Brain Advance Access originally published online on April 8, 2003
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Brain, Vol. 126, No. 6, 1474-1484,
June 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg131
Specific brain processing of facial expressions in people with alexithymia: an H215O-PET study
Departments of 1 Pharmacology, 2 Behavioral Medicine, 3 Psychosomatic Medicine, Tohoku University School of Medicine, 4 Department of Psychology, Tohoku University, Sendai, 5 ATR-International Human Information Science Laboratories Department 2, Kyoto, 6 Cyclotron and Radioisotope Center, Tohoku University and 7 Department of Comprehensive Medicine, Tohoku University School of Medicine, Sendai, Japan
Correspondence to: Professor Kazuhiko Yanai, MD, PhD, Department of Pharmacology, Tohoku University School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan E-mail: yanai{at}mail.cc.tohoku.ac.jp
Alexithymia is a personal trait characterized by a reduced ability to identify and describe one’s own feelings and is known to contribute to a variety of physical and behavioural disorders. To elucidate the pathogenesis of stress-related disorders and the normal functions of emotion, it is important to investigate the neurobiology of alexithymia. Although several neurological models of alexithymia have been proposed, there is very little direct evidence for the neural correlates of alexithymia. Using PET, we studied brain activity in subjects with alexithymia when viewing a range of emotional face expressions. Twelve alexithymic and 12 non-alexithymic volunteers (all right-handed males) were selected from 247 applicants on the basis of the 20-item Toronto Alexithymia Scale (TAS-20). Regional cerebral blood flow (rCBF) was measured with H215O-PET while the subjects looked at angry, sad and happy faces with varying emotional intensity, as well as neutral faces. Brain response in the subjects with alexithymia significantly differed from that in the subjects without alexithymia. The alexithymics exhibited lower rCBF in the inferior and middle frontal cortex, orbitofrontal cortex, inferior parietal cortex and occipital cortex in the right hemisphere than the non-alexithymics. Additionally, the alexithymics showed higher rCBF in the superior frontal cortex, inferior parietal cortex and cerebellum in the left hemisphere when compared with the non-alexithymics. A covariance analysis revealed that rCBF in the inferior and superior frontal cortex, orbitofrontal cortex and parietal cortex in the right hemisphere correlated negatively with individual TAS-20 scores when viewing angry and sad facial expressions, and that no rCBF correlated positively with TAS-20 scores. Moreover, the anterior cingulate cortex and insula were less activated in the alexithymics’ response to angry faces than their response to neutral faces. These results suggest that people with alexithymia process facial expressions differently from people without alexithymia, and that this difference may account for the disorder of affect regulation and consequent peculiar behaviour in people with alexithymia.
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