The field of grounded and embodied cognition points to a bidirectional link between emotional processing and body functioning (Barsalou, 2008; Niedenthal et al., 2009). The relationship between the perception of a subjective (feeling) and an objective (bodily components) state influences the sense of coherence of the emotional experience (Sze et al., 2010), and appears to play an important role in emotional, behavioral and health regulation (Mehling et al., 2009). Psychiatric and psychological disorders as well as Somatic Symptom Disorder are all related to emotional regulation difficulties (Gross & Jazaieri, 2014). These difficulties occur at the affective, cognitive and social level, ranging from emotional awareness to regulatory strategies (Barlow et al., 2004; Boden & Thompson, 2015; Gross, 2002).
Difficulties in emotional awareness, associated with verbalization difficulties, have been widely studied in psychopathology and psychosomatics through the construct of alexithymia (Berthoz et al., 2011; Kojima, 2012a; Leweke et al., 2012). Alexithymia, initially introduced by Sifneos (Sifneos, 1973), is used to describe cognitive or personality traits including difficulty identifying emotions, describing feelings to others, externally oriented thinking (a preference for focusing on external events than personal feeling), and a limited imaginative capacity (Nemiah et al., 1976). More recently, beyond emotional awareness and its physiological component, greater attention is paid to the awareness of bodily states. Studies on chronic somatic disorders and pain has led to the proposition that they are characterized by alexithymia associated with physiological hyperarousal and an intense way of perceiving its sensations (and symptoms) as an hypersensitivity (Kano & Fukudo, 2013; Lumley et al., 1996) and sometimes, the reverse an hyposensitivity (Neumann et al., 2004; Rubio et al., 2014) both situations suggesting a mismatch between sensation and perception reflecting a disorder of interoception. Recently, the clinical importance of impairments in processing somatic sensation has been synthetized (Oka, 2020). Indeed, it helps to understand lack of consciousness of a present illness, and that could lead to kind of risky behaviors that contribute to maladaptive states (i.e. regulation of behaviors, awareness of fatigue and physical limits, therapeutical observance). Based on the Japanese construct of “shitsu-taikan-sho” (“shitsu” for lack, “taikan” for bodily sensations, and “sho” for symptoms) driven by psychosomatic studies, Ikemi suggested impairments that seems to be more extensive than alexithymia (emotion awareness) and refer to alexisomia (Ikemi & Ikemi, 1983).
Alexisomia, or “no words to describe bodily states”, is a clinical concept that refers to characteristics of having difficulties in the awareness and expression of somatic sensations (Kanbara & Fukunaga, 2016; Moriguchi & Komaki, 2013). In the most recent evolution of the conceptualization of alexisomia, this has been viewed as a related but independent construct of alexithymia (Ikemi & Ikemi, 1986).
If the concept of alexisomia appears relevant for neuropsychiatric, somatic and somatoform disorders (Fiene et al., 2018; Gan et al., 2016; Oka, 2020), it still needs to be understood and assessed since it should be linked to the ability to accurately sense the bodily states. Recently, a scale designed to assess the construct, named the Shitsu-taikan-sho Scale (STSS) has been developed and published in English by Oka (2020). This scale is composed of the following three dimensions: i) difficulties in identifying bodily sensations, ii) over-adaptations that refers to excessive responses to social demands which overlooks one’s real affective and physical states and needs, and iii) lack of health management based bodily sensations. At a conceptual level, it appears that non-affective body awareness represents the roots of the concept of alexisomia as it taps on a central deficit of interoception. Recent research underlines that alexisomia is a way to better understand processing involved in interoception. As this has been underlined from past research, we suggest measuring alexisomia through a scale that only focuses on this aspect: the Body Awareness Questionnaire (BAQ) (Shields et al., 1989). Indeed, the BAQ taps in explicit vigilance about the variations in body cues and its consequences for health. It is an 18-item scale designed to assess self-reported attention and awareness of normal non-affective bodily processes. It can be used as a unidimensional approach of interoception, but it can also be divided into four dimensions. These four dimensions refer to: i) the response or changes in body processes, ii) the prediction of body reaction, iii) the perception of sleep-wake cycles, and iv) the self-prediction of the onset of illness.
The aim of this study was twofold. First, to validate the French version of the Body Awareness Questionnaire (BAQ), and to test its psychometric properties in a general (non-clinical) population, and second, to test its relation to alexithymia. To the best of our knowledge, that is the first study that approach the BAQ through the construct of alexisomia and its relation to alexithymia.