Rebecca Brewer

Alexithymia, Not Autism, Predicts Poor Recognition of Emotional Facial Expressions

Despite considerable research into whether face perception is impaired in autistic individuals, clear answers have proved elusive. In the present study, we sought to determine whether co-occurring alexithymia (characterized by difficulties interpreting emotional states) may be responsible for face-perception deficits previously attributed to autism. Two experiments were conducted using psychophysical procedures to determine the relative contributions of alexithymia and autism to identity and expression recognition. Experiment 1 showed that alexithymia correlates strongly with the precision of expression attributions, whereas autism severity was unrelated to expression-recognition ability. Experiment 2 confirmed that alexithymia is not associated with impaired ability to detect expression variation; instead, results suggested that alexithymia is associated with difficulties interpreting intact sensory descriptions. Neither alexithymia nor autism was associated with biased or imprecise identity attributions. These findings accord with the hypothesis that the emotional symptoms of autism are in fact due to co-occurring alexithymia and that existing diagnostic criteria may need to be revised.

‘Theory of Mind’ is not Theory of Emotion: A cautionary note on the Reading the Mind in the Eyes Test

The ability to represent mental states (theory of mind [ToM]) is crucial in understanding individual differences in social ability and social impairments evident in conditions such as autism spectrum disorder (ASD). The Reading the Mind in the Eyes Test (RMET) is a popular measure of ToM ability, validated in part by the poor performance of those with ASD. However, the RMET requires recognition of facial emotion, which is impaired in those with alexithymia, which frequently co-occurs with ASD. Thus, it is unclear whether the RMET indexes emotion recognition, associated with alexithymia, or ToM, associated with ASD. We therefore investigated the independent contributions of ASD and alexithymia to performance on the RMET. ASD and alexithymia-matched control participants did not differ on RMET performance, whereas ASD participants demonstrated impaired performance on an alternative test of ToM, the Movie for Assessment of Social Cognition (MASC). Furthermore, alexithymia, but not ASD diagnosis, significantly influenced RMET performance but did not affect MASC performance. These results suggest that the RMET measures emotion recognition rather than ToM ability and support the alexithymia hypothesis of emotion-related deficits in ASD.

Alexithymia: a general deficit of interoception.

Alexithymia is a sub-clinical construct, traditionally characterized by difficulties identifying and describing ones own emotions. Despite the clear need for interoception (interpreting physical signals from the body) when identifying ones own emotions, little research has focused on the selectivity of this impairment. While it was originally assumed that the interoceptive deficit in alexithymia is specific to emotion, recent evidence suggests that alexithymia may also be associated with difficulties perceiving some non-affective interoceptive signals, such as ones heart rate. It is therefore possible that the impairment experienced by those with alexithymia is common to all aspects of interoception, such as interpreting signals of hunger, arousal, proprioception, tiredness and temperature. In order to determine whether alexithymia is associated with selectively impaired affective interoception, or general interoceptive impairment, we investigated the association between alexithymia and self-reported non-affective interoceptive ability, and the extent to which individuals perceive similarity between affective and non-affective states (both measured using questionnaires developed for the purpose of the current study), in both typical individuals (n = 105 (89 female), mean age = 27.5 years) and individuals reporting a diagnosis of a psychiatric condition (n = 103 (83 female), mean age = 31.3 years). Findings indicated that alexithymia was associated with poor non-affective interoception and increased perceived similarity between affective and non-affective states, in both the typical and clinical populations. We therefore suggest that rather than being specifically associated with affective impairment, alexithymia is better characterized by a general failure of interoception.

Can Neurotypical Individuals Read Autistic Facial Expressions? Atypical Production of Emotional Facial Expressions in Autism Spectrum Disorders

The difficulties encountered by individuals with autism spectrum disorder (ASD) when interacting with neurotypical (NT, i.e. nonautistic) individuals are usually attributed to failure to recognize the emotions and mental states of their NT interaction partner. It is also possible, however, that at least some of the difficulty is due to a failure of NT individuals to read the mental and emotional states of ASD interaction partners. Previous research has frequently observed deficits of typical facial emotion recognition in individuals with ASD, suggesting atypical representations of emotional expressions. Relatively little research, however, has investigated the ability of individuals with ASD to produce recognizable emotional expressions, and thus, whether NT individuals can recognize autistic emotional expressions. The few studies which have investigated this have used only NT observers, making it impossible to determine whether atypical representations are shared among individuals with ASD, or idiosyncratic. This study investigated NT and ASD participants’ ability to recognize emotional expressions produced by NT and ASD posers. Three posing conditions were included, to determine whether potential group differences are due to atypical cognitive representations of emotion, impaired understanding of the communicative value of expressions, or poor proprioceptive feedback. Results indicated that ASD expressions were recognized less well than NT expressions, and that this is likely due to a genuine deficit in the representation of typical emotional expressions in this population. Further, ASD expressions were equally poorly recognized by NT individuals and those with ASD, implicating idiosyncratic, rather than common, atypical representations of emotional expressions in ASD. Autism Res 2016, 9: 262–271.

Interoception and psychopathology: A developmental neuroscience perspective

Highlights • Reviews literature on the development of interoception.• Atypical interoception may cause onset of psychopathology in adolescence.• Atypical interoception may also cause risky behaviour in adolescence.• Interoceptive changes may underlie socio-emotional changes in late adulthood.

Intact facial adaptation in autistic adults

Adaptation paradigms seek to bias subsequently viewed stimuli through prolonged exposure to an adapting stimulus, thereby giving rise to an aftereffect. Recent experiments have found that children with autism spectrum disorders (ASD) show reduced facial aftereffects, prompting some researchers to speculate that all individuals with ASD exhibit deficient facial adaptation. However, caution is required when generalizing findings from samples of children with ASD to the wider ASD population. The reduced facial aftereffects seen in child samples may instead reflect delayed or atypical developmental trajectories, whereby individuals with ASD are slower to develop adaptive mechanisms. In the present study, two experiments were conducted to determine whether high‐functioning adults with ASD also show diminished aftereffects for facial identity and expression. In Experiment 1, using a procedure that minimized the contribution of low‐level retinotopic adaptation, we observed substantial aftereffects comparable to those seen in matched controls, for both facial identity and expression. A similar pattern of results was seen in Experiment 2 using a revised procedure that increased the contribution of retinotopic adaptation to the facial aftereffects observed. That adults with autism can show robust facial aftereffects raises the possibility that group differences are seen only at particular points during development, and may not be a lifelong feature of the condition. Autism Res 2014, 7: 481–490.

The Impact of Autism Spectrum Disorder and Alexithymia on Judgments of Moral Acceptability

One’s own emotional response toward a hypothetical action can influence judgments of its moral acceptability. Some individuals with autism spectrum disorder (ASD) exhibit atypical emotional processing, and moral judgments. Research suggests, however, that emotional deficits in ASD are due to co-occurring alexithymia, meaning atypical moral judgments in ASD may be due to alexithymia also. Individuals with and without ASD (matched for alexithymia) judged the moral acceptability of emotion-evoking statements and identified the emotion evoked. Moral acceptability judgments were predicted by alexithymia. Crucially, however, this relationship held only for individuals without ASD. While ASD diagnostic status did not directly predict either judgment, those with ASD did not base their moral acceptability judgments on emotional information. Findings are consistent with evidence demonstrating that decision-making is less subject to emotional biases in those with ASD.

The specificity of the link between alexithymia, interoception, and imitation.

Alexithymia is a subclinical condition traditionally characterized by difficulties identifying and describing one’s own emotions. Recent formulations of alexithymia, however, suggest that the condition may result from a generalized impairment in the perception of all bodily signals (“interoception”). Interoceptive accuracy has been associated with a variety of deficits in social cognition, but recently with an improved ability to inhibit the automatic tendency to imitate the actions of others. The current study tested the consequences for social cognition of the hypothesized association between alexithymia and impaired interoception by examining the relationship between alexithymia and the ability to inhibit imitation. If alexithymia is best characterized as a general interoceptive impairment, then one would predict that alexithymia would have the same relationship with the ability to control imitation as does interoceptive accuracy. Forty-three healthy adults completed measures of alexithymia, imitation-inhibition, and as a control, inhibition of nonimitative spatial compatibility. Results revealed the predicted relationship, such that increasing alexithymia was associated with an improved ability to inhibit imitation, and that this relationship was specific to imitation-inhibition. These results support the characterization of alexithymia as a general interoceptive impairment and shed light on the social ability of alexithymic individuals—with implications for the multitude of psychiatric, neurological, and neurodevelopmental disorders associated with high rates of alexithymia.

Atypical trait inferences from facial cues in alexithymia.

It is often difficult to distinguish strangers’ permanent facial shapes from their transient facial expressions, for example, whether they are scowling or have narrow-set eyes. Overinterpretation of ambiguous cues may contribute to the rapid character judgments we make about others. Someone with narrow eyes might be judged untrustworthy, because of strong associations between facial anger and threat. To test this hypothesis, we investigated the trait judgments made by individuals with severe alexithymia, associated with impaired recognition of facial emotion. Consistent with the hypothesis, alexithymic participants demonstrated reduced interrater consistency when judging the character traits of unfamiliar faces, and the presence of subtle emotions. Nevertheless, where alexithymics perceived, or misperceived, emotion cues, the character traits inferred thereafter were broadly typical. The finding that individuals with developmental deficits of emotion recognition exhibit atypical attribution of character traits, confirms the hypothesis that emotion-recognition mechanisms play a causal role in character judgments.

Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the Heartbeat Counting Task.

Interoception, the perception of ones internal state, is commonly quantified using the heartbeat counting task (HCT) - which is thought to be a measure of cardiac interoceptive sensitivity (accuracy). Interoceptive sensitivity has been associated with a number of clinical traits and aspects of higher order cognition, including emotion processing and decision-making. It has been proposed that alexithymia (difficulties identifying and describing ones own emotions) is associated with impaired interoceptive sensitivity, but new research questions this association. Problematically, much evidence attesting to the absence of this association has been conducted using the HCT, a measure affected by various physiological and psychological factors. Here, we present novel data (N = 287) examining the relationship between alexithymia and HCT performance, controlling for a number of potential confounds. Inclusion of these control measures reveals the predicted negative relationship between alexithymia and HCT performance. Results are discussed with regard to difficulties quantifying interoceptive sensitivity using the HCT.