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Alexithymia, a cognitive deficit in the experience of emotion, is associated with emotional dysregulation. Alexithymia as measured with the
20-item Toronto Alexithymia Scale (TAS-20) has been widely studied and related to a good number of clinical outcomes, both self-reported and observer-rated. However, it is not clear what kind of cognitive deficits the TAS-20 actually assesses and how they translate into “real-life” problems of emotion regulation. This study is an attempt to shed further light on the mechanisms involved in alexithymia and to evaluate how these mechanisms contribute to an experimentally induced performance of emotion regulation in a prospective design. The study has been supported in part by the APsaA Fund for Psychoanalytic Research.
The original formulation of alexithymia, stemming from the psychoanalytic observation of psychosomatic patients, emphasized a deficit in mentalization. The emblematic alexithymic patient suffered from what French psychoanalysts called operatory thinking (pensée opératoire), a profound “cognitive” deficit produced by the eradication of emotional representations. For those French analysts, the unavailability of representations for emotions was due to the massive use of a primitive form of suppression (répression in French) that weakened the preconscious system of operatory patients. The thinking of these extremely alexithymic individuals was found to be concrete and action-based. This formulation of alexithymia views it as the result of a deficit in representation and cognition.
Later formulations introduced the notion of a reversible form of alexithymia brought about by the defensive avoidance of emotional representations. A regression in affect differentiation and desomatization was seen as a way to cope with trauma or excesses of negative affects. Alexithymia was seen not as a deficit in representational resources, then, but as the manifestation of a defensive process. In empirical research studies, dissoc