2 The body as a (muffled) sound box for emotion 45 but a lack of affective responses corresponds to a prototypical description of a psychopath [60, 61]. Several studies indicate that both difficulty fantasizing and a limited emotional arousability have a suboptimal psychometric fit to the alexithymia concept [62]. Similarly, other studies have shown that there is no consistent relationship between (indicators of) emotion arousal and alexithymia [63-69]. However, it is hard to draw definitive conclusions based on these findings, as all the studies have methodological shortcomings that need to be taken into account, such as: use of small samples, problematic manipulation of emotional stimuli, no statistical correction for psychopathy, and no control on what subjects focus their attention on during the experimental task. Although more research is needed to provide a definitive answer on whether the definition of alexithymia should disregard the characteristics ‘difficulty fantasizing’, ‘lack of emotional arousability’, and to a lesser extent, ‘externally oriented thinking’, recently, a gradual shift can be observed in the academic research focusing on impaired emotional awareness that seems to be at the heart of the definition of alexithymia. 4. The third era: Embodied emotional awareness and interoception As noted above, there is an ongoing debate about which characteristics are central to the alexithymia concept and which are not. There is growing consensus that alexithymia is essentially about limited emotional awareness. Nevertheless, other topics are still being disputed. These issues may be resolved in the near future, in part because research is shifting its focus to processes in the brain that are involved in (limited) emotional awareness [8, 70-72]. In this modern neurocognitive view, low emotional awareness in alexithymia is seen as a consequence of a disturbance in the processing of emotional stimuli. Due to problems in functional processing, affective information that is not properly processed at lower cerebral levels does not or only partially becomes available to higher cerebral processing [44, 45, 73-75]. Accordingly, emotional awareness is thus placed on a hierarchically organized continuum, and alexithymia represents the ‘pathological end’ of the emotional awareness spectrum [76]. With rapidly expanding knowledge about neurocognitive processes and mechanisms, the essential role of the human body in discerning emotions has become apparent. In part, this follows logically, as our nerves transcend the brain and extend to the far regions of our extremities. The body is part of the entire neural
RkJQdWJsaXNoZXIy MjY0ODMw