Levels of emotional awareness and autism: An fMRI study

Abstract

Autism is associated with an inability to identify and distinguish one's own feelings. We assessed this inability using alexithymia and empathy questionnaires, and used fMRI to investigate brain activity while introspecting on emotion. Individuals with high functioning autism/Asperger syndrome (HFA/AS) were compared with matched controls. Participants rated stimuli from the International Affective Picture System twice, once according to the degree of un/pleasantness that the pictures induced, and once according to their color balance. The groups differed significantly on both alexithymia and empathy questionnaires. Alexithymia and lack of empathy were correlated, indicating a link between understanding one's own and others' emotions. For both groups a strong relationship between questionnaire scores and brain activity was found in the anterior insula (AI), when participants were required to assess their feelings to unpleasant pictures. Regardless of selfreported degree of emotional awareness, individuals with HFA/AS differed from controls when required to introspect on their feelings by showing reduced activation in self-reflection/mentalizing regions. Thus, we conclude that difficulties in emotional awareness are related to hypoactivity in AI in both individuals with HFA/AS and controls, and that the particular difficulties in emotional awareness in individuals with HFA/AS are not related to their impairments in selfreflection/mentalizing.

The Role of Alexithymia in Reduced Eye-Fixation in Autism Spectrum Conditions

“…In a break with previous research, however, we claim that there is a second distinct influence within these data: an inability to attend to emotional facial features in an optimal manner that is associated with alexithymia. Such a distinction supports the independence of autism and alexithymia reported elsewhere (Bird et al 2010;Hill et al 2004;Silani et al 2008), although the reason for the increased prevalence of alexithymia in individuals with autism is still unknown.…”

“…However, more research is needed on the important question of whether alexithymia in individuals with ASC is due to the same cause, and is manifested similarly, as in individuals without ASC. Notwithstanding these limitations, these results and others (Bird et al 2010;Silani et al 2008) suggest that the presence of alexithymia defines a subgroup of individuals with an autism spectrum disorder who exhibit emotional impairments related both to the self and the other in addition to the characteristic social impairments.…”

“…However, although neither a necessary nor sufficient feature of autism, studies have revealed severe degrees of alexithymia in approximately 50% of individuals with autism, with the majority showing slight or severe impairments (Berthoz and Hill 2005;Hill et al 2004;Lombardo et al 2007;Silani et al 2008). It has recently been shown that emotional deficits thought to be characteristic of autism have, in fact, been caused by the high prevalence of alexithymia within this group (Bird et al 2010;Silani et al 2008). For example, Bird et al (2010) demonstrated that the empathy deficits previously reported in autism were likely related to alexithymia.…”

Irritability in boys with autism spectrum disorders: an investigation of physiological reactivity

“…Parent, but not self‐reports of irritability and anxiety were positively correlated, which may be due to introspection difficulties or alexithymia, a condition characterized by difficulties in identifying and describing emotions (e.g., Silani et al., 2008). Future studies should examine this possibility, since introspection difficulties and alexithymia were not measured in our study.…”

Investigating emotional impairments in adults with autism spectrum disorders and the broader autism phenotype

“…Whereas the ASD pattern of attention allocation was not related to the severity of their autistic symptoms (ADOS scores), alexithymia scores were found to be negatively correlated with the number of fixations to the eye region (relative to the mouth region) (see also Lombardo et al, 2007). At the cerebral level, this issue is well illustrated in a study which investigated the neural correlates of empathy for pain in adults with ASD and healthy controls: Bird et al (2010) not only showed that, in both groups, the higher the level of alexithymia the lower the empathy-related activity in the insula when the partner received pain, but also that there were no group differences in brain activity when alexithymia scores were entered as a covariate (see also Silani et al 2008). Thus, extending our knowledge of socio-affective abnormalities such as alexithymia, as well as anhedonia (i.e., the inability to experience pleasure) in ASD could not only explain previously inconsistent results in our understanding of ASD (Bird et al, 2011; see also Bernhardt and Singer 2012), but also help to tailor therapeutic interventions for this group.…”