Alexithymia (“no words for emotions”) and its Link with Social and Cognitive Neuroscience: Evidence from Basic and Clinical Research

Chairs: Beate M. Herbert

Psychosomatic Medicine and Psychotherapy, Research Department, University Clinic Tuebingen, Eberhard-Karls-University Tuebingen, Germany

Abstract:

The term "alexithymia", meaning "no words for emotion", was originally coined by Peter E. Sifnéos and John C. Nemiah in 1972, who were working with psychosomatic patients, showing extreme difficulties in expressing and talking about feelings. Since then, alexithymia has been found to be associated with a broad range of somatic and psychiatric disorders and the concept has been refined theoretically. Alexithymia is now accepted as an affective deficit and a normally distributed multifaceted personality variable characterized by impairments in the ability to experience and symbolize own and other’s emotions, and to regulate one’s emotions. The alexithymia construct has become of important relevance for affective, social and cognitive neuroscientific research as it is tightly linked to the understanding of mechanisms of cognitive and affective processing, emotional awareness and social interaction. This symposium presents new findings and models on affective and cognitive mechanisms of alexithymia in healthy and clinical samples: Talk 1 highlights a theoretical framework with empirical support for considering alexithymia as a model to investigate links between brain, cognition and behavior from a social neuroscientific perspective; Talk 2 presents data showing that patients with somatoform disorders have specific alexithymic deficits and impaired social cognition capacity; Talk 3 provides new insights on the relevance of alexithymia for impaired social cognition in borderline personality disorder; Talk 4 highlights the importance of specific neuropsychological deficits in alexithymia for understanding emotional dysfunctions in schizophrenia; and Talk 5 demonstrates evidence for alexithymic deficits to reflect altered top down behavioral control as a basic mechanism. 

Talk 1:

Alexithymia from the Social Neuroscience Perspective

Sylvie Berthoz
Inserm U669 and Institut Mutualiste Montsouris, Paris Sud and Paris Descartes Universities, France

Though Sifnéos and Nemiah considered alexithymics have difficulties interacting and dealing with their social environment, very few studies attempted to objectively investigate whether alexithymia is associated with poor socio-affective skills. We explored this issue in a disorder associated with abnormal social adaptation. Thirty-eight adults with autism spectrum disorder (ASD), 87 parents of ASD and 47 typical adults completed self-reports assessing ASD traits, alexithymia, physical and social anhedonia. Autistic traits and alexithymia scores were strongly correlated. The ASD displayed higher scores than both the parents and typical adults. Further, the parents differed from the typical adults on measures of alexithymia and anhedonia. Hence, alexithymia is not only a key feature of ASD, but may also be observed in the broader autism phenotype. At the cerebral level, we explored how alexithymia modulates the responses to a social threat, with a specific emphasis on the impact of personal involvement. We compared the behavioral and cerebral responses of normal individuals with maximally divergent alexithymia scores (10 vs. 11) to self- or other-oriented angry and neutral body expressions. Alexithymics showed greater activity in the human mirror neuron system and experienced high levels of threat with both self- and other-oriented angry expressions. Alexithymics displayed activation within vmPFC for self-oriented anger and experienced greater levels of threat with self- as compared to other-oriented angry expressions. This further demonstrates alexithymia is a relevant model to investigate the links between brain, social cognition and behavior, notably to delineate potential pathways between dysfunctional cerebral circuits, poor emotional insight, and intersubjectivity.

Talk 2:

Relations between Alexithymia and Mentalizing


Subic-Wrana C, Beutel M.E, Wiltink J.
Universitätsmedizin Mainz, Klinik für Psychosomatische Medizin und Psychotherapie, Germany

Disturbances in the ability to attribute mental states to self and others in order to understand and predict behavior (ToM = theory of mind) is discussed as an underlying mechanism in the development of severe psychiatric illnesses, e. g. autism spectrum disorders and schizophrenia. To date, there is little empirical evidence for answering the question if patients who suffer from psychosomatic and psychic conditions that require psychotherapeutic intreatment have also an impairment in building up a theory of mind and if this impairment is connected to their decreased ability to be aware of their emotions consciously. The emotional awareness construct (Lane & Schwartz, 1989) refers to alexithymia, as defined by Sifnéos, but extends this definition by relating alexithymia to a general model of cognitive-emotional development and highlighting that in alexithymia the conscious awareness of affect arousal as emotions that can be verbalized, is impaired. Empirical data will be presented that demonstrate that inpatients with somatoform disorders, as compared to healthy controls, have deficits in emotional awareness and ToM-capacity and that these deficits are interrelated (Subic-Wrana C, Beutel ME, Knebel A, Lane RD. Theory of Mind and Emotional Awareness Deficits in Patients with Somatoform Disorders. Psychosom Med, 72 (4): 404-411, 2010). Additionally, new and unpublished mentalizing data on 200 patients before and at the end of inpatient treatment will be presented. After reviewing other empirical evidence for an interrelation between alexithymia and deficits in ToM-functioning, this interrelation will be discussed from a developmental perspective.

Talk 3:

On the Relationship between Alexithymia and Social Cognition in Borderline Personality Disorder

Simone Lang, Carina Frick, Sven Barnow
Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Germany

Patients with borderline personality disorder (BPD) are characterized by emotional dysregulation, especially in social settings. It has been shown that BPD patients show a particular high degree of alexithymia among psychiatric disorders. Previous studies have shown reduced capability in cognitive empathy and higher levels of personal distress in healthy alexithymic individuals. Research on social cognition in BPD have revealed divergent findings with improved emotion recognition in BPD patients or impaired emotion recognition. The present study aimed at investigating the relationship between alexithymia and social cognition in 23 BPD patients and 34 healthy subjects. Social cognition was examined with an empathy self-report (Interpersonal Reactivity Index, IRI) and an objective approach. For the latter we performed the Reading the Mind in the Eyes task (RMET), which tests theory of mind. The results showed that BPD patients scored significantly higher in the IRI subscale ‚Personal distress’ than healthy subjects. Moreover, BPD patients were significantly better and faster in the RMET. Correlation analyses revealed an inverse relationship between the performance on the RMET and alexithymia in the BPD group. In addition, a negative correlation was found between alexithymia and the IRI subscales ‚empathic concern’ (affective empathy) and ‚perspective taking’ (cognitive empathy) and a positive correlation between alexithymia and personal distress. The findings highlight the importance of considering alexithymia in BPD when testing social cognition.

Talk 4:

Can’t Say What I Feel: Cognitive and Neural Basis of Alexithymia and Relevance for Schizophrenia

André Aléman
University of Groningen, the Netherlands

Having difficulties in identifying and verbalizing one‘s emotions are characteristics of the personality trait of alexithymia. Schizophrenia is associated with higher levels of alexithymia. Here I present results from two recent studies in which we used event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI) to investigate emotional processing in people with and without alexithymia. The results from functional neuroimaging suggest compromised activation of brain systems involved in emotional awareness. This was corroborated by an analysis of connectivity in the resting state. Twenty alexithymic and eighteen non-alexithymic healthy volunteers underwent a resting state fMRI scan. Independent component analysis was used to identify the default mode network (DMN). The alexithymic subjects showed lower connectivity within frontal areas of the DMN (medial frontal areas and medial temporal gyrus). In contrast, connectivity of this group was higher for the sensorimotor cortex, occipital areas and right lateral frontal cortex. These results suggest a diminished connectivity within the frontal DMN of alexithymic subjects, in brain areas that may also be involved in emotional awareness and self-referential processing. In contrast, alexithymia was associated with stronger functional connections of the DMN with brain areas involved in sensory input and control of emotion. The ERP study revealed reduced perceptual sensitivity to affective cues in emotional speech. With regard to schizophrenia, we suggest that, whereas subjective affect might be intact in schizophrenia, the more cognitive aspect (identifying, analyzing and verbalizing of emotion) is impaired. Evidence in favor of this assertion will be presented and discussed.

Talk 5:

Alexithymia is associated with Altered Top Down Control of Behavior

Beate M. Herbert
University of Tuebingen, Germany

Alexithymia has gained increased attention as a possible vulnerability factor for a variety of medical and psychopathological disorders. Collectively, alexithymic facets have been shown to reflect deficits in the capacity to process and consciously experience emotions as well as to regulate emotional states through cognitive processes. Evidence supporting the view that alexithymia represents deficits in the top down control of cognitive-affective functions also comes from neuroimaging studies, revealing that during emotional contexts alexithymia is associated with altered activity in a brain network subserving executive and behavioral control. Response inhibition is the ability to suppress actions that are no longer behaviorally relevant and represents a key function of the human executive control system. To investigate the association between top down control of behavior regulation that reflects inhibitory control, i.e. response inhibition, and alexithymic features in healthy persons, the Stop Signal Task was used in positive, negative and neutral contexts. This task allows the indirect estimation of the capacity of behavior inhibition by calculating Stop Signal Response Time (SSRT). The results suggest that in a neutral context alexithymia is associated with a greater capacity of response inhibition. However, this capacity becomes more compromised when an emotional context is present. These findings underscore the relevance of altered inhibitory executive functions in alexithymia as a basic mechanism also for understanding its importance in different clinical populations.