What’s in the name ‘alexithymia’? A commentary on “Affective agnosia: Expansion of the alexithymia construct and a new opportunity to integrate and extend Freud’s legacy.”

• Published in: Neuroscience and biobehavioral reviews Vol. 68; pp. 1006 - 1020
• Main Authors: Taylor, Graeme J., Bagby, R. Michael, Parker, James D.A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.09.2016
• Subjects: Affective Symptoms; Agnosia; Alexithymia; Anomia; Awareness; Emotional awareness; Emotions; Humans; Mentalization; Primal repression; Psychotherapy; Toronto Alexithymia Scale; Trauma; Primal repression; Emotional awareness; Alexithymia; Mentalization; Psychotherapy; Trauma; Anomia; Agnosia; Toronto Alexithymia Scale
• ISSN: 0149-7634; 1873-7528
• DOI: 10.1016/j.neubiorev.2016.05.025

•Alexithymia is more than a lack of words for feelings.•The emotional awareness construct does not include pensée opératoire.•The TAS-20 is a valid measure of the alexithymia construct.•Affective agnosia is analogous to Freud’s concept of primal repression.•Psychotherapy of alexithymic patients may activate intense trauma-related emotions. The recent proposal of a new type of agnosia termed ‘affective agnosia’ extends Freud’s legacy and captures the concept of not knowing one’s own emotions. This concept links well with the theory of levels of emotional awareness and maps onto a hierarchical model of neural substrates of emotional experience, but does not encompass the pensée opératoire component of the alexithymia construct. Moreover, identifying agnosia and anomia subtypes, which connotes a categorical conceptualization of alexithymia, is inconsistent with the dimensional nature of the construct. We describe a more widely accepted definition of alexithymia, and argue that although aptly descriptive, the concept of affective agnosia does not advance the theory, measurement, and treatment of alexithymia. A review of alexithymia literature indicates that impairment in the mental representation of emotions has been a central aspect of alexithymia theory since the concept was introduced, and guided the development of the Toronto Alexithymia Scale and other measures of the construct. Moreover, techniques to enhance mentalization of emotions have been used by psychotherapists for several decades.