• Dawn Neumann, Barbra Zupan, James F Malec, and Flora Hammond.
• 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).
• J Head Trauma Rehabil. 2014 Jan 1;29(1):E18-27.

ObjectivesTo 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.ParticipantsSixty adults with moderate-to-severe TBI; 60 age and gender-matched controls.ProceduresParticipants 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).ResultsParticipants 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.ConclusionsResults 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.

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