Non-declarative representational and regulatory systems in alexithymia.

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.