Alexithymia and mental imagery

Alfredo Camposa,*, Matty Chivab, MaryleÁ ne Moreaub

aDepartment of PsicologõÂa BaÂsica, University of Santiago de Compostela, Alfredo Campos, 15706 Santiago deCompostela, Spain

bUniversity of Paris X Nanterre, Paris, France

Received 26 March 1999; received in revised form 30 September 1999; accepted 22 October 1999

Abstract

One of the de®ning characteristics of alexithymic patients is their reduced ability to use mentalimages. In the present study, imaging capacity was evaluated in a total of 69 alexithymic subjects and 64non-alexithymic subjects (all university students). Alexithymic subjects showed lower imaging capacitythan non-alexithymic subjects. New approaches for investigation of the relationship between alexithymiaand imagery vividness are proposed. 7 2000 Elsevier Science Ltd. All rights reserved.

Keywords: Alexithymia; Imagery; Emotions; Personality

1. Introduction

Alexithymia is a personality construct that may be a potential vulnerability factor for a

number of psychiatric disorders and physical illnesses. The term alexithymia (Sifneos, 1973)

refers to a group of symptoms, namely (a) di�culty in identifying and describing emotions, (b)

reduced capacity to use images, giving rise to poor mental imagery and (c) a cognitive style

denominated `pense e ope ratoire' (operational thinking). Though not included as a diagnostic

category in either DSM-III-R or DSM-IV, alexithymia may occur within a wide range of

psychiatric disorders (Ferna ndez-Montalvo & Ya rnoz, 1994). It can be considered as a

personality construct with di�erent degrees, normally distributed in the general population,

Personality and Individual Di�erences 29 (2000) 787±791

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* Corresponding author. Tel.: +34-981-563-100; fax: +34-981-521-581.E-mail address: pscampos@uscmail.usc.es (A. Campos).

re¯ecting a de®cit in the capacity for emotional regulation and constituting a risk factor fororganic and psychiatric disorders (Taylor, 1994; Taylor, Bagby & Parker, 1997).Alexithymia is related to mental imaging capacity in several ways. Lang (1979) states that

there are individual di�erences in the capacity to evoke mental images, and that a lack ofimaginative ability may constitute a de®ning part of the cognitive style of various pathologicaltypes, namely the psychosomatic and alexithymic types. Mental images play an important rolein emotional processes and are closely involved in emotional regulation (Izard & Kobak, 1991;Lang, 1984; Lang, Greenwald, Bradley & Hamm, 1993). Sifneos (1988) states that theimaginative de®cit of alexithymic subjects is manifested in ``an inability to associate one'svisual images, fantasies, and thoughts with a speci®c emotional state''. Krystal (1979) statesthat in alexithymic subjects ``imagination related to drive ful®lment is limited''.Friedlander, Lumley, Farchione and Doyal (1997) compared 42 alexithymic subjects with 42

sex- and race-matched non-alexithymic subjects as regards physiological and subjectiveresponses to an autogenic relaxation exercise and three di�erent laboratory stressors. Thegroups did not di�er in the degree to which they relaxed, but alexithymic subjects reported lessenjoyment of, less involvement in and poorer imagery during relaxation.Most researchers have found that alexithymic subjects dream little or not at all, that the

content of their dreams is limited and realist and that daydreaming and fantasy are infrequent(Pe dinielli, 1992). Image techniques are frequently used in the treatment of alexithymia(Wheeler & Broad, 1994).Some previous studies have likewise found that sex has no signi®cant e�ect, but most have

found that women tend to have better imaging capacity (see Campos and Sueiro, (1993) for areview) and to use mental images more frequently (Campos, Gonza lez & Pe rez, 1998;Gonza lez, 1998). On certain tasks involving image rotation, however, women may performworse, or no better, than men (Campos & Cofa n, 1986).In previous studies, the imaginative capacity of alexithymic subjects has been measured by

indirect techniques (dream evaluation, image±thought association, imagery during relaxation,etc.) and has not been measured directly. In the present study, we aimed to evaluate whetherimage vividness di�ers between alexithymic and non-alexithymic subjects and between womenand men.

2. Method

2.1. Subjects

The initial sample comprised 1172 students of economics, law, literature, foreign languages,sports studies or psychology at the University of Paris X Nanterre (France). Age rangedbetween 18 and 28 years. Following the recommendations of Taylor, Parker, Bagby and Acklin(1992), subjects were classed as alexithymic if they scored 61 or more on the TAS-20 scale (seeSection 2.2) and as non-alexithymic if they scored 51 or less. The proportion of alexithymicstudents in the initial sample was 10.66% (for a review of the incidence of alexithymia in thegeneral population, see Sivak and Wiater (1997)). This proportion is similar to those obtained

A. Campos et al. / Personality and Individual Di�erences 29 (2000) 787±791788

in previous characterizations of student samples using the TAS: 17% in the study of Loiselleand Dawson (1988) and 8.1% in the study of Pe dinielli (1992).The ®nal sample comprised 133 subjects, of whom 69 (50 women and 19 men) were

alexithymic and 64 (44 women and 20 men) were non-alexithymic. Mean age was 21.8 years.The highest TAS-20 score obtained by an alexithymic subject was 78 and the lowest 61�M � 65:23, S:D: � 3:92). The highest TAS-20 score obtained by a non-alexithymic subject was35 and the lowest 22 �M � 30:97, S:D: � 3:43).

2.2. Instruments

Alexithymia was assessed with TAS-20, the most recent version of the Toronto AlexithymiaScale (Bagby, Parker & Taylor, 1994a; Bagby, Taylor & Parker, 1994b), a questionnairecomprising 20 items, each with a score of 1±5. The three factors of this instruments' structuremeasure are (a) di�culty in identifying feelings, (b) di�culty in describing feelings and (c)externally-oriented thinking. Bagby et al. (1994a) reported alpha reliability coe�cients of 0.80(student sample) and 0.83 (psychiatric patient sample).Visual imaging capacity was measured with the Vividness of Visual Imagery Questionnaire

(VVIQ) (Marks, 1973), which comprises 16 items referring to di�erent situations that thesubject is asked to visualize, rating image vividness on a 5-point scale. The subject ®rstcompletes the questionnaire with eyes open, and then again with eyes closed. A high score onthis questionnaire indicates low imaging capacity. The reliability of this test is high: Marks(1973) obtained a split-half reliability coe�cient of 0.85, while Rossi (1977) obtained an alphacoe�cient of 0.91.

2.3. Procedure

The initial total of 1172 students ®rst completed the French version of the TAS-20, in theirnormal lecture rooms, it having been explained to them that the purpose of the study wasresearch. All subjects participated voluntarily. Once the completed questionnaires had beenevaluated, a total of 1039 subjects were rejected, leaving the ®nal total of 133. These werecontacted personally by telephone to arrange a second session in their faculty, for applicationof the French version of the VVIQ. Again, all subjects participated voluntarily.

3. Results

To investigate whether imaging capacity varied signi®cantly between the alexithymic andnon-alexithymic groups, a 2 � 2 analysis of variance (factors group and sex) was used. Meansand standard deviations of VVIQ score in each category are shown in Table 1.These results indicate that alexithymia had a signi®cant e�ect on imaging capacity�F�1, 128� � 6:469, p < 0.05), but that sex �F�1, 128� � 0:456, p > 0.05) had no signi®cante�ect. Likewise, the group±sex interaction had no signi®cant e�ect �F�1, 128� � 0:814, p >0.05).The VVIQ score was signi®cantly correlated with the TAS-20 score �r � 0:23, p < 0.01).

A. Campos et al. / Personality and Individual Di�erences 29 (2000) 787±791 789

However, Deary, Scott and Wilson (1997) have demonstrated that the three factors ofalexithymia are not necessarily unitary. We, therefore, investigated correlations between eachfactor and imaging capacity. VVIQ score correlated signi®cantly only with `di�culty describingfeelings' �r � 0:23, p < 0.01), not with `di�culty identifying feelings' �r � 0:19, p > 0.01) or`externally-oriented thinking' �r � 0:19, p>0.01).

4. Discussion

Alexithymic subjects showed lower imaging capacity than non-alexithymic subjects. Similarresults were obtained by Sifneos (1988) and Friedlander et al. (1997).In the present study, imaging capacity was evaluated on the basis of subjective self-report.

Subsequent studies should use alternative measurement techniques, with the aim of determiningwhether the de®cit a�ects all types of image or particular image qualities. It would clearly bepreferable to use some sort of non-subjective measure of imaging capacity; with the exceptionof image rotation tests, however, no such measure currently exists. Neither sex nor the sex±alexithymia interaction had signi®cant e�ects on imaging capacity.The fact that imaging capacity di�ered signi®cantly between alexithymic and non-alexithymic

subjects does not necessarily mean that alexithymic subjects have weaker imaging capacity thannormal subjects, but rather simply that alexithymic subjects report less vivid images than non-alexithymic subjects. In view of this, there is a need for further studies, both to con®rm thepresent results obtained using a self-report test and to investigate the responses of alexithymicsubjects using performance-based objective measures of imaging capacity.

Acknowledgements

We thank anonymous reviewers whose thoughtful comments enabled the presentation of thiswork to be greatly improved.

Table 1Means and standard deviations of VVIQ score in each alexithymia/sex category

Subjects Non-alexithymic Alexithymic group

M S.D. M S.D.

Female 2.18 0.60 2.53 0.67

Male 2.37 0.69 2.50 0.70Total 2.24 0.63 2.53 0.68

A. Campos et al. / Personality and Individual Di�erences 29 (2000) 787±791790

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