title: Role of theory of mind in emotional awareness and alexithymia: Implications for conceptualization and measurement.
abstract: The goal of this study was to determine whether alexithymia, which is characterized by difficulty in recognizing and describing emotions, is associated with impairments in the ability to mentally represent emotional states. We studied 89 outpatients including 29 conversion disorder patients, 30 functional somatic syndrome [e.g. fibromyalgia] patients and 30 medical controls. Groups did not differ on affective or cognitive Theory of Mind (ToM) measures, the Levels of Emotional Awareness Scale (LEAS) or the Twenty-Item Toronto Alexithymia Scale (TAS-20) after adjusting for Positive and Negative Affect Scale (PANAS) variables. Across all patients, LEAS but not TAS-20 correlated positively with affective and cognitive ToM measures after adjusting for PANAS scores. Impairments in ToM functioning influence LEAS performance but not TAS-20 scores. These findings support the distinction between a milder "anomia" form of alexithymia associated with impaired emotion naming and a more severe "agnosia" form associated with impaired mental representation of emotion.
authors.affiliation: Departments of Psychiatry, Psychology and Neuroscience, University of Arizona, Tucson, AZ, United States. Electronic address: lane@email.arizona.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lane
authors.affiliation: Division of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, United States.
authors.forename: Chiu-Hsieh
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic in Arizona, Scottsdale, AZ, United States.
authors.forename: Dona E C
authors.initials: DE
authors.lastname: Locke
authors.affiliation: Department of Family and Community Medicine, University of Arizona, Tucson, AZ, United States.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ritenbaugh
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic in Arizona, Scottsdale, AZ, United States.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Stonnington
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000503:physiopathology*; D000377:Agnosia / Q000503:physiopathology*; D001364:Awareness / Q000502:physiology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013001:Somatoform Disorders / Q000503:physiopathology*; D056345:Theory of Mind / Q000502:physiology*; D055815:Young Adult
keywords: Affective agnosia; Alexithymia; Emotional awareness; Somatic symptom disorders; Theory of mind