Chapter 2 40 environment; nevertheless, disturbed emotional perception remains central. Thus, the new perspective is also more medically oriented. With increasing knowledge about the workings of the brain with regard to our emotional functioning, the essential role of the body cannot be overestimated. The process of interoception, or the perception of the internal state of the body, seems to be of great importance for emotional perception [9-14]. In this chapter we provide an overview of the clinical-theoretical and scientific backgrounds, developments and latest insights with regard to alexithymia, and an insight into the role that the body plays in the awareness of emotional signals. We will also discuss the most common diagnostic tools and provide some guidance for the psychotherapeutic treatment of alexithymia. We conclude the chapter with a discussion of the necessity for further research on the neurocognitive phenotype of alexithymia, as well as its operationalizations. 2. The first era: Origin and definition The term ‘alexithymia’ was first used in 1973 by the psychiatrist Peter Sifneos [15]. Sifneos, construed the term by combining the Greek words a (lack), lexis (word), and thymos (emotion, mind). He coined the term to describe his observations of patients in the ‘psychosomatic’ ward where he worked. He noticed that it seemed almost impossible for some of his patients to express their emotions and feelings. These patients had feelings, but they did not seem to be aware of them, which would lead to all kinds of problems and difficulties. For a long time, alexithymia has been associated with functional somatic conditions for which a sought-after medical explanation was missing. It is now known that alexithymia is not limited to patients with ‘somatic symptom disorders’ [16]. Another disorder that alexithymia is often associated with is autism. The relationship between autism and alexithymia is complex. As with alexithymia, the conceptualization of autism has changed over time and is now regarded as a spectrum formed by a number of dimensional traits [17]. The 5th edition of the DSM refers to an autism spectrum disorder (ASD) [18]. This development has not made it any easier to set alexithymia and ASD apart. Formal descriptions of both concepts both include the mention of reduced self-consciousness and a limited emotional lexicon, as well as a concrete way of thinking [17]. Research shows that in about 50% of the people who meet the criteria of a ASD diagnosis, also are alexithymic, while in the other 50% they are not [19-21]. In other words, alexithymia – specifically a patient’s low emotional awareness as derived from a limited bodily awareness – is quite common in patients with ASD yet is not an intrinsic part of its definition. So, although complicated by the current DSM5 criteria of ASD, both ASD and alexithymia
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