Alexithymia is associated with neural reactivity to masked emotional faces in adolescents who self-harm

Lauren A. Demers, Melinda Westlund Schreiner, Ruskin H. Hunt, Bryon A. Mueller, Bonnie Klimes-Dougan, Kathleen M. Thomas, Kathryn R. Cullen

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Non-suicidal self-injury (NSSI) is a major, trans-diagnostic mental health problem among adolescents. Alexithymia has been identified as a developmental risk factor for NSSI. Research on how alexithymia relates to the neurobiology of automatic emotion processing is only beginning to emerge. This study evaluates the relationship between alexithymic features and neural responses to automatic processing of emotional content in adolescents with NSSI. Methods: 25 female adolescents (ages 13–21) with a history of repeated engagement in NSSI completed the Toronto Alexithymia Scale and the Difficulties with Emotion Regulation Scale and underwent functional magnetic resonance imaging (fMRI) during a task in which participants were exposed to masked emotions. Results: One facet of alexithymia, limited internal emotion awareness or externally-oriented thinking (EOT), was related to differential reactivity to masked emotional faces in clusters in the right supramarginal gyrus and right inferior frontal gyrus. Follow-up assessment of regional reactivity revealed that greater EOT is associated with lower activation to masked happy faces but higher activation to masked fearful faces. Other facets of alexithymia did not show relationships with reactivity to masked emotional faces. Limitations: This is a cross-sectional and small sample that only includes females, which may attenuate generalizability of findings. Conclusions: We report neural correlates of multiple facets of alexithymia in adolescents with NSSI. Among adolescents who self-harm, those with higher levels of EOT may be less alert to subtle positively-valenced emotion cues. For this subset of adolescents with NSSI, interventions designed to enhance mental representation of emotional responses and attention to positive emotions may be appropriate.

Original languageEnglish (US)
Pages (from-to)253-261
Number of pages9
JournalJournal of Affective Disorders
StatePublished - Apr 15 2019

Bibliographical note

Funding Information:
The authors would like to sincerely thank the participants and families that participated in this study. The study was funded by National Institute of Mental Health grant 1R21MH094558 (Dr. Cullen) and the University of Minnesota Academic Health Center Faculty Research Development Grant Program (Grant #. 11.12). The authors acknowledge the Minnesota Supercomputing Institute (MSI) at the University of Minnesota for providing resources that contributed to the research results reported within this paper. URL: . Trainee support was provided by the University of Minnesota's Institute of Child Development via a National Institute of Mental Health National Research Service Award Grant no. 2T32MH015755-39 (to LAD).

Publisher Copyright:
© 2019 Elsevier B.V.


  • Alexithymia
  • Masked faces
  • Non-suicidal self-injury (NSSI)
  • fMRI


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