International Center for Psychological Trauma @ Traumaterapiakeskus, Helsinki, Finland.
J Trauma Dissociation. 2009;10(4):469-87. doi: 10.1080/15299730903143675.
Alexithymia, originally defined as a lack of words for feelings, has generally been conceived as a cognitive deficit in emotional information processing. Structural dissociation theory hypothesizes that the full range of trauma spectrum symptoms and disorders, including an alexithymic presentation, may be related to posttraumatic disruptions in operations that integrate personality. Review of multilevel descriptive research in the areas of traumatic stress, dissociation, alexithymia, and affective neuroscience suggests that posttraumatic alexithymia may be related to trauma-specific alterations in non-declarative representational and self-regulatory operations. Similar patterns of altered neural activity have been observed in studies of traumatic stress and of alexithymia and in research on neurovisceral integration. Neuroanatomical studies of affective information processing suggest that disruption of a key non-declarative integrative operation, interoception, may be related to the declarative deficit manifest in posttraumatic alexithymia. Refinement of the alexithymia construct in line with these empirical findings and with the theory of structural dissociation is accordingly proposed. A novel heuristic, apraxithymia, defined as a procedural discoordination of the hierarchical representation and regulation of affective experience, is introduced as a reformulation of posttraumatic alexithymia. In apraxithymia, altered action of the feeling of feelings is hypothesized to underlie a manifest lack of words for feelings. Clinical implications and suggestions for further research are briefly outlined.
述情障碍最初被定义为缺乏描述情感的词汇，通常被认为是情绪信息处理的认知缺陷。结构分离理论假设，包括述情障碍表现在内的创伤谱症状和障碍的全部范围，可能与人格整合操作的创伤后中断有关。对创伤性应激、分离、述情障碍和情感神经科学领域的多层次描述性研究进行综述表明，创伤后述情障碍可能与非陈述性代表性和自我调节操作的创伤特异性改变有关。在创伤性应激和述情障碍的研究中以及在神经内脏整合的研究中，观察到了类似的改变的神经活动模式。情感信息处理的神经解剖学研究表明，关键的非陈述性整合操作——内感受的中断，可能与创伤后述情障碍中表现出的陈述性缺陷有关。因此，提出了根据这些实证发现和结构分离理论对述情障碍结构进行细化。作为对创伤后述情障碍的重新表述，引入了一个新的启发式概念——行为性述情障碍，定义为情感体验的层次表示和调节的程序性协调障碍。在行为性述情障碍中，改变了对感觉的感觉的作用，这被假设是缺乏描述情感的词汇的表现的基础。简要概述了临床意义和进一步研究的建议。
