Alexithymia and individual differences in emotional expression

Improving the Objective Measurement of Alexithymia Using a Computer-Scored Alexithymia Provoked Response Questionnaire with an Online Sample

The study and measurement of alexithymia - a trait marked by difficulty identifying and describing feelings - can be improved by incorporating objective measures to supplement self-report scales. The Alexithymia Provoked Response Questionnaire (APRQ) is an observer-rated alexithymia tool that shows promise yet can be time-consuming to administer. The present study aimed to assess the feasibility of computer administration and scoring of the APRQ. Further, the APRQ's association with verbal IQ and emotional vocabulary use was examined, as was the relationship between the APRQ and the self-report Bermond-Vorst Alexithymia Questionnaire-B (BVAQ-B). Adult participants (n = 366), including a proportion gathered through purposive sampling, participated in an online study. Inter-rater reliability measures indicated that computerized scoring of the APRQ is as reliable as human scoring, making the measure scalable for use with large samples. Alexithymia levels were independent of two measures of verbal IQ. Correlational analyses indicated overlap in alexithymia as measured by the APRQ and most of the subscales of the BVAQ-B. The APRQ, as an objective measure, may capture deficits in emotional awareness independent of self-insight.

Language or rating scales based classifications of emotions: computational analysis of language and alexithymia

Rating scales are the dominating tool for the quantitative assessment of mental health. They are often believed to have a higher validity than language-based responses, which are the natural way of communicating mental states. Furthermore, it is unclear how difficulties articulating emotions-alexithymia-affect the accuracy of language-based communication of emotions. We investigated whether narratives describing emotional states are more accurately classified by questions-based computational analysis of language (QCLA) compared to commonly used rating scales. Additionally, we examined how this is affected by alexithymia. In Phase 1, participants (N = 348) generated narratives describing events related to depression, anxiety, satisfaction, and harmony. In Phase 2, another set of participants summarized the emotions described in the narratives of Phase 1 in five descriptive words and rating scales (PHQ-9, GAD-7, SWLS, and HILS). The words were quantified with a natural language processing model (i.e., LSA) and classified with machine learning (i.e., multinomial regression). The results showed that the language-based responses can be more accurate in classifying the emotional states compared to the rating scales. The degree of alexithymia did not influence the correctness of classification based on words or rating scales, suggesting that QCLA is not sensitive to alexithymia. However, narratives generated by people with high alexithymia were more difficult to classify than those generated by people with low alexithymia. These results suggest that the assessment of mental health may be improved by language-based responses analyzed by computational methods compared to currently used rating scales.

Effects of DBT-based interventions on alexithymia: a systematic review

While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.

The Moderating Effects of “Dark” Personality Traits and Message Vividness on the Persuasiveness of Terrorist Narrative Propaganda

Terrorism researchers have long discussed the role of psychology in the radicalization process. This work has included research on the respective roles of individual psychological traits and responses to terrorist propaganda. Unfortunately, much of this work has looked at psychological traits and responses to propaganda individually and has not considered how these factors may interact. This study redresses this gap in the literature. In this experiment (N = 268), participants were measured in terms of their narcissism, Machiavellianism, subclinical psychopathy, and everyday sadism—collectively called the Dark Tetrad. Participants were then exposed to a vivid or nonvivid terrorist narrative (or a control message). Results indicate that Machiavellianism interacts with both narrative exposure and narrative vividness to amplify the persuasive effect of terrorist narratives. Neither narcissism, subclinical psychopathy, nor everyday sadism had such an effect. These results highlight the importance of considering the psychological traits of audiences when evaluating proclivity for radicalization via persuasion by terrorist narratives.

Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms

BACKGROUND

Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood.

METHODS

In total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12-24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms.

RESULTS

Autistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44-0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07-0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41-0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08-0.62).

CONCLUSIONS

Our findings suggest that difficulties in identifying v. describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.

Eliciting Expressions of Emotion: An Exploratory Analysis of Alexithymia in Adults with Autism Utilising the APRQ

This study examined alternative methods for detecting alexithymia to the Toronto Alexithymia Scale-20 (TAS-20) by comparing the emotional linguistic performance of ASD and NT samples (n = 32 in each) on the Alexithymia Provoked Responses Questionnaire (APRQ). We utilised both the LIWC and tidytext approaches to linguistic analysis. The results indicate the ASD sample used significantly fewer affective words in response to emotionally stimulating scenarios and had less emotional granularity. Affective word use was correlated with ASD symptomatology but not with TAS-20 scores, suggesting that some elements of alexithymia are not well detected by the TAS-20 alone. The APRQ, in combination with the tidytext package, offers significant potential for sophisticated exploration of emotional expression in ASD.

Impacts of the psychological stress response on nonsuicidal self-injury behavior in students during the COVID-19 epidemic in China: the mediating role of sleep disorders

Background

The sudden outbreak of COVID-19 had a great impact on the physical and mental health of people all over the world, especially for students whose physical and mental development was not yet mature. In order to understand the physical and mental conditions of students during the epidemic period and provide a theoretical basis for coping with psychological problems in public health emergencies, this study explored the mediating role of sleep disorders in the effect of the psychological stress response (PSR) on non-suicidal self-injury (NSSI), along with the moderating role of emotional management ability (EMA).

Methods

The SRQ-20, Pittsburgh Sleep Quality Index, NSSI Behavior Questionnaire, and Emotional Management Questionnaire were used to investigate the mental health of Chinese students in April 10–20 (Time point 1, T1) and May 20–30 (Time point 2, T2), 2020. A total of 1,955 students (Mage = 19.64 years, 51.4% male) were examined at T1 and 342 students (Mage = 20.06 years, 48.2% male) were reassessed at T2.

Results

Overall, the detection rate of PSR and NSSI were 17.60% (n = 344) and 24.90% (n = 486) respectively in the T1 sample, and were 16.37% (n = 56) and 25.44% (n = 87), in the T2 sample. We also found that sleep disorders played a mediating role in the effect of PSR on NSSI in the T1 and T2 samples. In addition, EMA was shown to regulate the effect of PSR on sleep disorders and the effect of sleep disorders on NSSI in the T1 samples.

Conclusion

We found that PSR resulting from public health emergency might lead to NSSI behaviors in individuals. PSR may also cause sleep disorders, which can bring about NSSI. However, these effects were also moderated by the EMA. This research expands our understanding of PSR and NSSI in students during the pandemic.

Associations between Cognitive Concepts of Self and Emotional Facial Expressions with an Emphasis on Emotion Awareness

Recognising our own and others’ emotions is vital for healthy social development. The aim of the current study was to determine how emotions related to the self or to another influence behavioural expressions of emotion. Facial electromyography (EMG) was used to record spontaneous facial muscle activity in nineteen participants while they passively viewed negative, positive and neutral emotional pictures during three blocks of referential instructions. Each participant imagined themself, another person or no one experiencing the emotional scenario, with the priming words “You”, “Him” or “None” presented before each picture for the respective block of instructions. Emotion awareness (EA) was also recorded using the TAS-20 alexithymia questionnaire. Corrugator supercilii (cs) muscle activity increased significantly between 500 and 1000 ms post stimulus onset during negative and neutral picture presentations, regardless of ownership. Independent of emotion, cs activity was greatest during the “no one” task and lowest during the “self” task from less than 250 to 1000 ms. Interestingly, the degree of cs activation during referential tasks was further modulated by EA. Low EA corresponded to significantly stronger cs activity overall compared with high EA, and this effect was even more pronounced during the “no one” task. The findings suggest that cognitive processes related to the perception of emotion ownership can influence spontaneous facial muscle activity, but that a greater degree of integration between higher cognitive and lower affective levels of information may interrupt or suppress these behavioural expressions of emotion.

Cognitive-emotional processing in alexithymia: an integrative review

Alexithymia is a multifaceted personality construct characterised by difficulties identifying one's feelings and distinguishing them from bodily sensations, difficulties describing one's feelings to others, and an externally oriented cognitive style. Over the past 25 years, a burgeoning body of research has examined how alexithymia moderates processing at the cognition-emotion interface. We review the findings in five domains: attention, appraisals, memory, language, and behaviours. The preponderance of studies linked alexithymia with deficits in emotion processing, which was apparent across all domains, except behaviours. All studies on behaviours and a proportion of studies in other domains demonstrated emotional over-responding. Analysis at the facet level revealed deficits in memory and language that are primarily associated with externally oriented thinking, while over-responding was most often linked to difficulty identifying feelings and difficulty describing feelings. The review also found evidence for contextual modulation: The pattern of deficits and over-responding was not restricted to emotional contexts but also occurred in neutral contexts, and in some circumstances, emotional over-responding in alexithymia was beneficial. Taken together, this review highlights alexithymia as a central personality dimension in the interplay between cognition and emotion.

New Technologies as Promising Tools for Assessing Facial Emotion Expressions Impairments in ASD: A Systematic Review

The ability to recognize and express emotions from facial expressions are essential for successful social interactions. Facial Emotion Recognition (FER) and Facial Emotion Expressions (FEEs), both of which seem to be impaired in Autism Spectrum Disorders (ASD) and contribute to socio-communicative difficulties, participate in the diagnostic criteria for ASD. Only a few studies have focused on FEEs processing and the rare behavioral studies of FEEs in ASD have yielded mixed results. Here, we review studies comparing the production of FEEs between participants with ASD and non-ASD control subjects, with a particular focus on the use of automatic facial expression analysis software. A systematic literature search in accordance with the PRISMA statement identified 20 reports published up to August 2020 concerning the use of new technologies to evaluate both spontaneous and voluntary FEEs in participants with ASD. Overall, the results highlight the importance of considering socio-demographic factors and psychiatric co-morbidities which may explain the previous inconsistent findings, particularly regarding quantitative data on spontaneous facial expressions. There is also reported evidence for an inadequacy of FEEs in individuals with ASD in relation to expected emotion, with a lower quality and coordination of facial muscular movements. Spatial and kinematic approaches to characterizing the synchrony, symmetry and complexity of facial muscle movements thus offer clues to identifying and exploring promising new diagnostic targets. These findings have allowed hypothesizing that there may be mismatches between mental representations and the production of FEEs themselves in ASD. Such considerations are in line with the Facial Feedback Hypothesis deficit in ASD as part of the Broken Mirror Theory, with the results suggesting impairments of neural sensory-motor systems involved in processing emotional information and ensuring embodied representations of emotions, which are the basis of human empathy. In conclusion, new technologies are promising tools for evaluating the production of FEEs in individuals with ASD, and controlled studies involving larger samples of patients and where possible confounding factors are considered, should be conducted in order to better understand and counter the difficulties in global emotional processing in ASD.

A sensorimotor control framework for understanding emotional communication and regulation

Our research team was asked to consider the relationship of the neuroscience of sensorimotor control to the language of emotions and feelings. Actions are the principal means for the communication of emotions and feelings in both humans and other animals, and the allostatic mechanisms controlling action also apply to the regulation of emotional states by the self and others. We consider how motor control of hierarchically organised, feedback-based, goal-directed action has evolved in humans, within a context of consciousness, appraisal and cultural learning, to serve emotions and feelings. In our linguistic analysis, we found that many emotion and feelings words could be assigned to stages in the sensorimotor learning process, but the assignment was often arbitrary. The embodied nature of emotional communication means that action words are frequently used, but that the meanings or senses of the word depend on its contextual use, just as the relationship of an action to an emotion is also contextually dependent.

Negative valence specific deficits in judgements of musical affective quality in alexithymia

Alexithymia is characterised by a lack of words for emotional experiences and it has been implicated in deficits in emotion processing. Research in this area has typically focused on judgements of discrete emotions rather than of affect, which is a precursor to emotion construction. In the current study, higher alexithymia was predicted to be related to more neutral judgements of valence and arousal of music representing a range of emotions. Participants (N = 162) listened to ten 15-second musical pieces that represented five target emotions (happy, sad, tender, angry, and fearful) and rated the valence and arousal of each. Participants also listed emotion words they knew to be expressed in music. Analyses revealed that alexithymia was not related to the number of emotion words generated but was related to valence-specific affect judgements of music. Participants higher in alexithymia rated sad, angry, and fearful pieces as more neutral in valence and arousal. Alexithymia was not related to ratings of valence or arousal for happy and tender pieces. These findings suggest that perceptual deficits in alexithymia may be specific to negative emotions. Our results are consistent with the idea that alexithymia is related to the direction of attention away from negative stimuli.

The Role of Perspective Taking and Alexithymia in Associations Between Shame, Guilt, and Social Anxiety

The present study expanded previous research concerning relationships between shame, guilt, and social anxiety by examining both internal and external shame and exploring the role of two cognitive constructs relating to emotion regulation, perspective taking, and alexithymia. Findings were consistent with the literature regarding positive associations between shame and social anxiety and no relationship between guilt and social anxiety. Perspective taking was positively related to guilt, while alexithymia was positively related to both shame types. Social anxiety was predicted by shame-proneness, external shame, and alexithymia. There were also small indirect effects for both types of shame on social anxiety through alexithymia. Further replication of relationships between shame, alexithymia, and social anxiety is needed. Alexithymia, with and without concurrent shame, has implications for therapeutic interventions for social anxiety as it may represent a barrier to implementing conventional therapies.

Psycholinguistic and socioemotional characteristics of young offenders: Do language abilities and gender matter?

PURPOSE

Previous research demonstrates an association between developmental language disorder (DLD) and criminal offending. International research also implicates alexithymia as being over-represented in forensic samples. This study provides a comprehensive examination of the psycholinguistic and socioemotional profiles of males and females in the youth justice system, with a focus on first-time entrants. In the context of restorative justice (RJ) underpinning youth justice disposals, this allows for informed intervention and identifies those who may be compromised in their ability to effectively engage in certain interventions.

METHODS

Participants (N = 145) from a triage centre and youth offending teams, with a mean age of 15.8, completed a range of standardized psycholinguistic assessments considering non-verbal IQ, expressive and receptive language measures, and literacy. Additionally, socioemotional measures completed included The Alexithymia Scale and the Strengths and Difficulties Questionnaire.

RESULTS

Developmental language disorder was present in 87 participants. Except for the emotional score, no statistically significant gender differences were found. The mean language scores for the DLD group were more than 2.25 standard deviations below the normative mean, and they demonstrated greater literacy difficulties. A high proportion of the group met the criteria for alexithymia/possible alexithymia (60%), and this was not associated with DLD.

CONCLUSIONS

High prevalence values for DLD and socioemotional difficulties, not generally gender-specific, were found. These difficulties have the possibility to compromise a young person's ability to engage in rehabilitative strategies. Language assessment and identification of difficulties, especially DLD, upon entry to the youth justice service, would assist when planning interventions.

Memory for emotional information and alexithymia A systematic review

Alexithymia is a deficit in the recognition, expression and regulation of emotions, which has the following features: difficulty in identifying or describing feelings, difficulty distinguishing between feelings and bodily sensations, stringent imaginal processes, and externally oriented cognitive style. This personality trait is associated with many psychiatric and psychosomatic disorders, as well as with risky behaviors.

Emotional overactivity in patients with irritable bowel syndrome

BACKGROUND

Negativity is often observed in patients with irritable bowel syndrome (IBS). No study has examined their emotional expressiveness as a marker of emotional reactivity. We investigated IBS patients' vulnerability to an emotional load by associating their expressiveness with psychological and neurophysiological assessments. We hypothesized that IBS would be characterized by a lack of expressiveness coupled with high scores in psychological and neurophysiological parameters.

METHODS

We assessed the emotional facial expressions (EMFACS), psychological (anxiety, depression, alexithymia), and neurophysiological (cortisol, heart rate variability (HRV)) parameters of 25 IBS patients and 26 healthy controls (HC) while they watched fear-eliciting movie extracts.

KEY RESULTS

Overall, the task elicited an increase in state anxiety and consistent HRV responses. However, IBS patients differed from HC as they displayed more sadness and tended to display more rage. Contrary to HC, IBS patients showed an increase in heart rate and a decrease in parasympathetic regulation, reflecting an enhanced responsiveness corroborated by higher scores in depression and state anxiety. Consistent with their higher difficulty in identifying feelings, a component of alexithymia positively correlated with their expressions of rage, they were not aware of their increase in anxiety during the task, whereas HC were. No linear relationship between patients' expressions and their neurophysiological responses was found.

CONCLUSIONS & INFERENCES

Irritable bowel syndrome patients displayed greater emotional expressiveness with negative prevalence. This reflects an emotional vulnerability potentially related to low regulation skills and underscores the importance of considering the central dysregulation hypothesis in IBS as a promising avenue of research.

Language and alexithymia: Evidence for the role of the inferior frontal gyrus in acquired alexithymia

The clinical relevance of alexithymia, a condition associated with difficulties identifying and describing one's own emotion, is becoming ever more apparent. Increased rates of alexithymia are observed in multiple psychiatric conditions, and also in neurological conditions resulting from both organic and traumatic brain injury. The presence of alexithymia in these conditions predicts poorer regulation of one's emotions, decreased treatment response, and increased burden on carers. While clinically important, the aetiology of alexithymia is still a matter of debate, with several authors arguing for multiple 'routes' to impaired understanding of one's own emotions, which may or may not result in distinct subtypes of alexithymia. While previous studies support the role of impaired interoception (perceiving bodily states) in the development of alexithymia, the current study assessed whether acquired language impairment following traumatic brain injury, and damage to language regions, may also be associated with an increased risk of alexithymia. Within a sample of 129 participants with penetrating brain injury and 33 healthy controls, neuropsychological testing revealed that deficits in a non-emotional language task, object naming, were associated with alexithymia, specifically with difficulty identifying one's own emotions. Both region-of-interest and whole-brain lesion analyses revealed that damage to language regions in the inferior frontal gyrus was associated with the presence of both this language impairment and alexithymia. These results are consistent with a framework for acquired alexithymia that incorporates both interoceptive and language processes, and support the idea that brain injury may result in alexithymia via impairment in any one of a number of more basic processes.

Alexithymia, but not autism spectrum disorder, may be related to the production of emotional facial expressions

Background

A prominent diagnostic criterion of autism spectrum disorder (ASD) relates to the abnormal or diminished use of facial expressions. Yet little is known about the mechanisms that contribute to this feature of ASD.

Methods

We showed children with and without ASD emotionally charged video clips in order to parse out individual differences in spontaneous production of facial expressions using automated facial expression analysis software.

Results

Using hierarchical multiple regression, we sought to determine whether alexithymia (characterized by difficulties interpreting one’s own feeling states) contributes to diminished facial expression production. Across groups, alexithymic traits—but not ASD traits, IQ, or sex—were associated with quantity of facial expression production.

Conclusions

These results accord with a growing body of research suggesting that many emotion processing abnormalities observed in ASD may be explained by co-occurring alexithymia. Developmental and clinical considerations are discussed, and it is argued that alexithymia is an important but too often ignored trait associated with ASD that may have implications for subtyping individuals on the autism spectrum.

Assessing Anger Expression: Construct Validity of Three Emotion Expression-Related Measures

Self-report measures of emotional expression are common, but their validity to predict objective emotional expression, particularly of anger, is unclear. We tested the validity of the Anger Expression Inventory (AEI; Spielberger et al., 1985 ), Emotional Approach Coping Scale (EAC; Stanton, Kirk, Cameron, & Danoff-Burg, 2000 ), and Toronto Alexithymia Scale-20 (TAS-20; Bagby, Taylor, & Parker, 1994 ) to predict objective anger expression in 95 adults with chronic back pain. Participants attempted to solve a difficult computer maze by following the directions of a confederate who treated them rudely and unjustly. Participants then expressed their feelings for 4 min. Blinded raters coded the videos for anger expression, and a software program analyzed expression transcripts for anger-related words. Analyses related each questionnaire to anger expression. The AEI Anger-Out scale predicted greater anger expression, as expected, but AEI Anger-In did not. The EAC Emotional Processing scale predicted less anger expression, but the EAC Emotional Expression scale was unrelated to anger expression. Finally, the TAS-20 predicted greater anger expression. Findings support the validity of the AEI Anger-Out scale but raise questions about the other measures. The assessment of emotional expression by self-report is complex and perhaps confounded by general emotional experience, the specificity or generality of the emotion(s) assessed, and self-awareness limitations. Performance-based or clinician-rated measures of emotion expression are needed.

Integrated modelling of alexithymia: psychological predictors and method of response functions

The objective of this study was to construct the integrated model of alexithymia (ALEX) based on the method of response function approach that allows to predict the impact of the subjects' psychological variables on the actual level of alexithymia. Extraversion, neuroticism, autonomy, locus of control and hostility were selected as the appropriate predictors of the alexithymia level. Evaluation of ALEX model's parameters and its validation was provided on a wide set of experimental data (N = 224). ALEX model predicts the level of alexithymia satisfactorily and allows obtaining the partial response functions of its psychological predictors.

The match-mismatch model of emotion processing styles and emotion regulation strategies in fibromyalgia

OBJECTIVE

Individuals differ in their style of processing emotions (e.g., experiencing affects intensely or being alexithymic) and their strategy of regulating emotions (e.g., expressing or reappraising). A match-mismatch model of emotion processing styles and emotion regulation strategies is proposed and tested. This model specifies that for people high on affect intensity, emotion expression is more adaptive than reappraisal, whereas for alexithymic people, reappraisal is more adaptive than expression. The present study tested this model in 403 women with fibromyalgia (mean age 46.5±12.3 years).

METHODS

In a cross-sectional design, we assessed affect intensity (Berkeley Expressivity Questionnaire), alexithymia (Toronto Alexithymia Scale-20), cognitive reappraisal (Emotion Regulation Questionnaire), and emotion expression (Emotional Approach Coping Scales), as well as the impact of fibromyalgia (Fibromyalgia Impact Questionnaire).

RESULTS

Multiple regression analyses with interaction terms indicated that among people high on affect intensity, emotion expression - but not cognitive reappraisal - was associated with less fibromyalgia impact. No support was found for the hypothesis that among alexithymic people, cognitive reappraisal would be more adaptive than emotion expression.

CONCLUSION

Findings suggest that for women with fibromyalgia who experience their emotions intensely, an emotional disclosure or expression intervention may be beneficial. This hypothesis requires verification in experimental studies.

Impaired self-reflection in psychiatric disorders among adults: a proposal for the existence of a network of semi independent functions

Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: (a) sense of ownership of one's own thoughts and actions, (b) emotional awareness, (c) distinction between fantasy and reality and (d) the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another.