavi Asl et al.
(2020). Some descriptive statistics and Cronbach’s alpha reliability coefficients from an Australian adult general
community sample (N = 748; Preece et al., 2018) are provided in the table below.
Score Use and Interpretation
Scores for each PAQ item can range from 1 to 7, as indicated by examinees on the 7-point Likert Scale. Higher
scores indicate higher levels of alexithymia. Item scores can be summed by the examiner into various subscale
and composite scores. As mentioned above, when using the PAQ, we tend to focus our analyses and reporting on
the 5 subscale scores and the total scale score. This provides comprehensive and specific information about each
component of alexithymia (i.e., via the subscales), as well as a marker of one’s overall level of alexithymia (i.e.,
the total scale score). That said, the other composite scores (which represent theoretically meaningful
combinations of specific subscales) may also be of additional interest for some research or clinical questions.
To interpret PAQ scores, we recommend that a respondent’s score be compared to scores from an appropriate
normative sample. Alexithymia is a dimensional (rather than categorical) construct that is normally distributed in
the general population, so alexithymia scores are best thought of as existing on a continuum. Everyone has some
level of alexithymia, whether that be a low, average, or high level. The number of standard deviations (SDs) a
respondent’s score is from the mean of an appropriate normative sample indicates the degree of alexithymia. We
interpret PAQ scores in the following way, keeping in mind that higher scores indicate a higher level of
alexithymia:
• Scores 1SD or more above the mean = “high level of alexithymia”
• Scores less than 1SD from the mean = “average level of alexithymia”
• Scores 1SD or more below the mean = “low level of alexithymia”
Total Sample (N=748)
Females (N=468)
Males (N=280)
Subscale/
Composite
M SD
Cronbach’s
alpha
M SD M SD
Subscales
N-DIF
13.38
6.41
0.89
14.03
6.57
12.28
5.98
P-DIF
11.30
5.76
0.89
11.38
6.08
11.18
5.20
N-DDF
15.35
6.89
0.91
15.80
7.00
14.60
6.63
P-DDF
12.97
6.12
0.90
12.72
6.24
13.38
5.90
G-EOT
28.97
11.19
0.90
27.92
11.35
30.74
10.72
Composites
G-DIF
23.68
11.28
0.92
25.41
11.57
23.45
10.68
G-DDF
28.32
12.16
0.93
28.52
12.30
27.98
11.92
N-DAF
28.73
12.71
0.94
29.83
13.07
26.88
11.89
P-DAF
24.27
11.39
0.94
24.1
11.95
24.55
10.41
G-DAF
52.99
22.58
0.96
53.93
23.23
51.43
21.39
Total scale score
81.97
30.91
0.96
81.84
31.92
82.17
29.15
You may encounter some alexithymia research that categorises people as either “non-alexithymic” or
“alexithymic”. These labels can be thought of as synonymous to the labels “low level of alexithymia” or “high level
of alexithymia”, respectively. As such, the above PAQ score cut-offs (based on SDs from the mean of a normative
sample) can be used to classify a PAQ score as being in the “alexithymic” range if desired. However, given that
alexithymia is a dimensional/continuous construct, we prefer labels that talk about levels of alexithymia.
Scoring the PAQ using the Lloyd & Preece Psychometric Auto-Scorer
The Lloyd & Preece Psychometric Auto-Scorer (downloadable here) is a programmed Excel sheet that will
complete the abovementioned scoring and interpretation process for you automatically if desired. In this Excel
sheet, you can input in an examinee’s raw scores for each item, and it will automatically calculate all the subscale
and composite scores, compare these scores to normative data, interpret/categorise the scores as a low, average,
or high score compared to norms, and plot these scores on a graph to visually show the alexithymia profile.
Permission to Use the PAQ
A key goal of developing the PAQ was to enhance the accessibility of robust alexithymia assessments. As such, the
PAQ is freely available for use. As the copyright holders (© Preece et al. 2018), we grant you permission to use
the PAQ an unlimited number of times. You can use and reproduce the PAQ in paper form, or can administer the
PAQ to respondents online (i.e., you do not need to contact us to obtain permission to use the PAQ). However, if
you intend to translate or modify the content of the PAQ, we require that you contact us
(david.preece@curtin.edu.au) to obtain additional permissions for such actions.
Language Translations
The PAQ was originally developed in English, and several translations into other languages have been developed.
These include the following translated forms with download links:
• Afrikaans (Allan et al., 2023)
• Bulgarian (Dimitrova, 2023)
• Chinese (Cai et al., 2023)
• Dutch (Walentynowicz et al., 2021)
• Estonian (Sikka et al., 2023)
• Finnish (Sikka et al., 2023)
• French (Luminet et al., 2021)
• German (Kaemmerer et al., 2021)
• Italian (Bovo et al., 2023)
• Persian (Mousavi Asl, 2020)
• Persian (Mazidi et al., 2023)
• Polish (Larionow et al., 2022)
• Russian (Larionow et al., 2023)
• Spanish (Spain) (Kiskimska & Martinez-Sanchez, 2023)
• Spanish (Chile) (Becerra et al., 2021)
• Turkish (Bilge & Bilge, 2020)
6-Item Short Form of the PAQ
There is also a 6-item brief version of the PAQ called the Perth Alexithymia Questionnaire-Short Form (PAQ-S;
Preece et al., 2023). It has demonstrated strong psychometric properties as a brief measure of overall alexithymia
(Preece et al., 2023). You can download a copy of the PAQ-S here.
Contacts
If you have any questions or comments about the PAQ, or would like to collaborate with our group on some
research, please feel free to contact Dr David Preece at david.preece@curtin.edu.au
PAQ Reference
Preece, D., Becerra, R., Robinson, K., Dandy, J., & Allan, A. (2018). The psychometric assessment of alexithymia:
Development and validation of the Perth Alexithymia Questionnaire. Personality and Individual
Differences, 132, 32-44.
Other References
Bilge, Y., & Bilge, Y. (2020). The measurement of attention-appraisal model of alexithymia: Psychometric
properties of the Perth Alexithymia Questionnaire in Turkish. Anatolia Journal of Psychiatry, 21, 71-79.
Becerra, R., Baeza, C. G., Fernandez, A. M., & Preece, D. A. (2021). Assessing Alexithymia: Psychometric Properties
of the Perth Alexithymia Questionnaire in a Spanish-Speaking Sample. Frontiers in Psychiatry, 1722.
Chan, J., Becerra, R., Weinborn, M., & Preece, D. (2022). Assessing alexithymia across Asian and western cultures:
psychometric properties of the perth alexithymia questionnaire and Toronto alexithymia scale-20 in
Singaporean and Australian samples. Journal of Personality Assessment, 1-17.
Fynn, D., Preece, D. A., Gignac, G., Pestell, C. F., Allan, A., Vander Kraats, C., Weinborn, M., Green, S., & Becerra, R.
(2022). Alexithymia in acquired brain injury: Psychometric properties of the Perth Alexithymia
Questionnaire. Journal of Affective Disorders.
Greene, D., Hasking, P., Boyes, M., & Preece, D. (2020a). Measurement Invariance of Two Measures of
Alexithymia in Students Who Do and Who Do Not Engage in Non-suicidal Self-Injury and Risky
Drinking. Journal of Psychopathology and Behavioral Assessment, 1-18.
Greene, D., Hasking, P., & Boyes, M. (2020b). A comparison of the associations between alexithymia and both
non-suicidal self-injury and risky drinking: The roles of explicit outcome expectancies and refusal self-
efficacy. Stress and Health, 1-13.
Larionow, P., Preece, D. A., & Mudło-Głagolska, K. (2022). Assessing alexithymia across negative and positive
emotions: Psychometric properties of the Polish version of the Perth Alexithymia Questionnaire.
Larionow, P., Preece, D. A., Khokhlova, O., & Iakovleva, M. V. (2023). Assessing Alexithymia: Psychometric
Properties of the Russian Version of the Perth Alexithymia Questionnaire.
Lashkari, A., Dehghani, M., Sadeghi-Firoozabadi, V., Heidari, M., & Khatibi, A. (2021). Further Support for the
Psychometric Properties of the Farsi Version of Perth Alexithymia Questionnaire. Frontiers in
Psychology, 12.
Luminet, O., Bagby, R. M., & Taylor, G. J. (2001). An evaluation of the absolute and relative stability of alexithymia
in patients with major depression. Psychotherapy and Psychosomatics, 70, 254-260.
Mousavi Asl, E., Mahaki, B., Khanjani, S., & Mohammadian, Y. (2020). The Assessment of Alexithymia Across
Positive and Negative Emotions: The Psychometric Properties of the Iranian Version of the Perth
Alexithymia Questionnaire. Iranian Journal of Psychiatry and Behavioral Sciences, 14, e102317.
Preece, D., Becerra, R., Allan, A., Robinson, K., & Dandy, J. (2017). Establishing the theoretical components of
alexithymia via factor analysis: Introduction and validation of the attention-appraisal model of
alexithymia. Personality and Individual Differences, 119, 341-352.
Preece, D. A., Becerra, R., Boyes, M. E., Northcott, C., McGillivray, L., & Hasking, P. A. (2020a). Do self-report
measures of alexithymia measure alexithymia or general psychological distress? A factor analytic
examination across five samples. Personality and Individual Differences, 155, 1-8.
Preece, D. A., Becerra, R., Allan, A., Robinson, K., Chen, W., Hasking, P., & Gross, J. J. (2020b). Assessing
alexithymia: Psychometric properties of the Perth Alexithymia Questionnaire and 20-item Toronto
Alexithymia Scale in United States adults. Personality and Individual Differences, 166, 1-8.
Preece, D. A., Becerra, R., Robinson, K., Allan, A., Boyes, M., Chen, W., Hasking, P., & Gross, J. J. (2020c). What is
Alexithymia? Using Factor Analysis to Establish its Latent Structure and Relationship with Fantasizing and
Emotional Reactivity. Journal of Personality, 1-15.
Preece, D. A., & Gross, J. J. (2023). Conceptualizing alexithymia. Personality and Individual Differences, 215,
112375.
Preece, D. A., Mehta, A., Becerra, R., Chen, W., Allan, A., Robinson, K., Hasking, P., & Gross, J. J. (2022). Why is
alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation. Journal of
Affective Disorders, 296, 337-341.
Preece, D. A., Mehta, A., Petrova, K., Sikka, P., Bjureberg, J., Chen, W., ... & Gross, J. J. (2023). The Perth
Alexithymia Questionnaire-Short Form (PAQ-S): A 6-item measure of alexithymia. Journal of Affective
Disorders, 325, 493-501.
Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and
Psychosomatics, 22, 255-262.
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