2 The body as a (muffled) sound box for emotion 39 1. Introduction: Three Eras in Alexithymia Research This chapter focuses on alexithymia and the essential role the body plays in our understanding this concept. One of the central characteristics of alexithymia is limited emotional perception. The aim of this chapter is to demonstrate that the perception of the internal state of the body and bodily signals (interoception) also plays an essential role in alexithymia. Alexithymia is a transdiagnostic phenomenon of significant importance to clinical practice. Research on alexithymia indicates that it occurs in about 10% of the general population and is not linked to race or ethnicity [1-3]. In mental health care, rates are found up to four times as high as in the average population and can amount to 45% of all patients [3, 4]. Over time, the main theoretical focus and the type of research on alexithymia has changed. As with other concepts in psychiatry, the concept retained its name, but its meaning changed as research progressed. In this context, we discuss three ‘eras’ in the history of alexithymia [5]. The term ‘alexithymia’ was originally used to define a series of clinical observations of patients that displayed a limited ability to identify and express feelings and who had an externally oriented style of thinking and a limited fantasy life. This phenomenological description has been the starting point of a line of research that has since then received increasing attention from both scholars and clinicians. The first era commenced when the concept of alexithymia was introduced and its incidence and prevalence explored, including descriptions of cases and the settings in which it occurred. The second era in alexithymia research started when the main focus became the operationalization of the concept as a dimensional personality trait [6, 7]. With more advanced research tools and statistically more complex researchmethods – within the available scientific paradigms – research in the second era has advanced the alexithymia concept in two ways: 1) it added refinement and depth to the concept, and 2) it gave alexithymia a clearer demarcation with regard to related concepts. This era thus clarified which characteristics are intrinsic to the concept – and which are not. The third era, which has only just begun, is about the critical reassessment of the concept, resulting in proposals to (partially) redefine it. Stimulated by alexithymia researcher Richard Lane and his colleagues, several scholars have attempted to integrate accumulated knowledge on alexithymia from clinical, psychodynamic and (neuro)cognitive realms over the years. Combining all these data should eventually result in a new definition of alexithymia [5, 8], with the result being that alexithymia will increasingly enter the domain of cognitive and affective neurosciences. Consequently, “Alexithymia 3.0” [5] is regarded as a disturbance of various neurocognitive processes that are influenced by both predisposition and
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