2 The body as a (muffled) sound box for emotion 59 clinical practice or research. What does limit its use in daily practice, at least in the Netherlands, is a lack of an official translation of the test, as well as missing validation studies and representative norm groups for the Dutch population. Currently, the only norms for scoring that are available are based on American samples. Tilburg University has produced a provisional Dutch translation of the LEAS. However, as this translation is still unapproved and norms are not yet available, it is not suitable for use in daily clinical practice or applied research. 5.1.3 Conclusions and implications regarding diagnostics Clinicians operating in the Dutch language have a couple of questionnaires at their disposal to start the process of assessing alexithymia. Although these questionnaires are suitable for initial screening, more extensive assessment and refined diagnosis are still required to determine proper treatment planning and choice of interventions. For these purposes a multi-method assessment is recommended, using a combination of questionnaires, observer rating scales, and/or structured interviews [97]. Such extra, multi-source information will help the clinician to obtain a richer picture and deeper understanding of the individual case. Proper diagnosis and treatment planning require an assessment of alexithymia (and emotional awareness) that provides more than just an indication about whether or not alexithymia is present. To this end, a dimensional, multi-faceted perspective on alexithymia, in which emotional awareness has become central, is increasingly becoming standard practice in the diagnostic process. However, in following this course of action, clinicians can be confronted with the limited convergence between different types of instruments, which can yield contrasting results. Although this likely reflects the fact that different instruments cover different aspects of the alexithymia concept, further research on the interrelatedness of different instruments is warranted [97]. A drawback that concerns mental health care in the Netherlands is that the full array of instruments needed for this new way of assessing is not yet available. Notwithstanding the current evolution of the assessment process, true progress would imply a shift towards the assessment of underlying neurobiological or psychological mechanisms [5, 59, 70, 76]. Recent scholarly research on alexithymia has identified that there are at least seven semi-related mechanisms that, in different constellations, could all lead to the same phenotype of alexithymia. Centering diagnostic assessment on these mechanisms would greatly advance the level of understanding and add to personalized treatment, as it would then become possible to see, for example, whether someone has deficits regarding emotional reactivity (emotional arousability) regarding the cognitive representation and/or processing of emotions, or that both areas of emotional functioning are intact but that conscious access to emotions is temporarily blocked due to emotional overload
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