Alexithymia Is Associated With Deficits in Visual Search for Emotional Faces in Clinical Depression

Background: The concept of alexithymia is characterized by difficulties identifying and describing one's emotions. Alexithymic individuals are impaired in the recognition of others' emotional facial expressions. Alexithymia is quite common in patients suffering from major depressive disorder. The face-in-the-crowd task is a visual search paradigm that assesses processing of multiple facial emotions. In the present eye-tracking study, the relationship between alexithymia and visual processing of facial emotions was examined in clinical depression. Materials and Methods: Gaze behavior and manual response times of 20 alexithymic and 19 non-alexithymic depressed patients were compared in a face-in-the-crowd task. Alexithymia was empirically measured via the 20-item Toronto Alexithymia-Scale. Angry, happy, and neutral facial expressions of different individuals were shown as target and distractor stimuli. Our analyses of gaze behavior focused on latency to the target face, number of distractor faces fixated before fixating the target, number of target fixations, and number of distractor faces fixated after fixating the target. Results: Alexithymic patients exhibited in general slower decision latencies compared to non-alexithymic patients in the face-in-the-crowd task. Patient groups did not differ in latency to target, number of target fixations, and number of distractors fixated prior to target fixation. However, after having looked at the target, alexithymic patients fixated more distractors than non-alexithymic patients, regardless of expression condition. Discussion: According to our results, alexithymia goes along with impairments in visual processing of multiple facial emotions in clinical depression. Alexithymia appears to be associated with delayed manual reaction times and prolonged scanning after the first target fixation in depression, but it might have no impact on the early search phase. The observed deficits could indicate difficulties in target identification and/or decision-making when processing multiple emotional facial expressions. Impairments of alexithymic depressed patients in processing emotions in crowds of faces seem not limited to a specific affective valence. In group situations, alexithymic depressed patients might be slowed in processing interindividual differences in emotional expressions compared with non-alexithymic depressed patients. This could represent a disadvantage in understanding non-verbal communication in groups.