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Chapter 5 endnote 48, from How Emotions are Made: The Secret Life of the Brain by Lisa Feldman Barrett.
Some context is:

...people who have a naturally impoverished conceptual system for emotion, a condition called alexithymia, which by one estimate affects about 10 percent of the world’s population. [...] The word “alexithymia” comes from the roots “a” (lack), “lexis” (word), and “thymos” (mood).

People with alexithymia have difficulty perceiving emotion in others as well. [...]

People with alexithymia also have a restricted emotion vocabulary...

People who describe themselves as alexithymic report a lot of bodily (somatic) symptoms like stomach aches, have difficulty experiencing emotions, and have impoverished mental representations of emotions.[1][2][3] They have difficulties perceiving emotions in faces, words, pictures depicting situations in which emotions occur.[4][5][6][7] They also have a limited ability to describe other people’s emotional experiences.[8]

Alexithymia has been estimated to occur in about 10% of the population[9] and has been identified in both Western and Eastern cultures.[10][11][12][3]

People who describe themselves as alexithymic have a restricted emotion vocabulary.[4][13][14][15] Some studies have found a link between verbal IQ and alexithymia,[16] but this does not completely account for the difficulties with emotion vocabulary.

According to a meta-analysis of 15 brain-imaging studies, people who suffer from alexithymia have less activity in key nodes in their interoceptive network (specifically, the default mode network) —crucial for predicting with emotion concepts—when they view pictures of various objects and scenes, including facial configs for emotion.[17][18] Other evidence indicates that their interoceptive network is tuned toward negativity, for example, relatively greater activity in the dorsal part of the anterior cingulate cortex (ACC), also known as the anterior midcingulate cortex, which is usually associated with reports of negativity, among other phenomena. (Dorsal ACC is also associated with the processing of pain, i.e., nociception,[19] and is thought to be associated with the amplification of somatic symptoms in alexithymia.[20][21] Indeed, people who are described as alexithymic experience complain of physical symptoms and negative affect[4] but fail to experience them as emotional.[3][22]) The people with alexithymia in these studies showed normal functioning of their interoceptive network when presented with images that are likely to evoke interoceptive changes that will be experienced as unpleasant, but relatively less activation in key interoceptive regions (such as primary interoceptive cortex and the anterior insula) when presented with images that will evoke interoceptive changes that will be experienced as pleasant.

Individuals with alexithymia also have weaker perceptual representations of emotional faces,[23] suggesting less effective conceptual predictions during categorizations. Individuals who describe themselves as alexithymic also have reduced prediction error signals Here, “reduced” means relative to people with normally functioning conceptual systems when viewing anger and disgust facial configs. For example, one study recorded event related potentials (ERPs) that are associated with prediction errors (ERP prediction error signals, N2b and P3a) while alexithymic and normal individuals were categorizing posed scowls and nose wrinkled faces (i.e., stereotyped expressions for angry and disgust). Non-alexithymic individuals produced normal ERP prediction errors associated with normal categorization of the faces during the experiment, but alexithymic individuals did not.[24]

Notes on the Notes

  1. Nemiah, John C., H. J. Freyberger, and P. E. Sifneos.  1976. "Alexithymia: a view of the psychosomatic process." Modern Trends in Psychosomatic Medicine 3: 430-439.
  2. Sifneos, Peter E. 1975. "Problems of psychotherapy of patients with alexithymic characteristics and physical disease." Psychotherapy and Psychosomatics 26 (2): 65-70.
  3. 3.0 3.1 3.2 Lane, Richard D., Geoffrey L. Ahern, Gary E. Schwartz, and Alfred W. Kaszniak. 1997. "Is alexithymia the emotional equivalent of blindsight?." Biological Psychiatry 42 (9): 834-844.
  4. 4.0 4.1 4.2 For a review, see Lindquist, Kristen, and Lisa Feldman Barrett. 2008. "Emotional complexity." In Handbook of Emotions, 3rd edition, edited by Michael Lewis, Jeannette M. Haviland-Jones, and Lisa Feldman Barrett, 513-530. New York: Guilford Press.
  5. Lane, Richard D., Sechrest Lee, Robert Reidel, Victoria Weldon, Alfred Kaszniak, and Gary E. Schwartz. 1996. "Impaired verbal and nonverbal emotion recognition in alexithymia." Psychosomatic Medicine 58 (3): 203-210.
  6. Lane, Richard D., Lee Sechrest, Robert Riedel, Daniel E. Shapiro, and Alfred W. Kaszniak. 2000. "Pervasive emotion recognition deficit common to alexithymia and the repressive coping style." Psychosomatic Medicine 62 (4): 492-501.
  7. Prkachin, Glenda C., Catherine Casey, and Kenneth M. Prkachin. 2009. "Alexithymia and perception of facial expressions of emotion." Personality and Individual Differences 46 (4): 412-417.
  8. Bydlowski, Sarah, Maurice Corcos, Philippe Jeammet, Sabrina Paterniti, Sylvie Berthoz, Catherine Laurier, Jean Chambry, and Silla M. Consoli. 2005. "Emotion‐processing deficits in eating disorders." International Journal of Eating Disorders 37 (4): 321-329.
  9. Salminen, Jouko K., Simo Saarijärvi, Erkki Äärelä, Tuula Toikka, and Jussi Kauhanen. 1999. "Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland." Journal of Psychosomatic Research 46 (1): 75-82.
  10. Bermond, Bob, Kymbra Clayton, Alla Liberova, Olivier Luminet, Tomasz Maruszewski, Pio E. Ricci Bitti, Bernard Rimé, Harrie H. Vorst, Hugh Wagner, and Jelte Wicherts. 2007. "A cognitive and an affective dimension of alexithymia in six languages and seven populations." Cognition and Emotion 21 (5): 1125-1136.
  11. Moriguchi, Yoshiya, Takashi Ohnishi, Richard D. Lane, Motonari Maeda, Takeyuki Mori, Kiyotaka Nemoto, Hiroshi Matsuda, and Gen Komaki. 2006. "Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia." Neuroimage 32 (3): 1472-1482.
  12. Moriguchi, Yoshiya, Motonari Maeda, Tetsuya Igarashi, Toshio Ishikawa, Masayasu Shoji, Chiharu Kubo, and Gen Komaki. 2007. "Age and gender effect on alexithymia in large, Japanese community and clinical samples: a cross-validation study of the Toronto Alexithymia Scale (TAS-20)." BioPsychoSocial Medicine 1 (1): 1-6.
  13. Lecours, S., G. Robert, and F. Desruisseaux. 2009. "Alexithymia and verbal elaboration of affect in adults suffering from a respiratory disorder." European Review of Applied Psychology-Revue Europeenne De Psychologie Appliquee 59 (3): 187-195.
  14. Roedema, Thomas M., and Robert F. Simons. 1999. "Emotion‐processing deficit in alexithymia." Psychophysiology 36 (3): 379-387.
  15. Meganck, Reitske, Stijn Vanheule, Ruth Inslegers, and Mattias Desmet. 2009. "Alexithymia and interpersonal problems: A study of natural language use." Personality and Individual Differences 47 (8): 990-995.
  16. For a review, see Grynberg, Delphine, Betty Chang, Olivier Corneille, Pierre Maurage, Nicolas Vermeulen, Sylvie Berthoz, and Olivier Luminet. 2012. "Alexithymia and the processing of emotional facial expressions (EFEs): systematic review, unanswered questions and further perspectives." PloS One 7 (8): e42429.
  17. Van der Velde, Jorien, Michelle N. Servaas, Katharina S. Goerlich, Richard Bruggeman, Paul Horton, Sergi G. Costafreda, and André Aleman. 2013. "Neural correlates of alexithymia: A meta-analysis of emotion processing studies." Neuroscience & Biobehavioral Reviews 37 (8): 1774-1785.
  18. Reker, Maraike, Patricia Ohrmann, Astrid V. Rauch, Harald Kugel, Jochen Bauer, Udo Dannlowski, Volker Arolt, Walter Heindel, and Thomas Suslow. 2010. "Individual differences in alexithymia and brain response to masked emotion faces." Cortex 46 (5): 658-667.
  19. Vogt, Brent A. 2005. "Pain and emotion interactions in subregions of the cingulate gyrus." Nature Reviews Neuroscience 6 (7): 533-544.
  20. Kano, Michiko, and Shin Fukudo. 2013. "The alexithymic brain: the neural pathways linking alexithymia to physical disorders." BioPsychoSocial medicine 7: 1.
  21. Moriguchi, Yoshiya, and Gen Komaki. 2013. "Neuroimaging studies of alexithymia: physical, affective, and social perspectives." BioPsychoSocial Medicine 7: 8.
  22. Lane, Richard D., and David AS Garfield. 2005. "Becoming aware of feelings: Integration of cognitive-developmental, neuroscientific, and psychoanalytic perspectives." Neuropsychoanalysis 7 (1): 5-30.
  23. Reker, Maraike, Patricia Ohrmann, Astrid V. Rauch, Harald Kugel, Jochen Bauer, Udo Dannlowski, Volker Arolt, Walter Heindel, and Thomas Suslow. 2010. "Individual differences in alexithymia and brain response to masked emotion faces." Cortex 46 (5): 658-667.
  24. Vermeulen, Nicolas, Olivier Luminet, Mariana Cordovil De Sousa, and Salvatore Campanella. 2008. "Categorical perception of anger is disrupted in alexithymia: Evidence from a visual ERP study." Cognition and Emotion 22 (6): 1052-1067.