The term “alexithymia” was introduced in the lexicon of psychiatry in the early ‘70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the ‘80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.

The long-standing hypothesis that emotions rely on bodily states is back in the spotlight. This has led some researchers to suggest that alexithymia, a personality construct characterized by altered emotional awareness, reflects a general deficit in interoception. However, tests of this hypothesis have relied on heterogeneous assessment methods, leading to inconsistent results. To shed some light on this issue, we administered a battery of self-report questionnaires of interoception and alexithymia to three samples from Italy, the U.S., and Singapore (N = 814). Correlation and machine learning analyses showed that alexithymia was associated with deficits in both subjective interoceptive accuracy and attention. Alexithymics’ interoceptive deficits were primarily related to difficulty identifying and describing feelings. Interoception showed a weaker association with externally-oriented thinking as operationalized by the Toronto Alexithymia Scale (TAS-20) and no association with the affective dimension of alexithymia later introduced by the Bermond-Vorst Alexithymia Questionnaire (BVAQ). We discuss our results with reference to the theoretical and psychometric differences between these two measures of alexithymia and their shortcomings. Overall, our results support the view that interoceptive deficits are a core component of alexithymia, although the latter cannot be reduced to the former.

Socio-emotional features are crucial in the development and maintenance of anorexia nervosa (AN). The present study investigates the patterns of altered and preserved empathic abilities in AN. Empathy is an umbrella term that comprises the ability to recognise another's emotional state, take another's perspective, and fantasise (cognitive empathy), as well as the ability to experience vicarious emotions and signal them (affective empathy). These empathic abilities were measured in 43 AN patients and 33 healthy women through a multi-method approach comprising self-report measures, behavioural tasks and bodily correlates. Further, we assessed self-reported approachavoidance attitudes towards suffering others. Results showed that, within the domain of cognitive empathy, AN patients reported impairment in recognising emotional expressions of anger and fantasising. Concerning affective empathy, they manifested lower sharing of others' positive emotions, higher selfreported distress, and higher facial expressiveness during a video depicting a suffering person. Finally, AN patients reported lower motivation to approach suffering others. Our results draw a complex picture of preserved and altered empathic abilities in AN and capture which are the deficits mediated by the higher levels of anxiety and depression reported by the AN population and those that seem to persist independently from these co-morbid conditions.

Interoception is the perception of internal bodily signals. It is considered fundamental to developing emotional awareness. For this reason, interoceptive deficits are often associated with alexithymia, a condition characterized by difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and an externally-oriented style of thinking (EOT). Yet, the atypical interoception found in alexithymia might be of a similar type and/or more serious than those found in other partially overlapping constructs that entail emotional difficulties and behavioural patterns associated with specific emotional styles. Our study explores this issue by examining the relationship between the interoceptive deficits associated with alexithymia and the Big Five personality traits. A non-clinical sample (N = 504) completed the Toronto Alexithymia Scale, the Big Five Inventory and the Multidimensional Assessment of Interoceptive Awareness. Data were analysed using a network analytic approach that conceives psychological traits as networks of interacting symptoms. The estimated network highlighted that EOT is the alexithymia component least associated with interoception and most associated with lower Openness to Experience. Conversely, DIF and Neuroticism are, respectively, the dimensions of alexithymia and the Big Five most highly associated with interoception. We also compared interoceptive abilities in the four groups of participants whose scores were a) high for both alexithymia and neuroticism, b) high only for alexithymia c), high only for neuroticism, and d) low for both. High alexithymia was especially associated with the tendency to ignore sensations of pain or discomfort, while neuroticism was more indicative of the tendency to worry about these sensations. These results suggest that while high alexithymia and neuroticism share some interoceptive deficits, others are unique to alexithymia and contribute to overall lower interoceptive ability in this condition. Our findings suggest that interventions to enhance awareness of bodily sensations can be beneficial especially for profiles who present high neuroticism and alexithymia.

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