Affective agnosia: a core affective processing deficit in the alexithymia spectrum
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Affective agnosia: a core affective processing deficit in the alexithymia spectrum Richard D. Lane1,2,3*, Mark Solms4,5, Karen L. Weihs1,6, Alex Hishaw7,1 and Ryan Smith6
Abstract Affective agnosia, an impairment in knowing how one feels emotionally, has been described as an extreme deficit in the experience and expression of emotion that may confer heightened risk for adverse medical outcomes. Alexithymia, by contrast, has been proposed as an over-arching construct that includes a spectrum of deficits of varying severity, including affective agnosia at the more severe end. This perspective has been challenged by Taylor and colleagues, who argue that the concept of affective agnosia is unnecessary. We compare these two perspectives by highlighting areas of agreement, reasons for asserting the importance of the affective agnosia concept, errors in Taylor and colleagues’ critique, and measurement issues. The need for performance-based measures of the ability to mentally represent emotional states in addition to metacognitive measures is emphasized. We then draw on a previously proposed three-process model of emotional awareness that distinguishes affective response generation, conceptualization and cognitive control processes which interact to produce a variety of emotional awareness and alexithymia phenotypes - including affective agnosia. The tools for measuring these three processes, their neural substrates, the mechanisms of brain-body interactions that confer heightened risk for adverse medical outcomes, and the differential treatment implications for different kinds of deficits are described. By conceptualizing alexithymia as a spectrum of deficits, the opportunity to match specific deficit mechanisms with personalized treatment for patients will be enhanced. Keywords: Alexithymia, Emotional awareness, Affective agnosia, Neuroscience, Medical outcome
Introduction The concept of alexithymia has been an important advance in our understanding of how dysregulated emotions may adversely affect physical health. The term “alexithymia” was coined by Sifneos [1] with the intention of describing a deficit in the ability to identify and describe emotions that included a limitation in the ability to put emotions into words. Although there were forerunners of this concept in Ruesch’s [2] “infantile personality,” Alexander’s [3] * Correspondence: [email protected] 1 Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85724-5002, USA 2 Department of Psychology, University of Arizona, 1503 E. University Blvd, Tucson, AZ 85721, USA Full list of author information is available at the end of the article
“visceral neurosis,” and Marty and d’Muzan’s [4] “pensée opératoire,” all of which involved limitations or impairments in the ability to symbolically represent emotions, the concept of alexithymia has come to dominate the field. Much credit for this goes not only to Sifneos and Nemiah for their clinical descriptions and early research but also to Graeme Taylor and his coll
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