Alexithymia, Not Autism, Predicts Poor Recognition of Emotional Facial Expressions
Abstract
Despite considerable research into whether face perception is impaired in autistic individuals, clear answers have proved elusive. In the present study, we sought to determine whether co-occurring alexithymia (characterized by difficulties interpreting emotional states) may be responsible for face-perception deficits previously attributed to autism. Two experiments were conducted using psychophysical procedures to determine the relative contributions of alexithymia and autism to identity and expression recognition. Experiment 1 showed that alexithymia correlates strongly with the precision of expression attributions, whereas autism severity was unrelated to expression-recognition ability. Experiment 2 confirmed that alexithymia is not associated with impaired ability to detect expression variation; instead, results suggested that alexithymia is associated with difficulties interpreting intact sensory descriptions. Neither alexithymia nor autism was associated with biased or imprecise identity attributions. These findings accord with the hypothesis that the emotional symptoms of autism are in fact due to co-occurring alexithymia and that existing diagnostic criteria may need to be revised.
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Impairments thought to be core characteristics of ASD, such as reduced empathic response of the insula and impaired recognition of emotional facial expressions, are in fact due to co-occurring alexithymia and, by inference, potentially interoceptive impairment.
“Using this design, we have observed that impairments thought to be core characteristics of ASD, such as reduced empathic response of the insula (Bird et al., 2010) and impaired recognition of emotional facial expressions (Cook, Brewer, et al., 2013; Oakley et al., 2016), are in fact due to co-occurring alexithymia and, by inference, potentially interoceptive impairment.”
From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Cook, Brewer, et al., 2013
Alexithymia is associated with impaired recognition of facial emotion.
“recent evidence suggests that apparent emotion recognition impairments in ASD are in fact due to alexithymia (a trait characterized by poor recognition of one’s own emotions; Nemiah, Freyberger, & Sifneos, 1976), which frequently co-occurs with ASD (the alexithymia hypothesis of emotion deficits in ASD; Bird & Cook, 2013; Cook, Brewer, Shah, & Bird, 2013).”
From ‘Theory of Mind’ is not Theory of Emotion: a cautionary note on the reading the Mind in the Eyes test (2016) · cites this paper as Cook, Brewer, Shah, & Bird, 2013
Recent evidence suggests that apparent emotion recognition impairments in ASD are in fact due to alexithymia.
“It is noteworthy, therefore, that recent evidence suggests that apparent emotion recognition impairments in ASD are in fact due to alexithymia (a trait characterized by poor recognition of one’s own emotions; Nemiah, Freyberger, & Sifneos, 1976), which frequently co-occurs with ASD (the alexithymia hypothesis of emotion deficits in ASD; Bird & Cook, 2013; Cook, Brewer, Shah, & Bird, 2013).”
From ‘Theory of Mind’ is not Theory of Emotion: a cautionary note on the reading the Mind in the Eyes test (2016) · cites this paper as Cook, Brewer, Shah, & Bird, 2013
Alexithymia frequently co-occurs with ASD.
“which frequently co-occurs with ASD.”
From ‘Theory of Mind’ is not Theory of Emotion: a cautionary note on the reading the Mind in the Eyes test (2016) · cites this paper as Cook, Brewer, Shah, & Bird, 2013
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References 44 · Cited by 378
- Authors
- Cook, R., Brewer, R., Shah, P., & Bird, G.
- Affiliations
- City, University of London (GB)
- University of London (GB)
- Venue
- Psychological Science
- Publisher
- SAGE Publications
- Published
- 2013-03-25
- Volume
- 24
- Issue
- 5
- Pages
- 723-732
- ISSN
- 0956-7976 (ISSN-L)
- 1467-9280
- OpenAlex
- W2137322949
- Cited by
- 378
- References
- 44
- Citations by year
- 2026: 23 · 2025: 22 · 2024: 29 · 2023: 31 · 2022: 32 · 2021: 43 · 2020: 41 · 2019: 24 · 2018: 37 · 2017: 23 · 2016: 30 · 2015: 23 · 2014: 13 · 2013: 6 · 2012: 1
- FWCI
- 13.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- BIROn (Birkbeck, University of London) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Face Recognition and Perception
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- alexithymia, autism spectrum disorder, emotional facial expressions, face perception, expression recognition, personal identification, autism severity, diagnostic criteria
- MeSH terms
- Adult, Affective Symptoms, Autistic Disorder, Emotions, Facial Expression, Female, Humans, Male, Neuropsychological Tests, Severity of Illness Index, Social Perception, Recognition, Psychology
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