Saturday, December 09, 2006

I Can't Feel Anything...

...and I can't describe it, either.

from Jackson, Meltzoff, & Decety (2005)

The Neurocritic has just noticed a new neuroimaging paper on empathy in individuals with alexithimia, which is an inability to describe one's own feelings. Coincidentally, Dr. Richard G. Petty has just posted on the topic, and I will quote from his description and send you over there for more information on the clinical syndrome.
The Harvard psychiatrist Peter Sifneos originally coined the term in 1972 to describe people who had extreme difficulty in emotional cognition. The word “alexithymia” literally means “no words for mood.” People with this problem lacked the ability to understanding, processing or describing their feelings verbally. As a result, most people who have the problem are largely unaware of their own feelings or what they signify. As a result they only rarely talk about their emotions or their emotional preferences, and they are largely unable to use their feelings or imagination to focus and fuel their drives and motivations.

People with alexithymia seem unable to fantasize and many report multiple somatic symptoms. However, alexithymia is also associated with a number of other complaints, such as hypertension, irritable bowel syndrome, substance use disorders, and some anxiety disorders. Their speech is often concrete, mundane and closely tied to external events. So they will describe physical symptoms rather than emotions, and don’t understand that their bodily sensations are signals of emotional distress.

Alexithymia lies on spectrum... For some people it is little more than an inability to get in touch with their emotions. But at the other end of the spectrum are a number of illnesses in which alexithymia may occur, including schizoid personality disorder, posttraumatic stress disorder, anorexia nervosa or Asperger's syndrome. It is also much more common in victims of trauma.
In the fMRI paper of Moriguchi and colleagues, the warm and fuzzy and trendy topic of empathy for other people's pain was under study, this time in individuals with alexithimia. The question here was whether a lack of knowledge of one's own emotional experiences would be associated with a lack of empathy for another's pain. Hence the ouch!-inducing photos in the figure above, which were contrasted with similar but non-owie pictures.
Moriguchi Y, Decety J, Ohnishi T, Maeda M, Mori T, Nemoto K, Matsuda H, Komaki G. (2006). Empathy and Judging Other's Pain: An fMRI Study of Alexithymia. Cereb Cortex. Dec 5 [Epub ahead of print].

Because awareness of emotional states in the self is a prerequisite to recognizing such states in others, alexithymia (ALEX), difficulty in identifying and expressing one's own emotional states, should involve impairment in empathy. Using functional magnetic resonance imaging (fMRI), we compared an ALEX group (n = 16) and a non-alexithymia (non-ALEX) group (n = 14) for their regional hemodynamic responses to the visual perception of pictures depicting human hands and feet in painful situations. Subjective pain ratings of the pictures and empathy-related psychological scores were also compared between the 2 groups. The ALEX group showed less cerebral activation in the left dorsolateral prefrontal cortex (DLPFC), the dorsal pons, the cerebellum, and the left caudal anterior cingulate cortex (ACC) within the pain matrix. The ALEX group showed greater activation in the right insula and inferior frontal gyrus. Furthermore, alexithymic participants scored lower on the pain ratings and on the scores related to mature empathy. In conclusion, the hypofunction in the DLPFC, brain stem, cerebellum, and ACC and the lower pain-rating and empathy-related scores in ALEX are related to cognitive impairments, particularly executive and regulatory aspects, of emotional processing and support the importance of self-awareness in empathy.
So what does all that mean? What is the significance of brain activation differences between the alexithymic and the control participants?

First, let's look at the empathy scores and pain ratings of the two groups. Before the experiment, Japanese versions of the emotional empathy scale (EES), the interpersonal reactivity index (IRI), and the stress coping inventory (SCI) were administered to all participants. During the experiment, each picture was shown for 2 s, followed by a 4-point pain-rating scale (no pain, a little pain, moderate pain, and worst possible pain). To no one's surprise,
Alexithymic participants showed lower pain ratings than non-alexithymics, indicating that they attributed lower levels of pain to the people depicted in the painful situation pictures. They scored lower on the IRI scales assessing "perspective taking" and "empathic concern," suggesting that they were less able to take the perspective of another and had less empathy. On the EES, alexithymics scored less on "warmth." Alexithymics scored lower on the SCI scales of "cognitive," "problem solving," and "positive reappraisal," indicating that they were less likely to use these approaches to manage emotional stimuli. On the other hand, alexithymics had significantly higher "personal distress" scores on the IRI.
What about the fMRI results?

from Moriguchi et al. (2006)

The top panel shows regions that were less active in alexithimics than controls, and include the left dorsolateral prefrontal cortex, the caudal anterior cingulate cortex, the dorsal pons (in the brainstem), and the cerebellum. The bottom panel shows regions that were more active in alexithimics, and include the anterior insula, the posterior insula, and the inferior frontal gyrus (all in the right hemisphere). Huh. The insula. More active for people lacking empathy. The insula has been shown previously to be associated with empathy for pain (e.g., Saarela et al., 2006; Singer et al., 2006). Hmm...what do the authors have to say about this?

Anterior insula:
Hemodynamic increases in the prelimbic area and decreases in the prefrontal cortex were reported in response to sadness, although these 2 areas demonstrated the inverse correlation as a person recovered from a depressive state (Mayberg et al. 1999). If an individual engages less cognitive processing for the painful pictures, the suppression of activation in the anterior insula would be decreased. The ALEX group, which has more impairment in cognitive aspects, may have had more activation in the anterior insula compared with the non-alexithymics as a result of decreased suppression.
Got that? Posterior insula:
...the dorsal posterior insula involves the primary (not metarepresentational) interoceptive representation of the inputs of physiological condition from all tissues of the body, including pain, temperature, itch, sensual touch, muscular and visceral sensations, vasomotor activity, hunger, thirst, and "air hunger." Thus, the posterior insula is related to lower level representation of the physical state. Considering that neural activity in this region positively correlated with the personal distress scale and negatively with cognition-related stress coping scales, the result of stronger activity in the posterior insula in the ALEX group indicates that individuals with ALEX might be stuck in lower level representation of one's own physical state.
The alexithimics attributed lower levels of pain to the people depicted in the owie pictures, yet they have more activity in an area that represents physical states. Fine, there is a disconnect between bodily sensations and emotion, but then they go on to say,
The posterior insula is associated with personal distress (self-oriented response), whereas the anterior insula is associated with empathy (other oriented emotional responses).
But, but... isn't empathy just what they're lacking? Have we learned anything useful from this study? I suppose the alexithimic individuals did show less activation than controls in other "empathy for pain" areas (namely the anterior cingulate). And there's more to read on impairments in self-awareness and theory of mind in these same individuals (Moriguchi, Ohnishi, et al., 2006).


Jackson PL, Meltzoff AN, Decety J. (2005). How do we perceive the pain of others? A window into the neural processes involved in empathy. Neuroimage 24: 771–779.

Moriguchi Y, Ohnishi T, Lane RD, Maeda M, Mori T, Nemoto K, Matsuda H, Komaki G. (2006). Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia. Neuroimage 32: 1472-82.

Saarela MV, Hlushchuk Y, Williams AC, Schurmann M, Kalso E, Hari R. (2006). The Compassionate Brain: Humans Detect Intensity of Pain from Another's Face. Cereb Cortex 2006 Feb 22; [Epub ahead of print].

Singer T, Seymour B, O'doherty JP, Stephan KE, Dolan RJ, Frith CD. (2006). Empathic neural responses are modulated by the perceived fairness of others. Nature 439:466-9.

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At December 24, 2006 1:00 AM, Blogger Mark said...

Just give them all a lobotomy.JOKE.
But seriously, who decided that alex thing is an illness needing to be treated?
pink floyds song "confortably numb" is a popular song, I wonder how abnormal the syndrom is.

At December 24, 2006 1:44 PM, Blogger The Neurocritic said...

Alexithimia isn't quite like a drug-induced numb state...

Is there anybody in there?
Just nod if you can hear me.
Is there anyone home?

Pink Floyd › Comfortably Numb

An inability to communicate emotions may not present a problem to the affected individual, but it would present quite a problem in communicating with friends and family.

Plus this from Dr. Petty:

Alexithymia can have some serious consequences. Apart from making relationships very difficult, it is more common in people who have near-fatal asthma attacks or have poor diabetic control. People with a history of alcohol abuse who have alexithymia are more likely to relapse. Alexithymia may predispose people to developing the insulin resistance syndrome.

At December 01, 2007 1:03 AM, Anonymous Tunnelblick said...

People with Asperger are also said to lack empathy. Recently there has been argued, that they show lower cognitive empathy, normal affective empathy, and more personal distress. (Rogers at al. 2006). How does it apply to alexithymia? There is also a debate about significant overlap with Asperger's.

At January 20, 2008 10:40 AM, Anonymous Bryan said...

I have only a rough understanding of neurology so It's very likely I'm missing something. But, I'm not sure if I follow the logic. How are they able to make comparisons between an Alex's empathetic response and the response that an Alex would have if they themselves were cutting their finger or stubbing their toe.
Has there been other research that correlates a normal pain scale to alexithymia. It seems that emotion and pain are connected, surely there is emotional pain which can manifest physically. So an alexithymic individual who has an inability to consciously process emotions might also be only registering the physical response of pain and not the emotional one. It might very well be that the alex's are reporting what their own response would be. So I guess what my argument comes down to is what kind of empathy are they talking about. Is it a relative or absolute empathy. My understanding of empathy is that it is one responding to another persons situation in the same way if the situation was happening to the one's self. But it seems here they are defining empathy as responding in the same manner as the affected individual not as if it were affecting the person in question.

I hope the pronouns didn't get too mixed up.

At June 04, 2011 12:56 PM, Anonymous Anonymous said...

There is a newer study like this that uses the Singer paradigm.

At July 28, 2011 8:45 PM, Anonymous Anonymous said...

i believe that I may have this particular problem. Relationships are really difficult not being able to tell if the person you are with needs a cuddle or a kiss, I can not feel much emotion in regards to love, I know I love that person, but I am unable to show it at all.
Is it my upbringing, or was i born this way? I have parents that were both incapable of showing any signs of love or verbal support and therfore I have been feeling alone most of my life, i hate feeling like this. Is there any treatment that you know of? I feel like my relationship is on the verge of collapse if something isnt done soon. I also have a daughter that is in the middle of all this, and I am feeling like I am playing at being a mother rather than feeling it. i know I love them both, but I need someone to help me feel.
i have tried making appointments with people, but it is so difficult getting in when you need to see someone. please any information on treatment would be great. much concern.

At October 16, 2011 11:18 PM, Anonymous Anonymous said...

i think i am suffering from this Alexi-something. ive been through traumas and i think this is it..could it be?
does that mean im a monster?
i konw i love people..i do. i dont how to show it.. but sometimes its very difficult to keep hold of someone..not feeling emotion does things to you.

At December 17, 2011 7:15 PM, Anonymous Anonymous said...

Ive done a lot of research...there is primary and secondary...primary meaning the way you were raised when it mattered, in the early years, and secondary meaning it derived from some sort of physical or emotional trauma...those that were not shown emotions in their early years, say from birth to 3ish, tended to continue to allow their brains to rewire and less and less emotion is required and/or felt throughout life...this would be me...if the neglect continues throughout childhood, u cannot change nor treat it...but if you suffered trauma, counseling may help because your brain was once wired to give and receive emotion...that is what i get from all of my reading...if someone has more, please enlighten 42 and would love to fall in love while i still can...

At December 09, 2017 9:06 PM, Anonymous Anonymous said...

I believe my ex-boyfriend had alexithymia. I just broke up with him, and his response was, "ok, what ever you want to do." I cried, and he wanted to discuss the weather. I immediately googled "lack of emotions" and read all about this condition, and he is pretty much a text book case.

In hindsight, I don't recall him ever describing anything with emotional emphasis, eg. "I am excited about my car." or "I am so angry about work." or "I am afraid to confront my sister." He never expressed "having fun" with is family/friends. All his talks were of factual information. He was a nice man, otherwise, over the year and a half we dated.

This is extremely hard to deal with as a partner because you tend to take the lack of action and words personally and assume you are not loved or wanted. Even when I expressed my concerns about his ability to convey his desire to keep our relationship going, he was unable to change. It, quite frankly, seemed like he had no desire to make me happy.

I will never know if he had this condition. I feel bad for him, really.


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