Testing Emotional Awareness, Alexithymia, And Psychophysiology In A Rare Patient Who Could Not Experience Emotions

Some people are much more aware of their emotions than others. Emotion researchers often refer to this characteristic as “trait emotional awareness” (tEA). People who self-report having low emotional awareness (e.g., that they do not understand their own emotions) are also referred to as having “alexithymia,” which literally means “not having words for emotions.”

In this paper, we describe a rare individual (“Jane”) who said she has never been able to feel emotions her entire life. Yet, she did show some outward signs of emotions. For example, while talking with a psychiatrist about some of her marriage problems, her eyes began to well up with tears; yet, she said she felt no sadness and stated that her eyes just “do this” sometimes. To understand this unusual phenomenon better, we asked her to participate in a study.

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In the first set of tests, we found that she had very high alexithymia scores and very low tEA scores. She also did not notice the changes in emotional intensity that most people feel in response to emotional pictures. However, Jane performed well on a test that measured her ability to recognize emotions in the facial expressions of others and she was also able to accurately recognize whether emotional pictures were pleasant or unpleasant.

In a second set of tests, we found that her face and body did not respond in typical ways to emotional images. While healthy people show microscopic increases in sweating in response to emotionally intense images, Jane did not show this automatic sweating response. Her facial muscle responses were also unusual. While most people show specific facial muscle responses when shown negative vs. positive images, several (but not all) of Jane’s facial muscles responded in a different pattern.

These test results support Jane’s claim that she did not have normal emotional experience. As she did not automatically react to emotional pictures with any intensity or with typical facial expressions, this could help explain why she didn’t report feeling anything. On the other hand, she could still recognize emotions well in others, which is less common in people with lower tEA scores. So she seemed to understand emotions but not to recognize or feel them in herself.

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This case study shows how different parts of emotional responses can come apart (e.g., crying but not feeling sad, recognizing emotional unpleasantness but not intensity) and that a life without emotional experience is possible.

These findings are described in the article entitled The importance of identifying underlying process abnormalities in alexithymia: Implications of the three-process model and a single case study illustration, recently published in the journal Consciousness and Cognition.

About The Author

Dr. Ryan Smith’s main research interests include understanding how conscious and unconscious emotion-related processes are realized within the brain, and in how these processes may be altered in mood and anxiety disorders. The primary research methods Dr. Smith employs in his research are neuroimaging and computational modeling. A major overarching focus is to characterize differences between mentally healthy and unhealthy individuals with the goal of improving diagnosis and treatment selection within psychiatry and clinical psychology.