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Relationships Between Alexithymia, Affect Recognition, and Empathy After Traumatic Brain Injury

Neumann, Dawn PhD; Zupan, Barbra PhD; Malec, James F. PhD; Hammond, Flora MD

Journal of Head Trauma Rehabilitation: January/February 2014 - Volume 29 - Issue 1 - p E18–E27
doi: 10.1097/HTR.0b013e31827fb0b5
Original Articles

Objectives: To determine (1) alexithymia, affect recognition, and empathy differences in participants with and without traumatic brain injury (TBI); (2) the amount of affect recognition variance explained by alexithymia; and (3) the amount of empathy variance explained by alexithymia and affect recognition.

Participants: Sixty adults with moderate-to-severe TBI; 60 age and gender-matched controls.

Procedures: Participants were evaluated for alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking); facial and vocal affect recognition; and affective and cognitive empathy (empathic concern and perspective-taking, respectively).

Results: Participants with TBI had significantly higher alexithymia; poorer facial and vocal affect recognition; and lower empathy scores. For TBI participants, facial and vocal affect recognition variances were significantly explained by alexithymia (12% and 8%, respectively); however, the majority of the variances were accounted for by externally-oriented thinking alone. Affect recognition and alexithymia significantly accounted for 16.5% of cognitive empathy. Again, the majority of the variance was primarily explained by externally-oriented thinking. Affect recognition and alexithymia did not explain affective empathy.

Conclusions: Results suggest that people who have a tendency to avoid thinking about emotions (externally-oriented thinking) are more likely to have problems recognizing others' emotions and assuming others' points of view. Clinical implications are discussed.

Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation and Rehabilitation Hospital of Indiana, Indianapolis (Drs Neumann, Malec, and Hammond); and Department of Applied Linguistics, Brock University, St Catharines, Ontario, Canada (Dr Zupan).

Corresponding Author: Dawn Neumann, PhD, Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation and Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN 46254 (

This work was supported by Cannon Research Center at Carolinas Rehabilitation in Charlotte, North Carolina, and the Humanity Research Institute at Brock University.

The information in this article and the article itself has never been published electronically or in print.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins