Alexithymia 3.0: Reimagining alexithymia from a medical perspective

Background: Although alexithymia research has greatly expanded in recent decades, our ability to treat it clinically remains limited. This article provides a new perspective on why that may be true and offers a fresh approach to clinical intervention. Summary: The recent distinction between the agnosia and anomia subtypes of alexithymia, coupled with the introduction of the three-process model of emotional awareness (consisting of affective response generation, affective response representation and cognitive control), suggests that alexithymia is a phenotype that includes a spectrum of deficits that vary in their underlying neurobiology. This advance creates the opportunity to improve our ability to treat alexithymia. In the history of medicine major advances in the ability to provide effective treatments became possible once the relevant underlying morbid anatomy and physiology were discovered and the different causes of a common clinical phenotype were identified. The author suggests that we may now be entering a new era of this type in alexithymia research and clinical care. According to this perspective, Era 1.0 consisted of the pioneering clinical observations of abnormalities in emotional functioning culminating in the consensus definition of alexithymia in Heidelberg in 1976. Era 2.0 from 1976 to the present has consisted of empirical studies in which sound psychometric measures based on this clinical phenotype have been used in combination with clinical assessments and objective measures such as emotion recognition ability, peripheral physiology and neuroimaging. We may now be entering Era 3.0 in which a new model of an alexithymia spectrum grounded in brain-body interactions can transcend the constraints of a phenotype standard and provide a guide for personalized clinical care targeting the specific deficits present in a given individual. This new approach is meant to supplement rather than replace existing research and clinical practices. Conclusion: This new era constitutes a medical perspective in three ways: 1) a focus on underlying neurobiology and associated clinical manifestations rather than an overarching phenotype; 2) a focus on the mechanisms of brain-body interactions associated with alexithymia that lead to adverse outcomes in systemic medical disorders; 3) clinical treatments directed at the specific deficits present in any given case.