Alexithymia, affect recognition, and the five-factor model of personality in normal subjects

Dimensions of Alexithymia and Identification of Emotions in Masked and Unmasked Faces

Alexithymia, a multifaceted personality construct, is known to be related to difficulties in the decoding of emotional facial expressions, especially in case of suboptimal stimuli. The present study investigated whether and which facets of alexithymia are related to impairments in the recognition of emotions in faces with face masks. Accuracy and speed of emotion recognition were examined in a block of faces with and a block of faces without face masks in a sample of 102 healthy individuals. The order of blocks varied between participants. Emotions were recognized better and faster in unmasked than in masked faces. Recognition performance was worst and slowest for participants starting the task with masked faces. In the whole sample, there were no correlations of alexithymia facets with accuracy and speed of emotion recognition for masked and unmasked faces. In participants starting the task with masked faces, the facet externally oriented thinking was positively correlated with reaction latencies of correct responses for masked faces. Our findings indicate that an externally oriented thinking style could be linked to a less efficient identification of emotions from faces wearing masks when task difficulty is high and support the utility of a facet approach in alexithymia research.

Recognizing and Looking at Masked Emotional Faces in Alexithymia

Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and communicating one's emotions and externally oriented thinking. Alexithymia has been found to be related to poor emotion decoding and diminished attention to the eyes. The present eye tracking study investigated whether high levels of alexithymia are related to impairments in recognizing emotions in masked faces and reduced attentional preference for the eyes. An emotion recognition task with happy, fearful, disgusted, and neutral faces with face masks was administered to high-alexithymic and non-alexithymic individuals. Hit rates, latencies of correct responses, and fixation duration on eyes and face mask were analyzed as a function of group and sex. Alexithymia had no effects on accuracy and speed of emotion recognition. However, alexithymic men showed less attentional preference for the eyes relative to the mask than non-alexithymic men, which was due to their increased attention to face masks. No fixation duration differences were observed between alexithymic and non-alexithymic women. Our data indicate that high levels of alexithymia might not have adverse effects on the efficiency of emotion recognition from faces wearing masks. Future research on gaze behavior during facial emotion recognition in high alexithymia should consider sex as a moderating variable.

Emotional recognition across the adult lifespan: Effects of age, sex, cognitive empathy, alexithymia traits, and amygdala subnuclei volumes

The ability to recognize others' emotions is vital to everyday life. The goal of this study was to assess which emotions show age-related decline in recognition accuracy of facial emotional expressions across the entire adult lifespan and how this process is related to cognitive empathy (Theory of Mind [ToM]), alexithymia traits, and amygdala subnuclei volumes in a large cohort of healthy individuals. We recruited 140 healthy participants 18-85 years old. Facial affect processing was assessed with the Penn Emotion Recognition task (ER40) that contains images of the five basic emotions: Neutral, Happy, Sad, Angry, and Fearful. Structural magnetic resonance imaging (MRI) datasets were acquired on a 4.7T MRI system. Structural equation modeling was used to test the relationship between studied variables. We found that while both sexes demonstrated age-related reduction in recognition of happy emotions and preserved recognition of sadness, male participants showed age-related reduction in recognition of fear, while in female participants, age-related decline was linked to recognition of neutral and angry facial expressions. In both sexes, accurate recognition of sadness negatively correlated with alexithymia traits. On the other hand, better ToM capabilities in male participants were associated with improvement in recognition of positive and neutral emotions. Finally, none of the observed age-related reductions in emotional recognition were related to amygdala and its subnuclei volumes. In contrast, both global volume of amygdala and its cortical and centromedial subnuclei had significant direct effects on recognition of sad images.

Law Enforcement Officers’ Ability to Recognize Emotions: The Role of Personality Traits and Basic Needs’ Satisfaction

Background: This study intended to explore the role of personality traits and basic psychological needs in law enforcement officers’ ability to recognize emotions: anger, joy, sadness, fear, surprise, disgust, and neutral. It was significant to analyze law enforcement officers’ emotion recognition and the contributing factors, as this field has been under-researched despite increased excessive force use by officers in many countries. Methods: This study applied the Big Five–2 (BFI-2), the Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS), and the Karolinska Directed Emotional Faces set of stimuli (KDEF). The data was gathered using an online questionnaire provided directly to law enforcement agencies. A total of 154 law enforcement officers participated in the study, 50.65% were females, and 49.35% were males. The mean age was 41.2 (age range = 22–61). In order to analyze the data, SEM and multiple linear regression methods were used. Results: This study analyzed variables of motion recognition, personality traits, and needs satisfaction and confirmed that law enforcement officers’ personality traits play a significant role in emotion recognition. Respondents’ agreeableness significantly predicted increased overall emotion recognition; conscientiousness predicted increased anger recognition; joy recognition was significantly predicted by extraversion, neuroticism, and agreeableness. This study also confirmed that law enforcement officers’ basic psychological needs satisfaction/frustration play a significant role in emotion recognition. Respondents’ relatedness satisfaction significantly predicted increased overall emotion recognition, fear recognition, joy recognition, and sadness recognition. Relatedness frustration significantly predicted decreased anger recognition, surprise recognition, and neutral face recognition. Furthermore, this study confirmed links between law enforcement officers’ personality traits, satisfaction/frustration of basic psychological needs, and emotion recognition, χ2 = 57.924; df = 41; p = 0.042; TLI = 0.929; CFI = 0.956; RMSEA = 0.042 [0.009–0.065]. Discussion: The findings suggested that agreeableness, conscientiousness, extraversion, and neuroticism play an essential role in satisfaction and frustration of relatedness needs, which, subsequently, link to emotion recognition. Due to the relatively small sample size, the issues of validity/reliability of some instruments, and other limitations, the results of this study should preferably be regarded with concern.

Having no words for feelings: alexithymia as a fundamental personality dimension at the interface of cognition and emotion

This special issue brings together two important reviews and seven cutting-edge empirical papers concerning the influence of alexithymia on cognitive and emotional processing. Alexithymia is a multifaceted construct that is characterised by difficulties identifying one's feelings; difficulties describing one's feelings to others; and an externally focused, utilitarian cognitive style. In this paper, we begin by considering how emotion science has evolved in its understanding of personality traits, before highlighting the potential importance of alexithymia research for the field of cognition and emotion. After summarising the historical context of alexithymia research, we consider the contributions of the featured papers to the literature of cognition and emotion. The collected works highlight that alexithymia influences several aspects of how one perceives and responds to neutral and emotional situations, by impacting upon multiple processes (attention, appraisals, memory, language and behaviour), showing the importance of drawing better connections amongst multiple processes, toward disentangling the effects of early processes on later ones. A lack of correspondence between processes, as well as amongst alexithymia facets, is another central finding of the special issue. This pattern is thought to lead to ineffective and inflexible emotion regulation and to pose significant risks for physical and mental illness.

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.

Examination of the paths between personality, current mood, its evaluation, and emotion regulation

In an ongoing longitudinal study, a Big Five Personality Inventory was completed by 122 men and 126 women at age 33. At age 36, the Brief Mood Introspection Scale, the Meta‐Evaluation Scale, and the Meta‐Regulation Scale were administered to 140 men and 127 women. The results, based on path analyses, lent support to a hypothesized model, according to which current mood (Negative, Positive, Active, Calm) and mood evaluation (Mood Influence, Typicality and Acceptance, Clarity) mediate the relationship between the Big Five personality traits and emotion regulation strategies (Repair, Dampening, Maintenance). For both sexes, Neuroticism was the most significant trait in terms of emotion regulation. A sex difference emerged: in general, personality traits and mood variables explained emotion regulation more significantly in men. Copyright © 2001 John Wiley & Sons, Ltd.

Teaching emotional and social competencies: Efficacy of a work readiness program designed for vulnerable youth

BACKGROUND: As emotional and social competency training proliferates within a work readiness context, concerns remain regarding their efficacy. Data on these programs tends to be scarce and outcome objectives are often poorly defined. OBJECTIVE: Authors developed and tested a work readiness emotional and social competency program specifically designed for at-risk young adults, tailored with best practices in mind. METHOD: 84 clients of a community organization that provides employment support to young adults with disabilities (48 men and 36 women) with a mean age of 28.17 years (SD = 11.64) completed measures of emotional intelligence and alexithymia on either side of the 4-week intervention. RESULTS: Men’s interpersonal scores and women’s adaptability scores showed significant improvement across the intervention. In addition, women’s scores in both identifying and describing feelings improved significantly, as did men’s scores in describing feelings. CONCLUSIONS: Within the context of work readiness, participants in an intervention to improve emotional and social competencies can see key improvements to competencies linked to occupational attainment.

Personality and Cognitive-Emotional Variables in Spanish Children and Adolescents With and Without Cleft Lip and/or Palate

OBJECTIVES

To analyze personality (Big Five Model) and cognitive-emotional variables in children and adolescents with a cleft lip/palate (s) in comparison to an equivalent peer sample without an orofacial cleft.

DESIGN

Cross-sectional study with data collected using self-reported questionnaires over 2 years.

SETTING

Data were collected during visits to health center dental clinics.

PATIENTS

Children and adolescents (aged 8-18 years) with nonsyndromic CL/P (n = 60) and without a cleft (n = 60).

METHOD

Patients completed questionnaires with assistance as needed from a member of the research team.

MAIN OUTCOME MEASURES

Children's Perceived Self-Efficacy, Cognitive Emotion Regulation Questionnaire (child version), Big Five Questionnaire for Children, and Alexithymia Questionnaire for Children.

RESULTS

When accounting for age, children with CL/P had normative self-efficacy and cognitive-emotional regulation strategies, with the protective factor of significantly lower rumination than peers. Children with CL/P were significantly lower on the Big Five personality areas of conscientiousness, openness to experience, extraversion, and agreeableness along with significantly higher neuroticism. They were similarly significantly higher than peers for alexithymia.

CONCLUSION

Children with CL/P showed strengths in self-efficacy typical of peers and less use of some maladaptive coping strategies; however, they also had higher levels of alexithymia and risk factors associated with the Big Five Model of personality. Strategies may be clinically useful that maximize areas of strength to support children with CL/P in expressing their emotions to reduce alexithymia, coping with of negative affect, and building assertiveness.

Increased Alexithymia But No Profound Emotion Processing Disorder in Burnout Syndrome

Our objectives were to investigate alexithymia in burnout patients while controlling for depression and anxiety, as well as to evaluate whether alexithymia may be part of a profound emotional processing disorder or of a mentalization deficit. Alexithymia, depressive, and anxious feelings were compared in patients with burnout, depression, and healthy controls using an age-, sex-, and education-matched cross-sectional design (n = 60). A facial emotion recognition task and an emotional mentalizing performance test as well as physical and emotional violation experiences were conducted. Alexithymia was significantly increased in burnout patients, mediated by negative affect in this group. No impairment of facial emotion recognition or mental attribution could be shown. Burnout patients demonstrated slightly increased emotional abuse experiences in early childhood. The present results corroborate the supposition that alexithymia in burnout primarily depends on affect and may rise due to current strain and overload experience, rather than based on a profound developmental disorder in emotion processing.

The role of alexithymia in social cognition: Evidence from a non-clinical population

BACKGROUND

Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment.

METHODS

We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills.

RESULTS

Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states.

LIMITATIONS

The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships.

CONCLUSIONS

These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.

Ego Depletion as a Measure of Emotion Processing Deficits among MUS Patients

Previous studies have found a link between emotion processing deficits and medically unexplained physical symptoms (MUS). The majority of previous studies have used self-report measures of emotional processing, with the majority focusing on alexithymia, and have produced inconsistent and contradictory results. In the present study, we investigated the role of emotion-processing deficits in MUS by assessing emotion regulation performance and the effects of performance on ego depletion. Participants with high or low levels of self-reported MUS watched emotion-evoking videos under instructions to allow or suppress their emotional reactions, and then performed an anagram task to measure their effort and perseverance. Contrary to the research with self-report measures, experimental analysis of emotion-processing revealed that MUS is correlated with the inability to regulate negative emotions. Unexpected self-regulatory tendencies of the participants with high symptom levels were discussed.

Characteristics of facial expression recognition ability in patients with Lewy body disease

Background

The facial expression of medical staff has been known to greatly affect the psychological state of patients, making them feel uneasy or conversely, cheering them up. By clarifying the characteristics of facial expression recognition ability in patients with Lewy body disease, the aim of this study is to examine points to facilitate smooth communication between caregivers and patients with the disease whose cognitive function has deteriorated.

Methods

During the period from March 2016 to July 2017, we examined the characteristics of recognition of the six facial expressions of “happiness,” “sadness,” “fear,” “anger,” “surprise,” and “disgust” for 107 people aged 60 years or more, both outpatient and inpatient, who hospital specialists had diagnosed with Lewy body diseases of Parkinson’s disease, Parkinson’s disease with dementia, and dementia with Lewy bodies. Based on facial expression recognition test results, we classified them by cluster analysis and clarified features of each type.

Results

In patients with Lewy body disease, happiness was kept unaffected by aging, age of onset, duration of the disease, cognitive function, and apathy; however, recognizing the facial expression of fear was difficult. In addition, due to aging, cognitive decline, and apathy, the facial expression recognition ability for sadness and anger decreased. In particular, cognitive decline reduced recognition of all of the facial expressions except for happiness. The test accuracy rates were classified into three types using the cluster analysis: “stable type,” “mixed type,” and “reduced type”. In the “reduced type”, the overall facial recognition ability declined except happiness, and in the mixed type, recognition ability of anger particularly declined.

Conclusion

There were several facial expressions that the Lewy body disease patients were unable to accurately identify. Caregivers are recommended to make an effort to compensate for such situations with language or body contact, etc., as a way to convey correct feeling to the patients of each type.

The influence of non-clinical eating-related psychopathology on the recognition of emotion from static faces and realistic social interactions

Emotion recognition deficits have consistently been reported in clinical and sub-clinical disordered eating. However, most studies have used static faces, despite the dynamic nature of everyday social interactions. The current aims were to confirm previous findings of emotion recognition deficits in non-clinical disordered eating and to determine if these deficits would be more evident in response to static as compared to dynamic emotional stimuli. We also aimed to establish if these emotion recognition deficits could be explained by comorbid psychopathology (depression, anxiety or alexithymia). Eighty-nine females were assigned to groups based on scores on the Eating Disorders Inventory (EDI); high (n = 45) and low (n = 44). Participants were presented with emotional faces and video clips portraying fear, anger, disgust, sadness, happiness, surprise and neutral affect. As predicted, the high EDI group correctly recognised fewer emotional displays than did the low EDI group. However, this deficit was not more evident for negative as opposed to positive emotions. Furthermore, the deficit was not larger for static stimuli in comparison to dynamic. Overall emotion recognition accuracy was negatively associated with Drive for Thinness, but not Bulimia or Body Dissatisfaction. Importantly, the emotion recognition deficits observed in the high EDI group and that were associated with eating disorder symptoms were independent of depression, anxiety and alexithymia. Findings confirm that even minor elevations in disordered eating are associated with poorer emotion recognition. This is important, as problems in recognition of the emotional displays of others are thought to be a risk factor for clinical eating disorders.

Alexithymic trait is associated with right IFG and pre-SMA activation in non-emotional response inhibition in healthy subjects

Event-related fMRI studies have explored emotion inhibitory processes in alexithymic individuals and have demonstrated abnormal BOLD activations in the processing of emotional stimuli. So far, no study has explored the relationship between the alexithymic trait and the general inhibition process, namely utilizing stimuli devoid of emotional valence. In this study 26 healthy subjects were administered the Toronto Alexithymic Scale (TAS-20) questionnaire to measure the alexithymic trait and performed an event related Go/Nogo task build up with letters during fMRI acquisition. We found no correlation between the TAS-20 z-score and the reaction times during the Go/Nogo task. Conversely, we observed a positive correlation between the degree of alexithymic trait -measured with the TAS-20 and the Nogo-Go activation of the right Inferior Frontal Gyrus and the right pre-Supplementary Motor Area. These data suggest that the general process of response inhibition may be modulated by the individual degree of alexithymic trait. We propose that such a relationship could reflect a compensatory mechanism implemented by participants with higher degree of alexithymic trait to reach a correct inhibition.

The effect of constraining eye-contact during dynamic emotional face perception-an fMRI study

Eye-contact modifies how we perceive emotions and modulates activity in the social brain network. Here, using fMRI, we demonstrate that adding a fixation cross in the eye region of dynamic facial emotional stimuli significantly increases activation in the social brain of healthy, neurotypical participants when compared with activation for the exact same stimuli observed in a free-viewing mode. In addition, using PPI analysis, we show that the degree of amygdala connectivity with the rest of the brain is enhanced for the constrained view for all emotions tested except for fear, and that anxiety and alexithymia modulate the strength of amygdala connectivity for each emotion differently. Finally, we show that autistic traits have opposite effects on amygdala connectivity for fearful and angry emotional expressions, suggesting that these emotions should be treated separately in studies investigating facial emotion processing.

Emotion Recognition and Expression in Young Obese Participants: Preliminary Study

This study of the presence of alexithymic characteristics in obese adolescents and preadolescents tested the hypothesis of whether they showed impaired recognition and expression of emotion. The sample included 30 obese young participants and a control group of 30 participants of normal weight for their ages. Stimuli, 42 faces representing seven emotional expressions, were shown to participants who identified the emotion expressed in the face. The Level of Emotional Awareness Scale was adapted for children to evaluate their ability to describe their emotions. Young obese participants had significantly lower scores than control participants, but no differences were found in recognition of emotion. The lack of words to describe emotions might suggest a greater prevalence of alexithymic characteristics in the obese participants, but the hypothesis of a general deficit in the processing of emotional experiences was not supported.

Subclinical alexithymia modulates early audio-visual perceptive and attentional event-related potentials

INTRODUCTION

Previous studies have highlighted the advantage of using audio-visual oddball tasks (instead of unimodal ones) in order to electrophysiologically index subclinical behavioral differences. Since alexithymia is highly prevalent in the general population, we investigated whether the use of various bimodal tasks could elicit emotional effects in low- vs. high-alexithymic scorers.

METHODS

Fifty students (33 females and 17 males) were split into groups based on low and high scores on the Toronto Alexithymia Scale (TAS-20). During event-related potential (ERP) recordings, they were exposed to three kinds of audio-visual oddball tasks: neutral-AVN-(geometrical forms and bips), animal-AVA-(dog and cock with their respective shouts), or emotional-AVE-(faces and voices) stimuli. In each condition, participants were asked to quickly detect deviant events occurring amongst a train of repeated and frequent matching stimuli (e.g., push a button when a sad face-voice pair appeared amongst a train of neutral face-voice pairs). P100, N100, and P300 components were analyzed: P100 refers to visual perceptive and attentional processing, N100 to auditory ones, and the P300 relates to response-related stages, involving memory processes.

RESULTS

High-alexithymic scorers presented a particular pattern of results when processing the emotional stimulations, reflected in early ERP components by increased P100 and N100 amplitudes in the emotional oddball tasks [P100: F (2, 48) = 20,319, p < 0.001; N100: F (2, 96) = 8,807, p = 0.001] as compared to the animal or neutral ones. Indeed, regarding the P100, subjects exhibited a higher amplitude in the AVE condition (8.717 μV), which was significantly different from that observed during the AVN condition (4.382 μV, p < 0.001). For the N100, the highest amplitude was found in the AVE condition (-4.035 μV) and the lowest was observed in the AVN condition (-2.687 μV, p = 0.003). However, no effect was found on the later P300 component.

CONCLUSIONS

Our findings suggest that high-alexithymic scorers require heightened early attentional resources in comparison to low scorers, particularly when confronted with emotional bimodal stimuli.

Alexithymia and the processing of emotional facial expressions (EFEs): systematic review, unanswered questions and further perspectives

Alexithymia is characterized by difficulties in identifying, differentiating and describing feelings. A high prevalence of alexithymia has often been observed in clinical disorders characterized by low social functioning. This review aims to assess the association between alexithymia and the ability to decode emotional facial expressions (EFEs) within clinical and healthy populations. More precisely, this review has four main objectives: (1) to assess if alexithymia is a better predictor of the ability to decode EFEs than the diagnosis of clinical disorder; (2) to assess the influence of comorbid factors (depression and anxiety disorder) on the ability to decode EFE; (3) to investigate if deficits in decoding EFEs are specific to some levels of processing or task types; (4) to investigate if the deficits are specific to particular EFEs. Twenty four studies (behavioural and neuroimaging) were identified through a computerized literature search of Psycinfo, PubMed, and Web of Science databases from 1990 to 2010. Data on methodology, clinical characteristics, and possible confounds were analyzed. The review revealed that: (1) alexithymia is associated with deficits in labelling EFEs among clinical disorders, (2) the level of depression and anxiety partially account for the decoding deficits, (3) alexithymia is associated with reduced perceptual abilities, and is likely to be associated with impaired semantic representations of emotional concepts, and (4) alexithymia is associated with neither specific EFEs nor a specific valence. These studies are discussed with respect to processes involved in the recognition of EFEs. Future directions for research on emotion perception are also discussed.

The neurocognition of alexithymia: evidence from neuropsychological and neuroimaging studies

OBJECTIVE

Alexithymia refers to an ineffective regulation and expression of emotions. It constitutes a major risk factor for a range of medical and psychiatric problems, including chronic pain, somatisation, anxiety and depression. Alexithymia is a multi-faceted concept, described in terms of cognitive and affective aspects. From a neuropsychological perspective, alexithymia can be defined as a disturbance in affective information processing and social cognition. As the growing literature on brain structures involved in alexithymia is fragmented and sometimes even contradictory, the aim of this article was to review findings on neural substrates with regard to their convergence.

METHODS

A narrative review was performed, including both early neuropsychological and more recent imaging studies, in order to achieve a better understanding of the aetiology of alexithymia.

RESULTS

Corpus callosum, cingulate cortex and insula are clearly involved in alexithymia. The amygdala and the orbitofrontal part of the cortex appear to be implicated as mediators, because of their broader involvement in emotional processing and executive control.

CONCLUSION

Notwithstanding the diffuse neural representation, the alexithymia construct can be usefully applied in the clinical and empirical studies of social cognition, particularly when adopting a dimensional neuropsychological approach.

The reliability and validity of the Japanese version of the Levels of Emotional Awareness Scale (LEAS-J)

Background

The Levels of Emotional Awareness Scale (LEAS) was developed to assess five levels of emotional awareness: bodily sensations, action tendencies, single emotions, blends of emotion, and combinations of blends. It is a paper and pencil performance questionnaire that presents 20 emotion-evoking scenes. We developed a Japanese version of the LEAS (LEAS-J), and its reliability and validity were examined.

Methods

The LEAS-J level was independently assessed by two researchers who scored each response according to the LEAS scoring manual. High inter-rater reliability and internal consistency were obtained for the LEAS-J. Measures were socioeconomic status, LEAS-J, Toronto Alexithymia Scale-20 (TAS-20), Interpersonal Reactivity Index (IRI), and NEO Five-Factor Inventory (NEO-FFI). TAS-20, IRI and NEO-FFI were the measures used to explore the construct validity of LEAS-J, as it was predicted that higher scores on the LEAS-J would be related to fewer alexithymic features, greater empathetic ability, and a greater sense of cooperation with others. Questionnaires were completed by 344 university students.

Results

The criterion-referenced validity was determined: a significant negative relationship was found with the externally-oriented thinking scores of TAS-20, and positive relationships were found with fantasy, perspective taking, and empathic concern on IRI and with extraversion, openness to experience, and agreeableness on NEO-FFI.

Conclusions

Consistent with our expectations, the findings provide evidence that the LEAS-J has good reliability and validity. In addition, women had significantly higher scores than men on LEAS-J, showing that the gender difference identified in the original LEAS was cross-culturally consistent.

Impairment in Cognitive and Affective Empathy in Patients with Brain Lesions: Anatomical and Cognitive Correlates

The present study was designed to examine the degree of impairment in cognitive and affective empathy among patients with focal brain lesions, and the contribution of specific cognitive abilities (such as cognitive flexibility and processing of emotional information), to empathy. The cognitive and affective empathic response of patients with localized prefrontal lesions (n=36) was compared to responses of patients with parietal lesions (n=15) and healthy control subjects (n=19). Results indicate that patients with prefrontal lesions (especially those with lesions involving the orbitoprefrontal and medial regions) were significantly impaired in both cognitive and affective empathy as compared to parietal patients and healthy controls. When the damage was restricted to the prefrontal cortex, either left- or right-hemisphere lesions resulted in impaired empathy. However, when the lesion involved the right hemisphere, patients with parietal lesions were also impaired. The pattern of relationships between cognitive performance and empathy suggested dissociation between the cognitive correlates of affective and cognitive empathy.

Emotion recognition and alexithymia in females with non-clinical disordered eating

OBJECTIVES

The aims were to determine if emotion recognition deficits observed in eating disorders generalize to non-clinical disordered eating and to establish if other psychopathological and personality factors contributed to, or accounted for, these deficits.

DESIGN

Females with high (n=23) and low (n=22) scores on the Eating Disorder Inventory (EDI) were assessed on their ability to recognise emotion from videotaped social interactions. Participants also completed a face memory task, a Stroop task, and self-report measures of alexithymia, depression and anxiety.

RESULTS

Relative to the low EDI group, high EDI participants exhibited a general deficit in recognition of emotion, which was related to their scores on the alexithymia measure and the bulimia subscale of the EDI. They also exhibited a specific deficit in the recognition of anger, which was related to their scores on the body dissatisfaction subscale of the EDI.

CONCLUSIONS

In line with clinical eating disorders, non-clinical disordered eating is associated with emotion recognition deficits. However, the nature of these deficits appears to be dependent upon the type of eating psychopathology and the degree of co-morbid alexithymia.

Alexithymia and temperament and character model of personality in alcohol-dependent Turkish men

AIMS

Alexithymia, a personality trait characterized as having problems identifying, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others, is only partly described within the context of personality. The aim of the present study was therefore to study the prevalence of alexithymia among male alcohol-dependent inpatients and investigate the relationship between alexithymia and the dimensions of Cloninger's psychobiological model of personality.

METHODS

The Turkish version of the Toronto Alexithymia Scale (TAS-20) and the Turkish version of the Temperament and Character Inventory (TCI) were administered to 111 male alcohol-dependent inpatients.

RESULTS

TAS-20 scores correlated positively with harm avoidance and self-transcendence and negatively with self-directedness and cooperativeness. Regression analysis identified high harm avoidance and self-transcendence and low self-directedness as independent predictors of alexithymia. Also harm avoidance and self-transcendence predicted alexithymia in a logistic regression model.

CONCLUSIONS

Alexithymia can be explained by specific dimensions within Cloninger's psychobiological model of personality in alcohol-dependent Turkish men.

Age and gender effect on alexithymia in large, Japanese community and clinical samples: a cross-validation study of the Toronto Alexithymia Scale (TAS-20)

Background

The construct validity of alexithymia and its assessment using the 20-item Toronto Alexithymia Scale (TAS-20) in Japan is unknown. Low reliability has been found for the third factor of the TAS-20 in some cultures, and the factor structure for psychosomatic disorder patients has not been adequately investigated. Although alexithymia most likely has certain developmental aspects, this has infrequently been investigated.

Methods

The newly-developed Japanese TAS-20 was administered to a normative sample (n = 2,718; 14–84 y.o.), along with the NEO Five-Factor Inventory (NEO-FFI) for cross validation. Psychosomatic patients (n = 1,924, 12–87 y.o.) were tested to evaluate the factor structure in a clinical sample. College students (n = 196) were used for a test-retest study. Internal reliability and consistency were assessed, and the factorial structure was evaluated using confirmatory and exploratory factor analyses for both the normative and the clinical samples. The correlations between the TAS-20 and the NEO-FFI factor scores were evaluated. Age-related and gender differences in the TAS-20 were explored using analysis of variance in the normative sample.

Results

The original three-factor model of the TAS-20 was confirmed to be valid for these Japanese samples, although a 4-factor solution that included negatively keyed items (NKI) as an additional factor was more effective. Significant correlations of the TAS-20 with the NEO-FFI were found, as has been previously reported. Factor analyses of the normative and patient samples showed similar patterns. The TAS-20 total, difficulty in identifying feelings (DIF), and difficulty in describing feelings (DDF) scores were high for teenagers, decreased with age, and from 30s did not change significantly. In contrast, externally oriented thinking (EOT) scores showed an almost linear positive correlation with age. DIF scores were higher for females, while EOT scores were higher for males, without any interaction between gender and age differences.

Conclusion

The original three-factor concept of the TAS-20 was generally supported for practical use. Age-related differences in TAS-20 scores indicate developmental aspects of alexithymia. Alexithymia is made up of two components with different developmental paths: DIF/DDF and EOT.

A neural network reflecting individual differences in cognitive processing of emotions during perceptual decision making

Even simple perceptual decisions are influenced by the emotional content of a stimulus. Recent neuroimaging studies provide evidence about the neural mechanisms of perceptual decision making on emotional stimuli. However, the effect of individual differences in cognitive processing of emotions on perceptual decision making remains poorly understood. Here, we investigated how changes in the fMRI signal during perceptual decision making on facial stimuli covaried with individual differences in the ability to identify and communicate one's emotional state. Although this personality trait covaried with changes in activity in the dorsal anterior cingulate cortex (dACC) during gender decisions on facial expressions, there was no correlation during emotion decisions. Further, we investigated whether individual differences in the ability to cognitively process emotions depend on differences in the functional integration of emotional and cognitive brain regions. We therefore compared task-dependent changes in effective connectivity of dACC in individuals with good and with poor ability to cognitively process emotions using a psychophysiological interaction analysis. We found greater coupling of dACC with prefrontal regions in individuals with good ability to identify and communicate their emotional state. Conversely, individuals with poor ability in this domain showed greater coupling of dACC with the amygdala. Our data indicate that individual differences in the ability to identify and communicate one's emotional state are reflected by altered effective connectivity of the dACC with prefrontal and limbic regions. Thus, we provide neurophysiological evidence for a theoretical model that posits that a discommunication between limbic areas and the neocortex impairs cognitive processing of emotions.

Dissociation of rated emotional valence and Stroop interference in observer-rated alexithymia

OBJECTIVE

The objective of this study was to investigate a theoretically predicted deficit in the capacity to process emotions in alexithymia. The performance of patients high and that of patients low in alexithymia was tested in a computerized emotional Stroop task.

METHODS

Reaction times of high and low self- and observer-rated alexithymia groups of 45 psychosomatic inpatients were compared. The task was to name the color of emotionally neutral, positive, negative, and bodily-symptom words as quickly as possible.

RESULTS

As expected, patients rated high versus those rated low in alexithymia by observers (but not by self-rating) showed a significantly lesser emotional bias for emotionally negative words and bodily-symptom words but did not differ in their explicit rating of the emotional valence of the words.

CONCLUSION

This dissociation between explicit and implicit reactions to the emotional valence of word stimuli suggests that patients high in alexithymia spontaneously allocate less processing resources to negative information.

Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia

Alexithymic individuals have difficulty in recognizing and describing emotions in themselves. We investigated the neuronal basis of mentalizing in alexithymia to determine whether there is a common neuronal substrate associated with knowing the mental states of the self and others. Individuals high in alexithymia (n = 16) and low in alexithymia (n = 14) were selected from a pool of 310 college students using a combination of the Toronto Alexithymia Scale (TAS-20) and the Structured Interview version of the Beth Israel Questionnaire (SIBIQ). We compared the two groups on psychological measures, including ratings of mentalizing and the Interpersonal Reactivity Index (IRI), and regional brain activation using functional magnetic resonance imaging (fMRI) during a mentalizing animation task. The results for both groups showed activation in regions associated with mentalizing: medial prefrontal cortices (MPFC), temporo-parietal junctions (TPJ), and the temporal pole (TP). Alexithymics had lower mentalizing and IRI perspective-taking scores and less activation in the right MPFC. Activity in the MPFC was positively correlated with the mentalizing score and the IRI perspective-taking score. Although there were no group differences in cerebral activity in the TPJ and the TP, the activity in the right TP had a positive correlation with mentalizing and IRI personal distress scores. These results suggest that alexithymic individuals have an impairment in mentalizing associated with an inability to take the perspective of others. Thus, the skills involved in comprehending the self and others are inter-related and play an important role in emotion regulation.

Alexithymia and facial emotion recognition in patients with eating disorders

OBJECTIVE

Patients with anorexia or bulimia nervosa are reported to show high levels of alexithymia and to have difficulties recognizing facially displayed emotions. The current study tested whether it could be that facial emotion recognition is a basic skill that is independent from alexithymia.

METHOD

We assessed emotion recognition skills and alexithymia in a group of 79 female inpatients with eating disorders and compared them with a group of 78 healthy female controls. Instruments used were the Toronto Alexithymia Scale, the Facially Expressed Emotion Labeling (FEEL) test, and the revised Symptom Check List (SCL-90-R).

RESULTS

There were no significant differences between patients and controls in their emotion recognition scores, but patients with eating disorders displayed significantly more alexithymia and psychopathology. Emotion recognition in patients was not related to alexithymia, psychopathology, or clinical symptoms.

CONCLUSION

We suggest that the reported alexithymia of patients with eating disorders is complex and independent from basic facial emotion recognition.

Alexithymia and interpersonal problems

BACKGROUND

Interpersonal relationships are substantially codetermined by nonverbal communication, e.g. facial affect. Given the deficits of nonverbal affect recognition and expression in alexithymia, we hypothesized that alexithymics had more interpersonal problems than nonalexithymic individuals, and that the various facets of the alexithymia construct are differentially related to interpersonal problems.

METHOD

149 subjects participating in an inpatient group psychotherapy program completed the Toronto Alexithymia Scale (TAS-20) and the Inventory of Interpersonal Problems (IIP-C) at the beginning of the treatment. The IIP-C was also administered to a subgroup at the end of the treatment.

RESULTS

Based on the alexithymia scores, patients were classified as low- (TAS-20 score </=51), moderate- or high-alexithymic (TAS-20 score >/=61). High-alexithymic patients had significantly more interpersonal problems than low alexithymics, particularly in the IIP-C scales indicating hostility and social avoidance. The TAS-20 subscale difficulty describing feelings showed the highest correlations with interpersonal problems (r between 0.23 and 0.55). At the end of the treatment, the high alexithymics still scored highest on the IIP-C, but the magnitude of change in interpersonal problems did not differ across the groups.

CONCLUSIONS

Our findings suggest that the interpersonal style of alexithymic individuals is characterized by a cold and socially avoidant behavior, corresponding to the predominantly insecure attachment pattern found in alexithymia. Additionally, our results indicate that group psychotherapy is as helpful for alexithymic as for nonalexithymic subjects with respect to interpersonal problems. Finally, we propose that alexithymia involves a reduced capacity to use social interactions for affect regulation.

Alexithymia, interhemispheric transfer, and right hemispheric specialization: a critical review

BACKGROUND

One neural model of alexithymia relates the condition to poor interhemispheric transfer, while another model associates it with a disturbance in right hemisphere activity.

METHODS

The available empirical evidence directly relating alexithymia to a deficit in interhemispheric transfer and/or in right hemisphere activity is critically reviewed.

RESULTS

The interhemispheric transfer studies have related alexithymia to a deficit in transfer, but the nature and directionality of the transfer deficit have yet to be determined. Many of the hemispheric specialization studies do not relate alexithymia to a right hemisphere dysfunction. Shortcomings of these studies are reviewed.

CONCLUSIONS

The hypothesis that alexithymia is related to a deficit in the right-to-left transfer of emotional information and to a right hemisphere impairment in emotion processing remains to be tested directly and definitively. Suggestions for future research are made.

The recognition of emotion in the faces and voice of anorexia nervosa

OBJECTIVE

The aim of this study was to examine emotional recognition (prosodic and visual) in anorexia nervosa.

METHODS

Thirty people with anorexia nervosa and a comparison group of 30 healthy women were tested with facial and vocal stimuli that expressed specific emotions and they were given a neutral task.

RESULTS

The group of women with anorexia nervosa was poor at emotional recognition. This was most marked for negative emotions in faces and for both positive and negative emotions in voices. This decreased ability to recognize negative affect in faces remained even after adjustment for confounding variables such as age, education, and depression.

DISCUSSION

People with anorexia nervosa have difficulty recognizing emotions from facial expression and vocal tone. This may contribute to poor interpersonal communication and a lack of empathy, both of which are associated with anorexia nervosa patients.

Cognitive and emotional characteristics of alexithymia: a review of neurobiological studies

OBJECTIVE

To review neurobiological studies of alexithymia in order to achieve a better understanding of the relationship between alexithymia and psychosomatic diseases and psychiatric illnesses.

METHODS

Neurobiological studies of alexithymia were reviewed with a special focus on how emotional and cognitive elements of alexithymia are reflected in earlier research.

RESULTS

Studies that have correlated alexithymia to corpus callosum dysfunctioning have mainly found impairments in cognitive characteristics of alexithymia, whereas from studies of right hemisphere and frontal lobe deficits, it may be concluded that both cognitive and emotional characteristics of alexithymia are impaired.

CONCLUSION

The fact that there is no general agreement on how to define alexithymia seems to have hampered theoretical and empirical progress on the neurobiology of alexithymia and related psychosomatic diseases and psychiatric illnesses. Alexithymia should no longer be approached as one distinct categorical phenomenon and follow-up studies should monitor subjects according to both the cognitive and emotional characteristics of alexithymia.

Specific brain processing of facial expressions in people with alexithymia: an H2 15O-PET study

Alexithymia is a personal trait characterized by a reduced ability to identify and describe one's own feelings and is known to contribute to a variety of physical and behavioural disorders. To elucidate the pathogenesis of stress-related disorders and the normal functions of emotion, it is important to investigate the neurobiology of alexithymia. Although several neurological models of alexithymia have been proposed, there is very little direct evidence for the neural correlates of alexithymia. Using PET, we studied brain activity in subjects with alexithymia when viewing a range of emotional face expressions. Twelve alexithymic and 12 non-alexithymic volunteers (all right-handed males) were selected from 247 applicants on the basis of the 20-item Toronto Alexithymia Scale (TAS-20). Regional cerebral blood flow (rCBF) was measured with H(2)(15)O-PET while the subjects looked at angry, sad and happy faces with varying emotional intensity, as well as neutral faces. Brain response in the subjects with alexithymia significantly differed from that in the subjects without alexithymia. The alexithymics exhibited lower rCBF in the inferior and middle frontal cortex, orbitofrontal cortex, inferior parietal cortex and occipital cortex in the right hemisphere than the non-alexithymics. Additionally, the alexithymics showed higher rCBF in the superior frontal cortex, inferior parietal cortex and cerebellum in the left hemisphere when compared with the non-alexithymics. A covariance analysis revealed that rCBF in the inferior and superior frontal cortex, orbitofrontal cortex and parietal cortex in the right hemisphere correlated negatively with individual TAS-20 scores when viewing angry and sad facial expressions, and that no rCBF correlated positively with TAS-20 scores. Moreover, the anterior cingulate cortex and insula were less activated in the alexithymics' response to angry faces than their response to neutral faces. These results suggest that people with alexithymia process facial expressions differently from people without alexithymia, and that this difference may account for the disorder of affect regulation and consequent peculiar behaviour in people with alexithymia.

Deficit in the discrimination of nonverbal emotions in children with obesity and their mothers

OBJECTIVE

Referring to the alexithymia construct and Bruch's clinical observations, this study investigated the ability to decode nonverbal signs of emotion in obese boys and girls, and their mothers.

METHOD

A group of 10 boys and 11 girls with obesity and their mothers, and a control group were tested. Both mothers and children were asked to recognize a set of 32 brief film sequences interpreted by four actors expressing four emotions (anger, sadness, fear, happiness) with two intensity levels. Each sequence was presented first without sound, second without video, and finally with video and sound.

RESULTS

As expected, boys and girls suffering from obesity and their mothers showed a reduced ability to decode visual and verbal signs of emotion compared to the control group.

DISCUSSION

This result may be interpreted in accordance with the alexithymia construct, and suggests the importance of developing therapeutic strategies to face alexithymic characteristics in obese children and their mothers.

Alexithymia, memory of emotion, emotional awareness, and perfectionism

The Toronto Alexithymia Scale (TAS-20; R. M. Bagby, J. D. A. Parker, & G. J. Taylor, 1994) is a self-assessment instrument designed to measure deficits in meta-emotional functioning (e.g., difficulties in identifying and describing emotions). Four studies were carried out to examine the association between the TAS-20 and (a) performance measures of meta-emotional functioning (memory of emotion and emotional awareness; Studies 1-2) and (b) measures of perfectionistic standards that may possibly be involved in the self-assessment of abilities-difficulties (Studies 3-4). The TAS-20 failed to correlate in the predicted direction with the performance measures but showed sizable correlations with measures of perfectionism. Moreover, perfectionism was found to predict TAS-20 scores independent of depression, anxiety, and somatic complaints. The results are discussed in terms of the TAS-20 measuring primarily certain aspects of meta-emotional self-efficacy.

ALEXITHYMIA AND PSYCHIATRIC SYMPTOMS IN A POPULATION OF NURSERY WORKERS: A STUDY USING THE 20-ITEM TORONTO ALEXITHYMIA SCALE

This study investigated alexithymia in a sample of professional nursery workers in Huddinge community, Sweden. In a previous study in general practice it was found that alexithymia, in a mixed population seeking medical advice, was associated with higher age, male gender, low education and the personality traits suspicion and distance as well as undetected depression. The choice of a professional female population allowed alexithymia to be studied in a refined way without the impact of some of the confounding elements of previous studies. The six variables investigated apart from alexithymia were feelings of well-being, symptoms of somatic and psychic anxiety, depressive symptoms, gastro-intestinal symptoms, and level of social dysfunction. The prevalence of alexithymia was 7.9%. Fifty percent of the items assessing somatic anxiety and 28.5% of those assessing depressive symptoms were related to high TAS- 20 scores in this healthy all-female population. The feeling factors of TAS-20, difficulty in identifying and expressing feelings, accounted in this study for the majority of relations to the other variables whilst the third factor, externally oriented thinking, remained independent and mainly nonrelated to the other measured variables. It had been hypothesised that a deficit in the cognitive processing and modulation of emotions may leave alexithymic individuals prone to states of heightened sympathetic arousal. Confirmation of these theories was found in this study where subjects expressing high levels of vegetative and visceral symptoms of anxiety also scored high for alexithymia and depressive symptoms.

The prisoners of despair: right hemisphere deficiency and suicide

This paper presents an integrative approach to understanding of the inner experience of suicidal persons in terms of hemispheric asymmetry. The right hemisphere is involved in formation of polysemantic context. Polysemantic context is determined by multiple interconnections among its elements, while each concrete element bears the stamp of the whole context. Left hemisphere functioning leads to formation of monosemantic context. It is suggested that due to functional insufficiency of the right hemisphere the suicidal person demonstrates a compensatory shift to left hemisphere functioning. This shift manifests itself in reversed asymmetry of neurotransmitters, tendency to dissociation, alienated and negative perception of the body, lower sensitivity to pain, disintegration of self-representation, cognitive constriction, overly general nature of personal memories, difficulties in affect regulation as well as such personality traits as low openness to experience and personal constriction. This hypothesis raises a number of suggestions for future research.