Alexithymia and Frontal-Amygdala Functional Connectivity in North Korean Refugees

Abstract

BACKGROUND: Refugees commonly experience difficulties with emotional processing, such as alexithymia, due to stressful or traumatic experiences. However, the functional connectivity of the amygdala, which is central to emotional processing, has yet to be assessed in refugees. Thus, the present study investigated resting-state functional connectivity of the amygdala and its association with emotional processing in North Korean (NK) refugees. METHODS: This study included 45 NK refugees and 40 native South Koreans (SK). All participants were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory (BDI), and Clinical-administered PTSD Scale (CAPS), and differences between NK refugees and native SK in terms of resting-state functional connectivity of the amygdala were assessed. Additionally, the association between the strength of amygdala connectivity and the TAS score was examined. RESULTS: Resting-state connectivity values from the left amygdala to the bilateral dorsolateral prefrontal cortex (dlPFC) and dorsal anterior cingulate cortex (dACC) were higher in NK refugees than in native SK. Additionally, the strength of connectivity between the left amygdala and right dlPFC was positively associated with TAS score after controlling for the number of traumatic experiences and BDI and CAPS scores. CONCLUSIONS: The present study found that NK refugees exhibited heightened frontal-amygdala connectivity, and that this connectivity was correlated with alexithymia. The present results suggest that increased frontal-amygdala connectivity in refugees may represent frontal downregulation of the amygdala, which in turn may produce alexithymia as a compensatory mechanism to avoid experiencing negative feelings. FUNDING: This research was supported by the Brain Research Program through the National Research Foundation of Korea, funded by the Ministry of Science, ICT & Future Planning (No.2016M3C7A1904338) and National Research Foundation of Korea (NRF) grant funded by the Korean government (No. 2016R1A2B4011561). DECLARATION OF INTERESTS: The authors declare that they have no conflict of interest including relevant financial interests, activities, relationships, and affiliations. ETHICS APPROVAL STATEMENT: The research protocol of the present study was approved by the Institutional Review Board of Seoul National University Hospital and all participants provided written informed consent after receiving a comprehensive written and verbal description of the study.