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14 Jun 2021, 9:21 am

Alexithymia, not autism, may drive eye-gaze patterns

Eye-gaze patterns when people look at a face relate more to alexithymia, a condition marked by difficulties recognizing one’s own emotions, than to autism, according to a new study. The findings suggest that some emotion-processing differences considered core to autism are actually due to alexithymia, the researchers say.

Although autistic people are often presumed to have trouble recognizing and responding to facial expressions and emotions, the research has been inconsistent.

But increasing evidence suggests that these difficulties are actually due to a high rate of alexithymia among autistic people, says senior investigator Geoff Bird, professor of cognitive neuroscience at the University of Oxford in the United Kingdom. About 50 percent of autistic people have alexithymia, compared with 5 percent of non-autistic people.

It’s the alexithymia and not the autism that’s driving these symptoms,” Bird says, “which is why you get such a mixture of results in the literature and such a variety of different competencies across autistic individuals.”

Researchers measure emotion processing by tracking how often a person focuses her gaze on another person’s eyes, usually in series of still images. In the new study, the team monitored how these gaze patterns changed in different circumstances and while participants watched videos, in an attempt to more closely approximate natural interactions.

The participants — 25 autistic and 45 non-autistic adults — watched short videos of people showing a neutral expression, which in most cases was followed by an expression of one of five emotions: happiness, sadness, anger, fear or disgust. In some cases, they attempted to recognize the emotion or judge its intensity, and they were sometimes told in advance which emotion they would see.

Each participant also filled out surveys measuring autism and alexithymia traits and symptoms of depression and anxiety.

Under all testing conditions, levels of alexithymia traits more accurately predicted how much time a participant spent looking at eyes, and how that behavior changed over time, than did levels of autism traits, the researchers found. And people with more alexithymia traits looked at eyes less often than people with fewer traits did, particularly while freely exploring the faces.

People with and without autism adjusted how much time they spent looking at eyes depending on what they’d been instructed to do. When cued to expect a certain emotion, for example, their gaze patterns were more structured and predictable than when they were evaluating the emotion — suggesting they were seeking less information from the eyes.

But higher levels of alexithymia lessened the extent to which a person modulated her gaze in response to instructions. And in people with alexithymia, gaze patterns became more unpredictable, not less, in the cued condition.

‘I’m not sure I would say yet that alexithymia is responsible for this lack of top-down integration or failing to use this prior information — that’d probably be too far,” Bird says. “But certainly the results are not really compatible with this idea that people with autism don’t use prior information in their judgment or their behavior.”

The paper provides strong evidence for Bird’s hypothesis that eye-gaze patterns are more driven by alexithymia than by autism, says Jennifer Cook, a senior fellow at the University of Birmingham in the U.K. And it underscores the need for researchers studying emotion recognition to measure alexithymia traits.

“That is crucial,” Cook says. “If you do a study where you haven’t controlled for alexithymia and you’re claiming that the thing you found is specific to autism, how do you know that if you haven’t controlled for it?”

Professionally Identified and joined WP August 26, 2013
DSM 5: Autism Spectrum Disorder, DSM IV: Aspergers Moderate Severity.

“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman


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14 Jun 2021, 9:58 am

Images of faces are not a good substitute for the real thing. Looking at images of eyes is a lot easier for me than real life eye contact.


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14 Jun 2021, 10:52 am

I have a formal diagnosis of Alexithymia, determined during my ASD assessment. I also failed the eyes test miserably, and my doctor said it was the lowest score she'd ever seen in her clinical practice. I don't even attempt to make eye contact with people. I'm not surprised they're all connected.

Tufted Titmouse
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19 Jun 2021, 6:10 am

I've used a lot of Bird's work in my studies, it's very interesting, although not as clear cut as the article makes it sound. Alexithymia is not really a condition, it's generally viewed as a trait. You can't really have a diagnosis of alexithymia because it's not in diagnostic manuals, best anyone can say is you have high levels of it.


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19 Jun 2021, 8:21 am

IsabellaLinton wrote:
I have a formal diagnosis of Alexithymia, determined during my ASD assessment. I also failed the eyes test miserably, and my doctor said it was the lowest score she'd ever seen in her clinical practice. I don't even attempt to make eye contact with people. I'm not surprised they're all connected.

I got mixed messages over Alexithymia. I struggled a little to describe how anger,sadness,happiness and other emotions felt to me inside, but on the other hand supposedly described anger and anxiety well - so didn't get coded.

However answering as conservatively as I could on the online Alexithymia questionnaire -


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