Figure 5

Neuropsychological model of emotional awareness and possible mechanism of alexithymia and alexisomia. Bodily states including autonomic, hormonal, and somatosensory status are the basis of the organism’s basic affective states, called ‘Core Affect’ [80, 82]. This is hypothesized as variable states of brain and body, consisting of the intensity (arousal level) with negative or positive affective value (i.e., valence). The Core Affect is mainly formulated from the information from the body known as ‘interoception’. Our information available for constructing our mental states should be 1) the Core Affect, i.e., information from the body, 2) information from the past stored in one’s brain, called ‘memory’, and 3) information from the world outside the body (e.g., visual, or auditory input etc.). These three information sources are ‘categorized’ in the brain and a certain mental state is formulated (which might be a “thought”, a “feeling”, or an “emotion” at the time); see [83, 84]. Emotional awareness is assumed to have “levels“ [13]. At the lower level of emotional awareness, the target of awareness is the core affect or basic level of affective states, which is strongly connected to physiological or bodily status, or interoceptive awareness. We can postulate that ‘alexisomia’ involves difficulty in the lower levels of emotional awareness, i.e., interoceptive awareness or awareness of core affective states. On the other hand, higher levels of (more cognitive) emotional awareness should include a ‘categorization’ process that integrates the three sources of information and constructs a mental state that is ‘experienced’. The core of the mechanism of ‘alexithymia’ could be a problem in categorization or cognitive awareness or metacognition of categorized emotional states (e.g., can’t identify or express one’s own emotional state as ‘angry’). If we accept that interoceptive awareness is fundamental to the construction of the emotional experience and awareness, alexithymia (difficulty in emotional awareness) and alexisomia (difficulty in interoceptive awareness) are closely connected to each other.