Alexithymic Traits Research Articles

Alexithymia in fibromyalgia syndrome

The study compared alexithymia in fibromyalgia syndrome (FMS) patients and healthy individuals, and analyzed its association with clinical, emotional, and functional variables. Forty-five FMS patients and 31 healthy individuals completed the Toronto Alexithymia Scale, which includes the dimensions: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally-Oriented Thinking (EOT). Participants also completed instruments assessing Eysenck's personality dimensions, pain, fatigue, sleep, anxiety, depression, health-related quality of life (HRQL) and coping with pain. FMS patients exhibited higher scores in DIF and DDF than healthy individuals; group differences were markedly lower when depression and anxiety were statistically controlled. Patients furthermore displayed greater depression-anxiety, fatigue, sleep problems and neuroticism, lower HRQL and dysfunctional coping. Alexithymia was overall more closely related to clinical variables in healthy individuals than in patients; in patients, many associations disappeared when anxiety and depression were controlled. The data corroborate the high prevalence of alexithymia in FMS; however, they also suggest that alexithymia may play a less important role in symptom experience in patients vs. healthy individuals. This result may be discussed by considering the distinction between state and trait alexithymia; the weaker associations in patients may be ascribed to specific enhancement of state alexithymia due to illness-related affective distress.

Alexitimia y consumo de drogas en hombres y mujeres en tratamiento

Introducción: la alexitimia es un rasgo de la personalidad caracterizado por la dificultad para identificar y expresar emociones, con mayor prevalencia en hombres que en mujeres y presente en la mitad de los consumidores de drogas. Objetivo: comparar la presencia de alexitimia en hombres y mujeres que acuden a solicitar tratamiento por consumo de drogas y explorar diferencias según el tipo de droga por la que se solicita atención (droga de mayor impacto). Método: estudio transversal comparativo por sexo y por droga de consumo. Resultados: la mitad de los 264 participantes presenta rasgos de personalidad alexitímicos, cuatro veces más que la población general, observándose diferencias por sexo únicamente en la dificultad para identificar emociones (mayor entre los hombres). También destaca que no existan diferencias en el nivel de alexitimia por tipo de droga. Discusión: en concordancia con lo reportado por la literatura, se observa una alta proporción de alexitimia entre los usuarios participantes, lo cual es relevante si se considera que los pacientes con este rasgo presentan una particular dificultad para responder a los tratamientos cognitivo conductuales, los cuales constituyen abordajes ampliamente utilizados en el tratamiento de adicciones. Asimismo, destaca la escasa diferencia entre hombres y mujeres respecto a la presencia de este rasgo, en comparación con lo que se observa en la población general, donde este rasgo es claramente mayor entre los hombres. Lo anterior pone en evidencia la necesidad de desarrollar estrategias que contribuyan a mejorar la capacidad introspectiva y de comunicación afectiva de estos pacientes.

Alexithymia in anorexia and bulimia: Ubiquitous and primary trait?

AbstractBackground: Alexithymia is associated to Eating Disorders (ED) and relevant for their prognosis but it is uncertain if it is ubiquitous, primary, and necessary for ED outburst. Methods: 124 ED outpatients and 80 healthy controls were compared with the Toronto Alexithymia Scale, personality, and psychopathology measures. Alexithymia and the other features are compared between anorexia nervosa (AN), bulimia nervosa (BN) and control groups. Alexithymia-based clusters were explored and compared with controls. Alexithymia traits are correlated with the other features. Results: Difficulty in identifying feelings was ubiquitous in ED subjects. A Non-Alexithymic Cluster (NAC) and an Alexithymic Cluster (ALC) were found with no difference in AN/BN distribution. ALC displays disordered personality and high psychopathology. Self-directiveness and interoceptive awareness were independently related to alexithymia and to depressive feelings. These two features along with depressive features completely accounted...

Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism.

This study investigated hypothetical moral choices in adults with high-functioning autism and the role of empathy and alexithymia in such choices. We used a highly emotionally salient moral dilemma task to investigate autistics’ hypothetical moral evaluations about personally carrying out harmful utilitarian behaviours aimed at maximizing welfare. Results showed that they exhibited a normal pattern of moral judgments despite the deficits in social cognition and emotional processing. Further analyses revealed that this was due to mutually conflicting biases associated with autistic and alexithymic traits after accounting for shared variance: (a) autistic traits were associated with reduced utilitarian bias due to elevated personal distress of demanding social situations, while (b) alexithymic traits were associated with increased utilitarian bias on account of reduced empathic concern for the victim. Additionally, autistics relied on their non-verbal reasoning skills to rigidly abide by harm-norms. Thus, utilitarian moral judgments in autism were spared due to opposite influences of autistic and alexithymic traits and compensatory intellectual strategies. These findings demonstrate the importance of empathy and alexithymia in autistic moral cognition and have methodological implications for studying moral judgments in several other clinical populations.

Alexithymia in a sample of alcohol-dependent patients: Clinical correlations and cognitive patterns

IntroductionAlexithymia represents a personality construct, characterized by an inability in identifying and verbally describing own and others’ emotions. According to the recent research on emotional dysregulation and the alexithymic construct, it has been described a positive correlation between alcoholism and alexithymia. The present study aims to evaluate the presence of alexithymia in a sample of alcohol dependant patients and, therefore, analyze how the presence of these alexithymic traits may influence/interact with a range of cognitive processes such as the anger rumination, metacognitive capabilities and dissociative experiences.MethodsA sample of 40 alcohol dependant inpatients affected with alcohol dependence and alcohol-related issues were recruited, evaluated and compared with a sample of 40 healthy controls. A clinical evaluation and a complete clinical and psychological assessment were carried out in order to investigate alcohol-related clinical patterns, alexithymia construct, anxiety and depression symptomatology and cognitive pattern.ResultsSubjects with alcohol addiction show higher total scores in all tests except the scale that evaluates anxiety, compared to healthy controls. Finally, a factorial ANOVA analysis demonstrated that alcoholism seems to be determined by the lack of emotional recognition from which derives a dissociative state, which consequently generates a depressive rumination.ConclusionsAccording to the recent literature, the present study identifies a significant proportion of alexithymic patients within the sample of subjects affected by alcohol-related disorders. Other clinical variables (i.e. depression, pathological anxiety-related worry, anger rumination, dissociation and metacognitive capabilities) mirror a specific cognitive pattern in the sample of alcoholics rather than the healthy group.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Alexithymia and Breast Cancer Surgery: A Systematic Review

The term alexithymia is a complex multidimensional construct that literally means “no words for mood”. There are two kind of alexithymia: primary and secondary or otherwise called trait and state alexithymia. There is still an unresolved debate about the nature of alexithymia as a trait or a state. The etiology of alexithymia has not been completely determined because of the numerous factors influencing its development. Alexithymia has been observed among patients with a variety of psychiatric disorders and medical conditions. The aim of this systematic review was to review studies investigating the correlations between alexithymia, depression and anxiety in breast cancer surgery women. Literature search was conducted in January, 2016. PubMed and Scopus databases were used to find studies for inclusion in the systematic review. Correlations between alexithymia, depression and anxiety evidenced that alexithymia may be considered a stable personality trait and an important factor to the development of anxiety symptoms. However, limitations of these studies must be considered and further investigations are needed.

Association between the Catechol-O-Methyltransferase (COMT) Val158Met Polymorphism and Alexithymia in Patients with Obsessive-Compulsive Disorder

PurposeAlexithymia, defined as a deficit in the ability to recognize and describe one's own feelings, may be related to the development and maintenance of obsessive-compulsive symptoms. The aim of this study was to evaluate the association between the catechol-O-methyltransferase (COMT) Val158Met polymorphism and alexithymia in patients with obsessive-compulsive disorder (OCD).Materials and MethodsWe recruited 244 patients with OCD (169 males, 75 females). Alexithymia was assessed using the 20-item Toronto Alexithymia Scale (TAS-20), and genotyping of the COMT Val158Met polymorphism was evaluated.ResultsPatients with the COMT Val/Val genotype had significantly higher total and "difficulty identifying feelings" (DIF) subdimension scores than those with the Val/Met or Met/Met genotypes. Patients with the COMT Val/Val genotype had significantly higher "difficulty describing feelings" (DDF) subdimension scores than those with the COMT Val/Met genotype. However, there were no differences in the scores for the "externally oriented thinking" (EOT) subdimension among the three genotypes.ConclusionThese results indicate that the high-activity Val allele of the COMT Val158Met polymorphism is associated with increased alexithymic traits in patients with OCD. The present finding suggests that alexithymia is an endophenotype of OCD that is mediated by the COMT Val158Met polymorphism.

Stereoscopy Amplifies Emotions Elicited by Facial Expressions.

Mediated facial expressions do not elicit emotions as strongly as real-life facial expressions, possibly due to the low fidelity of pictorial presentations in typical mediation technologies. In the present study, we investigated the extent to which stereoscopy amplifies emotions elicited by images of neutral, angry, and happy facial expressions. The emotional self-reports of positive and negative valence (which were evaluated separately) and arousal of 40 participants were recorded. The magnitude of perceived depth in the stereoscopic images was manipulated by varying the camera base at 15, 40, 65, 90, and 115 mm. The analyses controlled for participants’ gender, gender match, emotional empathy, and trait alexithymia. The results indicated that stereoscopy significantly amplified the negative valence and arousal elicited by angry expressions at the most natural (65 mm) camera base, whereas stereoscopy amplified the positive valence elicited by happy expressions in both the narrowed and most natural (15–65 mm) base conditions. Overall, the results indicate that stereoscopy amplifies the emotions elicited by mediated emotional facial expressions when the depth geometry is close to natural. The findings highlight the sensitivity of the visual system to depth and its effect on emotions.

Traumatic experiences, alexithymia, and Internet addiction symptoms among late adolescents: A moderated mediation analysis

The association between traumatic experiences, alexithymia, and substance abuse is well established. Less is known about the role of traumatic experiences and alexithymia in the onset and maintenance of Internet-related disorders. In the present study, self-report measures on traumatic experiences, alexithymia, and problematic Internet use were administered to 358 high school students (57% females) aged 18–19years old, to test whether alexithymic traits mediated the relationship between traumatic experiences and Internet addiction symptoms, and whether gender moderated the proposed mediation in the sample. While partial mediation occurred in the entire sample, gender directly affected the relationship between the investigated constructs: Internet addiction symptoms were independently related to traumatic experiences among males, and to alexithymic traits among females. Therefore, the results of this study suggest that trauma memories among males, and problems with affect regulation among females, may increase the risk of problematic Internet use during late adolescence. Such findings might have relevant implications to inform any treatment plan for late adolescent students who are overinvolved with online activities, pointing out that tailored approaches to their problems and difficulties are particularly needed in clinical practice.

Theory of mind abilities in patients with psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures (PNES) have been frequently linked to deficits in affect regulation and altered processing of emotionally salient information. However, less is known about how patients suffering from PNES actually process and interpret affective social stimuli. Thus, the present study aimed to investigate basal facial affect recognition as well as mind-reading skills in a sample of patients with PNES and matched control subjects. Patients with PNES (N=15) and healthy controls (N=15) completed self-report questionnaires that measured alexithymia and perceived stress vulnerability. Affect perception was tested using a series of computerized movies of models whose facial expressions slowly change from neutral to full-blown emotions (anger, fear, sadness, happiness, disgust, and surprise), allowing for a fine-grained assessment of facial emotion recognition impairments. Further, all participants were presented with the Movie for the Assessment of Social Cognition, a well-validated video-based test for the evaluation of subtle mind-reading deficits. Data analyses revealed increased alexithymic traits and, impaired mentalizing skills in individuals with PNES, while basal facial expression recognition was not compromised. The present findings are the first to demonstrate that patients with PNES exhibit several deficits in reasoning about their own and other people's mental states. Patients with PNES may benefit from psychotherapeutic interventions that focus on disturbed affect regulation and aim to enhance emotional awareness.

Alexithymia is associated with attenuated automatic brain response to facial emotion in clinical depression

BackgroundAlexithymia is a clinically relevant personality trait related to difficulties in recognizing and describing emotions. Previous studies examining the neural correlates of alexithymia have shown mainly decreased response of several brain areas during emotion processing in healthy samples and patients suffering from autism or post-traumatic stress disorder. In the present study, we examined the effect of alexithymia on automatic brain reactivity to negative and positive facial expressions in clinical depression. MethodsBrain activation in response to sad, happy, neutral, and no facial expression (presented for 33ms and masked by neutral faces) was measured by functional magnetic resonance imaging at 3T in 26 alexithymic and 26 non-alexithymic patients with major depression. ResultsAlexithymic patients manifested less activation in response to masked sad and happy (compared to neutral) faces in right frontal regions and right caudate nuclei than non-alexithymic patients. ConclusionsOur neuroimaging study provides evidence that the personality trait alexithymia has a modulating effect on automatic emotion processing in clinical depression. Our findings support the idea that alexithymia could be associated with functional deficits of the right hemisphere. Future research on the neural substrates of emotion processing in depression should assess and control alexithymia in their analyses.

Alexithymic Trait, Painful Heat Stimulation, and Everyday Pain Experience.

Alexithymia was found to be associated with a variety of somatic complaints, including somatoform pain symptoms. This study addressed the question of whether the different facets of alexithymia are related to responses in heat pain stimulation and its interrelations with levels of everyday pain as assessed by self-report. In the study, sensitivity to heat pain was assessed in 50 healthy female participants. Alexithymia facets were assessed by the Toronto Alexithymia Scale. Pain threshold and tolerance were determined using a testing the limits procedure. Participants, furthermore, rated subjective intensities and unpleasantness of tonic heat stimuli (45.5-47.5°C) on visual analog scales and on a questionnaire. Possible confounding with temperature sensitivity and mood was controlled. Everyday pain was assessed by self-report addressing everyday pain frequency, intensity, and impairment experienced over the last 2 months. Main results were that the facets of alexithymia were differentially associated with pain perception. The affective scale "difficulties in describing feelings" was associated with hyposensitivity to pain as indicated by higher pain tolerance scores. Furthermore, everyday pain frequency was related to increased alexithymia values on the affective scale "difficulties in identifying feelings," whereas higher values on the cognitive alexithymia scale "externally oriented thinking" were related to lower pain impairment and intensity. We conclude that the different facets of alexithymia are related to alternations in pain processing. Further research on clinical samples is necessary to elucidate whether different aspects of alexithymia act as a vulnerability factor for the development of pain symptoms.

Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense mechanisms.

In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES) do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline) personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of “neurotic” type; their goal is to lead to a “split”, either vertical (dissociation) or horizontal (repression). The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial). PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES) and need usually a different treatment (pharmacological or psychological). Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of specific psychiatric disorders.

When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders.

Introduction: In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients’ families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters’ evaluations of maternal alexithymia.Methods: 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of “ED” mothers (n = 20) and “non-ED” ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia.Results: Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs.Discussion: Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.

Maternal alexithymic traits, prenatal stress, and infant temperament

We aimed at investigating, whether maternal alexithymia or prenatal anxiety influences infant temperament (Infant Temperament Questionnaire, IBQ) at six months. Maternal alexithymic trait of “Difficulty in Identifying Feelings” predicted higher infant “Duration of Orienting”. “Fear of Bearing a Handicapped Child” predicted lower infant “Activity Level”.

The relationships between interoception and alexithymic trait. The Self-Awareness Questionnaire in healthy subjects.

Interoception is the basic process enabling evaluation of one's own bodily states. Several previous studies suggested that altered interoception might be related to disorders in the ability to perceive and express emotions, i.e., alexithymia, and to defects in perceiving and describing one's own health status, i.e., hypochondriasis. The main aim of the present study was to investigate the relationships between alexithymic trait and interoceptive abilities evaluated by the “Self-Awareness Questionnaire” (SAQ), a novel self-report tool for assessing interoceptive awareness. Two hundred and fifty healthy subjects completed the SAQ, the Toronto Alexithymia Scale-20 items (TAS-20), and a questionnaire to assess hypochondriasis, the Illness Attitude Scale (IAS). The SAQ showed a two-factor structure, with good internal consistency (Cronbach's alpha = 0.88). We observed significant direct correlations between SAQ, TAS-20 and two of its subscales, and the IAS. Regression analysis confirmed that the difficulty in identifying and expressing emotions is significantly related with awareness for one's own interoceptive feelings and with a tendency to misinterpret and amplify bodily sensations. From a clinical point of view, the assessment of interoceptive awareness by the SAQ could be pivotal in evaluating several psychopathological conditions, such as the somatoform disorders.

P85. Biased processing of social information in psychogenic nonepileptic seizures

The pathogenesis of psychogenic nonepileptic seizures (PNES) has been frequently related to specific psychological factors and personality traits. In particular, disturbances in emotion perception and affect regulation are supposed to trigger seizure-like episodes in these patients. However, less is known how PNES individuals process and interpret affective information and how this (inadaequate) information processing can affect vulnerability towards their attacks. Thus, the present study aimed to investigate basal facial affect recognition as well as higher-order cognitive mind-reading skills in order to further investigate specific perceptual and cognitive biases in the processing of social affective information in a homogenous sample of patients suffering from PNES. In the present study we assessed alexithymia via self-report in a sample of patients diagnosed with PNES and matched healthy controls. Affect perception was tested using a series of computerized movies of models whose facial expressions slowly change from neutral to full-blown emotion (anger, fear, sadness, happiness, disgust, and surprise), allowing a fine-grained assessment of facial emotion recognition impairments. Further, we presented all participants with the Movie for the Assessment of Social Cognition, a well-validated video-based test for the evaluation of subtle mind-reading deficits that permits the separate quantification of the use of aberrant mentalizing strategies like ‘overmentalizing’ and ‘undermentalizing’ related to affective and cognitive dimensions. We predicted that PNES patients would show deficits in both, affect perception and mentalizing. The first preliminary data analyses revealed increased alexithymic traits and specifically impaired mentalizing skills in PNES individuals, while basal facial expression recognition appeared to be intact in these patients. In summary, our findings suggest that patients suffering from PNES exhibit deficits in mind-reading abilities, but do not show impairments in basal facial affect recognition. More specifically, PNES individuals show a tendency to over-attribute inappropriate affective states to others, which could be the consequence of the inability to adequately experience and express their own emotional reactions. Hence, these patients might benefit from psychotherapeutic interventions that focus on the disturbed affect regulation and aim to enhance emotional awareness.

Neural activity during interoceptive awareness and its associations with alexithymia-An fMRI study in major depressive disorder and non-psychiatric controls.

Objective: Alexithymia relates to difficulties recognizing and describing emotions. It has been linked to subjectively increased interoceptive awareness (IA) and to psychiatric illnesses such as major depressive disorder (MDD) and somatization. MDD in turn is characterized by aberrant emotion processing and IA on the subjective as well as on the neural level. However, a link between neural activity in response to IA and alexithymic traits in health and depression remains unclear.Methods: A well-established fMRI task was used to investigate neural activity during IA (heartbeat counting) and exteroceptive awareness (tone counting) in non-psychiatric controls (NC) and MDD. Firstly, comparing MDD and NC, a linear relationship between IA-related activity and scores of the Toronto Alexithymia Scale (TAS) was investigated through whole-brain regression. Secondly, NC were divided by median-split of TAS scores into groups showing low (NC-low) or high (NC-high) alexithymia. MDD and NC-high showed equally high TAS scores. Subsequently, IA-related neural activity was compared on a whole-brain level between the three independent samples (MDD, NC-low, NC-high).Results: Whole-brain regressions between MDD and NC revealed neural differences during IA as a function of TAS-DD (subscale difficulty describing feelings) in the supragenual anterior cingulate cortex (sACC; BA 24/32), which were due to negative associations between TAS-DD and IA-related activity in NC. Contrasting NC subgroups after median-split on a whole-brain level, high TAS scores were associated with decreased neural activity during IA in the sACC and increased insula activity. Though having equally high alexithymia scores, NC-high showed increased insula activity during IA compared to MDD, whilst both groups showed decreased activity in the sACC.Conclusions: Within the context of decreased sACC activity during IA in alexithymia (NC-high and MDD), increased insula activity might mirror a compensatory mechanism in NC-high, which is disrupted in MDD.

Effects of facial expressions on visual short-term memory in relation to alexithymia traits

We examined dysfunctional memory processing of facial expressions in relation to alexithymia. Individuals with high and low alexithymia, as measured by the Toronto Alexithymia Scale (TAS-20), participated in a visual search task (Experiment 1A) and a change-detection task (Experiments 1B and 2), to assess differences in their visual short-term memory (VSTM). In the visual search task, the participants were asked to judge whether all facial expressions (angry and happy faces) in the search display were the same or different. In the change-detection task, they had to decide whether all facial expressions changed between successive two displays. We found individual differences only in the change-detection task. Individuals with high alexithymia showed lower sensitivity for the happy faces compared to the angry faces, while individuals with low alexithymia showed sufficient recognition for both facial expressions. Experiment 2 examined whether individual differences were observed during early storage or later retrieval stage of the VSTM process using a single-probe paradigm. We found no effect of single-probe, indicating that individual differences occurred at the storage stage. The present results provide new evidence that individuals with high alexithymia show specific impairment in VSTM processes (especially the storage stage) related to happy but not to angry faces.

Benefits of using culturally unfamiliar stimuli in ambiguous emotion identification: A cross-cultural study

A novel emotion recognition task that employs photos of a Japanese mask representing a highly ambiguous stimulus was evaluated. As non-Asians perceive and/or label emotions differently from Asians, we aimed to identify patterns of task-performance in non-Asian healthy volunteers with a view to future patient studies. The Noh mask test was presented to 42 adult German participants. Reaction times and emotion attribution patterns were recorded. To control for emotion identification abilities, a standard emotion recognition task was used among others. Questionnaires assessed personality traits. Finally, results were compared to age- and gender-matched Japanese volunteers. Compared to other tasks, German participants displayed slowest reaction times on the Noh mask test, indicating higher demands of ambiguous emotion recognition. They assigned more positive emotions to the mask than Japanese volunteers, demonstrating culture-dependent emotion identification patterns. As alexithymic and anxious traits were associated with slower reaction times, personality dimensions impacted on performance, as well. We showed an advantage of ambiguous over conventional emotion recognition tasks. Moreover, we determined emotion identification patterns in Western individuals impacted by personality dimensions, suggesting performance differences in clinical samples. Due to its properties, the Noh mask test represents a promising tool in the differential diagnosis of psychiatric disorders, e.g. schizophrenia.