Abstract Patients with alexithymia are unable to describe feelings appropriately, show improverished dream and fantasy life, and present an inert cognitive style (“pensée operatoire”). Psychiatric outpatients ( N = 178) were rated for alexithymia. A factor analysis identified four factors: (1) the principal factor reflected difficulties in handling emotions and “pensée operatoire”; (2) the second factor suggests communication problems, both verbal and non-verbal; (3) the third factor indicates educational achievements; and (4) the last factor reflects psychosomatic illness, and lack of dreams and fantasies, but it is poorly defined. Target populations which may score high on alexithymia include drug-dependent and pain-prone persons, and patients with psychosomatic illness, and borderline, compulsive, and narcissistic personalities. A revision of the alexithymia questionnaire is indicated and is underway.