2 The body as a (muffled) sound box for emotion 41 are best considered as two separate concepts. This is similar to the relationship between ASD and intellectual disability, which frequently occurs in ASD patients – alexithymia is common to, but not a requisite for being diagnosed with ASD. Indirect support follows from the fact that such a high co-incidence of alexithymia does not only exist with ASD, but with many, if not most, of the disorders listed in the DSM. For example, a high prevalence of alexithymia has been demonstrated in eating disorders, in particular anorexia nervosa [22-26], personality disorders [2735], psychotic disorders [19, 36], substance use disorders [37, 38], PTSD [39, 40], and anxiety and mood disorders [19, 41]. Alexithymia is, therefore, currently regarded as a transdiagnostic phenomenon and may thus be involved in the etiology, manifestation, and maintenance of various disorders [42]. In many cases it may also explain comorbidity [30]. Case description: Theo Theo (41 years old) registers for treatment with a psychotherapist. He recently – just barely – survived a suicide attempt and was referred for ‘further psychological treatment’ after physically recovering and being discharged from the hospital. The suicide attempt came a few weeks after his girlfriend decided to end their relationship. Theo does not really know himself why he should seek psychological treatment, as he does not experience any psychological problems. He is willing to enter treatment as long it serves to reach a practical, well-defined goal. Theo likes clarity. He finds it hard having to deal with people on a daily basis who just keep asking him about how he is feeling. For him this has very little priority as he barely attends to his emotions. Oh sure, he knows when he is feeling good or bad. He feels bad, for example, when he has the flu or when he gets a hefty traffic fine. So, if others see that he is not sick and he hasn’t had any fines, what more is there to say? Theo does not understand why other people are so preoccupied with feelings and spend so much time talking about them. The way he sees it, it is a useless pastime. He gets a headache when others go on about their feelings for too long. Literally. His doctor saw him twice in recent months for unexplained headaches and insomnia. Given his stoic and unemotional attitude, the psychiatrist expressed a suspicion of ASD, but Theo does not actually meet the criteria. The psychiatrist based his statement on a certain recognition of the characteristics of criterion A (deficiencies in social-emotional reciprocity, non-verbal communicative behavior, and in the development, maintenance and understanding of relationships). However, there is no evidence of the characteristics of criterion B – Theo has no stereotyped or repetitive movements, stereotype use of objects, or aberrant use of language. Theo has a structured life with the odd routines, but they serve practical purposes. If things
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