Abstract
Neuroscientific studies have mostly employed the 20-item Toronto Alexithymia Scale (TAS-20; Bagby et al., 1994a) for the assessment of alexithymia, a self-report scale that assesses the alexithymia facets difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. These facets can be considered to capture difficulties in the cognitive processing of emotions associated with alexithymia. However, Nemiah and Sifneos’ original conceptualization of alexithymia included also an affective component, a lack of imaginative capacities, which cannot be assessed using the TAS-20. Aiming to capture the entire alexithymia construct, the Bermond–Vorst Alexithymia Questionnaire (BVAQ; Vorst and Bermond, 2001) was developed, a self-report scale which assesses two affective facets (difficulty fantasizing and difficulty emotionalizing) in addition to three cognitive facets. Based on these facets, an affective and a cognitive dimension of alexithymia can be distinguished. By now, several neuroscientific studies have investigated the neural signatures of the different facets and dimensions of alexithymia. Here, I provide an overview of the history of the alexithymia facets and dimensions and review findings provided by functional and structural magnetic resonance imaging (MRI) studies that differentiated between the alexithymia facets and/or its affective and cognitive dimensions. I then provide a synopsis of the current neuroscientific evidence for dissociable substrates of alexithymia facets and dimensions. Finally, the scientific value and clinical implications of these findings are discussed.
Highlights
The term alexithymia was coined in 1973 by the psychotherapist Peter Emanuel Sifneos to describe patients with psychosomatic illnesses, who had several symptoms in common
A further study masking surprised faces with neutral ones after 33 ms found that the difficulty identifying feelings (DIF) facet was negatively correlated with activity in the fusiform face area, parahippocampal gyrus and superior temporal gyrus (Duan et al, 2010). These findings suggest that the DIF facet of alexithymia is linked to hypoactivation in areas that are important for facial emotion processing during automatic emotion processing. fMRI studies investigating the conscious processing of emotions observed similar patterns of hypoactivation of the amygdala for DIF in response to fear-inducing and disgusting pictures (Leweke et al, 2004) and hypoactivation of the right amygdala in response to fearful body expressions (Pouga et al, 2010)
In a VBM study of our lab, we investigated for the first time whether the cognitive and affective alexithymia dimensions could be differentiated at the structural brain level (Goerlich-Dobre et al, 2014)
Summary
The Multifaceted Nature of Alexithymia - A Neuroscientific Perspective Goerlich, Katharina S. Neuroscientific studies have mostly employed the 20-item Toronto Alexithymia Scale (TAS-20; Bagby et al, 1994a) for the assessment of alexithymia, a self-report scale that assesses the alexithymia facets difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. These facets can be considered to capture difficulties in the cognitive processing of emotions associated with alexithymia. Aiming to capture the entire alexithymia construct, the Bermond–Vorst Alexithymia Questionnaire (BVAQ; Vorst and Bermond, 2001) was developed, a self-report scale which assesses two affective facets (difficulty fantasizing and difficulty emotionalizing) in addition to three cognitive facets. The scientific value and clinical implications of these findings are discussed
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