Alexithymia predicts face emotion perception after acquired brain injury

This study investigated the presence and level of alexithymia and examined the relationship between alexithymia and affect recognition abilities after acquired brain injury (ABI), accounting separately for etiology due to stroke or traumatic brain injury (TBI). Ninety-nine neurologically healthy adults (NHA) and 119 adults with moderate-to-severe ABI (63 TBI, 56 stroke) participated. Main measures included the Toronto Alexithymia Scale-20 (TAS-20) and Multicultural Facial Emotion Perception Test (MFEPT). ABI groups endorsed greater alexithymia than NHA, but TBI and stroke subgroups did not significantly differ. Hierarchical multiple regression indicated that TAS-20 subscales difficulty identifying feelings (DIF) and externally oriented thinking (EOT), but not Difficulty Describing Feelings (DDF), added unique value to predicting objective affect recognition (MFEPT) after accounting for age, education, sex, face recognition ability, and general cognitive function. Moreover, the relationship between alexithymia and affect recognition was moderated by group: DIF and DDF were inversely related to MFEPT only for adults with ABI. EOT was inversely related to affect recognition for all three groups. Adults with ABI experience alexithymia more frequently and intensely than neurologically healthy adults, and this impairment may partly underlie struggles with affective processing frequently observed in these individuals on experimental tasks and in real-world interactions.