Take the Alexithymia test

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I dont think researchers consider alexithymia an ASD (do they?). Nevertheless its looking likely that alexithymia is a core symptom on all the diagnostic criteria for AS, and the forthcoming DSM-V may spell this out explicitly.

Just when I felt sure I knew the subject!

Posted by Ganymede
[Excerpted from 'Blocked Imagination~ Emptied Speech' – by Jason Thompson]

Ongoing research has revealed a significant overlap between alexithymia and autistic spectrum disorders (ASD's). Two recent studies suggest that individuals with ASD exhibit a higher degree of alexithymia than matched control participants, with 85% of the participants with ASD showing slight or severe alexithymic impairment. This raises the important questions for future research regarding how to explain the high co-morbidity of alexithymia and ASD, and from a clinical perspective the finding suggests that a diagnosis of ASD should be considered in patients with alexithymia.

[This] overlap may be applicable for Asperger's syndrome, which has similarities with alexithymic behaviour that have long been recognized. Every well known AS measure reflects the centrality of alexithymic phenomena in its diagnostic criteria: e.g. Lack of social or emotional reciprocity (DSM-IV), Impaired or deviant response to other people's emotions (ICD-10), Difficulty sensing feelings of others (Szatmari criteria), Difficulties expressing themselves, especially when talking about emotions (NAS definition), Emotionally inappropriate behaviour… Impairment of comprehension (Gillberg criteria).

Like all alexithymic persons, AS individuals have difficulty understanding their own and others' emotional arousal along with problems expressing feelings with verbal and nonverbal behaviour or in reading that of others, which correlate with the alexithymic subtraits: (a) difficulty identifying feelings and distinguishing between feelings and bodily sensations of emotional arousal, and (b) difficulty describing feelings to other people. In AS there is also a limited imagination, an absence of symbolic thinking, and a preoccupation with factual information which traits correlate with the alexithymic: (c) constricted imaginal processes, as evidenced by a paucity of fantasies, and; (d) a stimulus-bound, externally oriented cognitive style. The syndromes also share a propensity for psychosomatic disorders and hypochondriacal features.

Similarities noted, there are further distinguishing traits marking Asperger’s syndrome such as the tendency toward mild autistic behaviours like 'stereotyped and repetitive motor mannerisms such as hand or finger flapping or twisting, or complex whole-body movements which are not features of simple alexithymia, and secondly, whilst AS individuals are with few exceptions alexithymic they have added difficulties in reading the objective, non-emotional intentions of others' minds. This mind-reading or ‘Theory of Mind’ (ToM) is the ability individuals may or may not possess for understanding and interpreting the mindset of another person, where the observer predicts the thoughts of the target individual by placing him or herself in their position and simulating the actions or beliefs of the target individual. Whilst a lack of ToM is central to Asperger’s syndrome, a recent study has shown that this is not a deficiency integral to uncomplicated alexithymia. This study selected forty-five high alexithymic subjects to undertake a 'false belief task' which involved a picture-sequencing task of four cartoon-style cards focussing on beliefs of an objective kind that did not require the identification of an emotional component. The task gauged their ability to read the thoughts of others based on the available cues. Alexithymic subjects were able to correctly complete the task, sometimes performing better than samples from a group of non-alexithymic subjects who completed the task, leading to the conclusion that alexithymic individuals possessed a Theory of Mind. At present ToM measures do not gauge ability or inability to recognise discrete emotions, meaning it does not adequately distinguish between alexithymic and non-alexithymic traits; its aim is purely to measure an individual’s ability to read the objective thought patterns of other people.

Individuals with uncomplicated or ‘simple’ alexithymia are more socially adaptive than AS individuals principally because they have a Theory of Mind allowing a degree of social competence, but problems arise when they are faced with situations where intimacy is required. Alexithymics may develop the ability to interpret and navigate the social world by applying logical rules about the beliefs and behaviours of other people but cannot articulate the emotional nuances which are intertwined with these interpersonal beliefs, i.e. they are able to anticipate and interact with others so as to form functional, but not feelings-based intimacies.

As well as mild autistic behaviours and mind-blindness, alexithymia constitutes a core factor of Asperger's syndrome as it is presently conceived. While this has not been strongly recognised in the past, it is becoming increasingly clear that the alexithymia construct is the most accurate, scientifically validated measure for gauging the emotional ‘differences’ inherent to Asperger’s syndrome. As remarked by a leading AS researcher Tony Atwood: “We now have a psychological term, alexithymia, to describe another characteristic associated with Asperger’s syndrome, namely someone who has an impaired ability to identify and describe feeling states. Clinical experience and research have confirmed that alexithymia can be recognized in the profile of abilities of people with Asperger’s syndrome…”