Re-evaluation of the clinical meaningfulness of the Diagnostic Criteria for Psychosomatic Research-Revised alexithymia threshold in the Taiwanese population.

OBJECTIVE

This study aimed to re-evaluate the clinically meaningful diagnostic threshold for alexithymia using the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) in Taiwan to better differentiate true psychopathology from cultural norms.

METHODS

A total of 502 participants (277 clinical, 225 community) were included. Data collection included demographic information and self-report questionnaires assessing emotional disturbances, somatization-related features, and quality of life (QOL). Prevalence and clinical burden were examined across varying cut-offs (meeting 3-5 criteria). Multiple regression models were used to evaluate the clinical utility and discriminative contribution of individual criteria.

RESULTS

The conventional threshold (3 of 6 criteria) yielded a prevalence of 48.8% and failed to clearly differentiate clinical characteristics between alexithymic and non-alexithymic groups. Raising the cut-off to five criteria reduced prevalence to 10.2% and identified individuals with more severe depression, fewer behaviors related to health anxiety, and poorer overall, psychological, and social QOL. Item-level analyses indicated that criteria reflecting externally oriented thinking lacked discriminative value, whereas deficits in affect awareness and emotional regulation were robust predictors of clinical severity.

CONCLUSION

A stricter diagnostic threshold (5 criteria) for DCPR-R alexithymia is more appropriate in the Taiwanese population, improving the identification of clinically meaningful alexithymia characterized by emotional disturbances, somatization tendencies, and poorer QOL. Emphasizing affect regulation deficits rather than externally oriented thinking enhances the construct's clinical specificity and utility in Eastern populations.