Letter to the Editor THE OVERLAP BETWEEN ALEXITHYMIA AND ASPERGER’S SYNDROME Dear Editor Alexithymia is characterised by an inability to express emotions verbally and by improvished fan- tasy and imaginal life. Individuals so affected may also experience difficulty in distinguishing emotional states from bodily sensations. Alexithymia is thought of as a psychosomatic disorder since the inability to identify and verbalise feelings may predispose to somatization. The term was coined by Sifneos (1972) but descriptions of conditions with alexithymic fea- tures predate this work. Aetiological theories of the disorder have variously emphasised genetic, neurops- hysiological, developmental and psychodynamic fac- tors (Krystal, 1998; Parker & Taylor, 1997). Like Alexithymia, Asperger’s disorder is also characterised by core disturbances in speech and language and social relationships. Here we aim to demonstrate that there is considerable overlap in the clinical presenta- tion of persons with a diagnosis of Alexithymia and Asperger’s syndrome. As John Nemiah (1996) points out there is now a large literature devoted to the construction of stan- dardised Alexithymia rating scales and their applica- tions to clinical research. Alexithymia may now be measured as a valid and reliable clinical phenomenon (Nemiah, 1996, 1977). It is interesting that the description of Alexithymia focusing on aetiology and treatment all are similar to the literature on Asperger’s syndrome. Taylor, Bagby and Parker (1997) describes persons with Alexithymia as having difficulty in describing feelings and having difficulty in distinguishing between feelings and bodily sensa- tions. He also points out their difficulties with affective self-regulation. Thus sufferers may have difficulties in the appraisal and expression of emotion and in the ability to use feelings to guide behaviour. Indeed Taylor et al. (1997) state that persons with Alexithymia ‘‘know very little about their own feelings and, in most instances, are unable to link them with memories, fantasies, and higher level effects, or specific situations’’ (page 29). It is argued that the inability of the patient with Alexithymia to express and modulate feelings, may lead to a discharge of tension through, for example, impulsive acts or compulsive behaviour such as binge eating (Bagby & Taylor, 1997). COGNITIVE PROBLEMS IN ALEXITHYMIA/ ASPERGER’S SYNDROME Taylor et al. (1997) notes that individuals with Alexithymia have problems with introspection, poor capacity for fantasy, and that they show a stimulus bound, externally orientated cognitive style. Indeed James Grotstein (in Disorders of Affect Regulation by Taylor et al., 1997) describes Alexithymia as ‘‘an affect processing disorder that interrupts or seriously interferes with the organisms self-organising and reorganising processes’’ (page 12). This means that they have a diffuse sense of self. Indeed there is an earlier disorder called Pensee Operatoire (operative thinking) described by Marty and de M’Uzan (1963) where there is a similar utilitarian thinking style to that seen in Alexithymia and indeed Asperger’s disorder. Krystal (1998) has described patients with La Pensee Operatoire as showing a ‘‘dull, mundane, unimaginative, utilitarian, and sequential recitation of concrete facts’’ (page 246). He also notes that these patients show a cognitive style where there is an ‘‘absence of the human quality (which) contributes to making these patients thoughts ‘‘operative’’ or thing orientated’’ (page 247). Such patients may often be described as dull, colourless and boring even when they are intellectual and clever (Taylor, 1984). Of course many persons with Alexithymia or Asperger’s syndrome or La Pensee Operatoire can operate very well or indeed at superior levels in their work as mathematicians, engineers, etc. (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001). PROBLEMS WITH SOCIAL RELATIONSHIPS IN ALEXITHYMIA AND ASPERGER’S SYNDROME Taylor et al. (1997) noted that Alexithymic individuals are ‘‘unable to identify accurately their 573 0162-3257/06/0500-0573/0 Ó 2006 Springer ScienceþBusiness Media, Inc. Journal of Autism and Developmental Disorders, Vol. 36, No. 4, May 2006 (Ó 2006) DOI 10.1007/s10803-006-0096-z Published Online: May 10, 2006