Alexithymia–Anterior-Insula Underconnectivity

🧠 Overview

“Alexithymia–Anterior-Insula Underconnectivity” is a neurobiological framework that explains how, for some people, the fact that they “cannot clearly identify or describe their own emotions” is not due to a lack of psychological effort, but arises from abnormalities at the level of brain circuits — especially in the anterior insular cortex (AIC), which functions as the “hub of bodily perception (interoception)” and the “bridge between body–emotion–self-awareness.”

Under normal conditions, the anterior insula works together with the anterior cingulate cortex (ACC) and the prefrontal cortex to receive information from inside the body — for example, heart rate, changes in breathing, or muscle tension — and transform this information into “emotional feelings” that we can consciously perceive, such as fear, anger, or joy. But when the connection between the insula and ACC falls into a state of underconnectivity (weakened connection or incomplete synchronization), this process becomes disrupted.

As a result, the brain can register “bodily signals” but cannot “interpret” them accurately into emotional words or meanings — making the person feel as if their emotions are buried too deep to reach, leaving them speechless or confused between different feelings, such as not being sure whether they are currently “stressed, afraid, or exhausted.”

This condition is therefore not about a lack of self-understanding due to laziness, but about the brain having difficulty linking the body-perception system with the emotion-interpretation system, which are jointly operated by the entire salience network. When this circuit is weakened, the brain tends to rely more on “logic” and “analysis” instead of “feeling.”

People thus often explain themselves with reasons rather than feelings, for example: “I’m just overthinking it,” instead of “I feel afraid,” or “I feel lonely.” This makes emotional communication with others more difficult and may cause people around them to misunderstand them as being “cold” when, in fact, their internal emotional system is simply “not being accessed with clear explanations.”

In neurobiological terms, underconnectivity does not mean the brain is damaged; it refers to weakened or unstable functional connectivity between the insula and key emotional networks. This leads to delays in interpreting emotional and bodily signals, sometimes resulting in “emotional delay” — feeling the emotion many hours after the event has already passed.

Many fMRI and EEG studies have found that the anterior insula in this group responds more weakly to emotional stimuli — especially positive emotions — and shows desynchronized connectivity patterns with the ACC compared to control groups. This reflects that the perception of the “feeling of self” is not functioning at full efficiency.

In summary, the model “Alexithymia–Anterior-Insula Underconnectivity” shows that difficulty in knowing one’s own emotions is more of a “brain state” than a “personality trait,” and can be understood as a weakening of neural connections in the interoceptive–emotional circuit, causing the person to “feel but not know what they feel” — a state that truly lies between the body and the meaning of the mind.

💬 Core Symptoms

The symptom cluster of Alexithymia–Anterior-Insula Underconnectivity is a combination of “impaired emotional awareness” and “confusion about bodily signals (interoceptive confusion)” that arises from weakened connections between the anterior insula and the ACC–prefrontal–limbic network.
The core symptoms are therefore not just about “not being good at talking about emotions” but rather that “the internal brain system cannot accurately interpret the emotions that arise.”
When bodily signals (such as a racing heartbeat, sweating, or tension) are sent to the brain, the insula–ACC circuit is supposed to “name” them and “create emotional meaning” for those sensations. If this circuit is not synchronized, the signals become like faint sounds or lack narration, so the person only perceives that “something is happening inside” without knowing “what it is.”

1) Difficulty Identifying Feelings

People in this group often cannot clearly identify what they are feeling, even when the situation is clearly emotionally charged — such as conflict, loss, or receiving praise. The internal system cannot fully map events to emotions.
For example, they may feel “tightness in the chest, heaviness in the stomach, or shortness of breath” but do not know whether that sensation is “fear,” “anger,” or “excitement that is too intense.”
When asked, “How do you feel right now?” they tend to respond with rational or situational explanations such as “I’m tired because there’s a lot of work,” instead of saying “I feel drained and scared I won’t finish in time.”
Differentiating subtle feelings such as “fear” vs. “anxiety,” or “anger” vs. “disappointment,” is nearly impossible, because the brain receives them as a single “lumped-together signal” that has not been categorized into emotional types.

This pattern is related to reduced activity in the anterior insula, the hub of emotional interoception. When this brain region does not reliably send signals to the ACC and prefrontal cortex, emotional interpretation never fully occurs.
Some people therefore feel like “life is like watching a silent movie” — there are images but no sound — or “events are happening but the heart hasn’t felt anything yet.”

Consequences include:

• Decisions in relationships tend to rely too heavily on reason, because they are unsure what they truly feel.
• Emotion regulation fails because they don’t know “what exactly needs to be regulated.”
• When stress arises, the brain relies on logical pathways until it becomes exhausted (cognitive overload) without allowing emotions to be expressed and released.

Some may perceive themselves as “cold” or “heartless,” when in reality their emotional system is still working — it just lacks clear language or imagery for conscious understanding.

2) Difficulty Describing Feelings

In addition to not knowing what they feel, people in this group cannot “put emotions into words” even when they can sense something at the bodily level.
They may say only “I feel weird,” “uncomfortable,” or “not so good,” but cannot specify whether it is sadness, anger, or fear, because the insula–temporal–language network does not communicate well enough to link “raw emotion” with “words in the mind.”
When the anterior insula does not send information coherently to the language network (Broca’s/Wernicke’s areas), the translation of emotion into verbal expression breaks down halfway.

As a result, the person chooses to talk about “external things” instead of “inner feelings,” for example:

• “I know it’s unfair” instead of “I feel angry about being taken advantage of.”
• “I’m probably just tired” instead of “I feel hopeless and completely drained.”

This rational style of language serves both as a compensatory mechanism and an emotional defense, because when there is no clear explanation, the brain avoids feeling too much.

People in this group often communicate emotions through bodily behavior — sighing, avoiding eye contact, or withdrawing into silence — without realizing that they are “speaking with their body instead of words,” which easily creates misunderstandings in relationships.
They also tend to internalize emotions in the body — such as chronic headaches, stomachaches, or chest tightness — without knowing that the true origin is unexpressed emotion.

Clinically, this inability to identify and describe emotions is often associated with low functional connectivity between the anterior insula and ACC, and between the insula and prefrontal cortex, regions involved in emotion regulation and adding linguistic context.
This condition is therefore “being unable to speak because the brain does not send enough emotional information to be spoken,” not because of a lack of effort.

📋 Diagnostic Criteria 

Although not formally included in DSM or ICD, creating conceptual criteria helps researchers and therapists understand the nature of this symptom cluster more clearly, especially when considered from a neuro-functional perspective.

A. Affective Criteria (Emotion-Related Symptoms)

The person must have persistent difficulty in identifying or describing their own emotions:

• Feels that “something is happening inside” but cannot name the emotion.
• Can describe emotions only in very limited terms, such as using broad labels like “good/bad.”
• Cannot distinguish which emotion is linked to the bodily feelings they are experiencing.
• Tends to explain emotions using logic, e.g. “I’m not angry; it just doesn’t make sense.”

B. Interoceptive & Awareness Criteria

These reflect problems in perceiving and interpreting bodily signals:

• Reports vague self-states, e.g. “I feel heavy in my chest, but I don’t know why.”
• Shows physical symptoms from stress, such as headaches or stomachaches, without being able to link them to emotions.
• Feels “cut off from the inside” or “as if body and mind are in different places.”
• Has a level of self-awareness that is lower than average.
• On interoceptive accuracy tests (e.g. heartbeat perception task), usually scores lower than normative values.

C. Behavioural & Social Criteria

These show the impact of emotional deficits in social contexts:

• Avoids conversations about feelings because they don’t know how to answer.
• Appears unresponsive to others’ emotions or understands them slower than usual.
• In conflicts, often remains “silent” or “slow to respond” because they still don’t know what they themselves feel.
• Others may misinterpret them as cold, uncaring, or lacking empathy, when in fact it is a delay in the emotion-perception system.

D. Functional Impairment

Observable impacts on daily life:

• Difficulty forming and maintaining relationships because they cannot respond appropriately to others’ emotions.
• Often neglects physical health because they do not sense their own stress until the body breaks down.
• Makes major life decisions without referencing emotions — for example, choosing a job or partner based purely on logic, later feeling empty.
• Has a high risk of depression and burnout because emotions are suppressed and never discharged.

E. Neural / Research Specifier

For brain-based studies, additional points can be specified, such as:

• Functional MRI: Reduced connectivity between anterior insula and ACC, or mismatched activation patterns in response to emotional stimuli.
• Resting-state connectivity: Evidence of underconnectivity within the salience network, which detects important bodily–emotional signals.
• Structural MRI: Differences in volume of the insula or cingulate cortex compared to control groups in some studies.
• Behavioral correlation: Severity of alexithymia (measured by TAS-20 score) shows a negative correlation with connectivity levels between insula–ACC and insula–prefrontal regions.

Summary:

The syndrome Alexithymia–Anterior-Insula Underconnectivity is a breakdown in coordination between the “language of the body” and the “language of the mind” — the brain senses what is happening but cannot decode it into emotions with verbal meaning. As a result, the person may appear cold, while internally they are in turmoil, lacking the neural tools needed to understand those experiences in terms of language and meaning.

🧬 Subtypes or Specifiers

Within this model, we can divide the condition into subtypes or specify markers (specifiers) to explain the diversity of individuals, for example:

1) Cognitive-Dominant Type (“Thinks a lot but can’t talk about feelings”)

• Life is governed almost entirely by logic and reason.
• Very good at planning and analysis, but always stuck when asked, “And how do you feel about that?”
• Their inner world is more like a spreadsheet than a landscape of images and emotions.

2) Somatic-Alarm Type (Emotion Expressed Through the Body)

Emotions rarely appear as thoughts or tears but instead manifest as:

• Headaches
• Stomachaches
• Chest tightness
• Insomnia

They often visit doctors repeatedly but no clear physical cause is found.

3) Masked-Autistic / Neurodivergent-Linked Specifier

• High levels of alexithymia are found in groups with ASD, ADHD, PTSD, MDD, and other neurodivergent populations viejo.medwave.cl+2PubMed+2
• Some people have the skill to “act normal” (masking) in social situations, but internally have almost no sense of what they are feeling.

4) Trauma-Linked Specifier

• History of trauma or emotional neglect from childhood.
• The brain learns that “cutting off from emotions = a self-protection mechanism.”
• When combined with insula–ACC function under chronic stress, underconnectivity of the emotion–body perception circuit may develop. PubMed+1

5) Mood-Disorder-Linked Specifier

• Co-occurs with depression and/or anxiety disorders.
• Alexithymia makes it hard to notice early signs of relapse, so people often seek help only when symptoms are severe.
• Some studies find differences in insula activity between non-psychiatric alexithymia and groups with comorbid MDD. Frontiers+1

🧠 Brain & Neurobiology 

The brain structure and neural connectivity involved in Alexithymia–Anterior-Insula Underconnectivity have become a focal point of neuroscience over the past decade, because they explain precisely “why some people can feel in the body but not fully in the mind.”
This condition goes beyond personality or upbringing; it concerns the coordination of multiple brain regions working together as complex neural networks.

🧩 1) Role of the Anterior Insula (AIC)

The Anterior Insular Cortex lies deep within the folds of the front–temporal region. It plays a central role in interoception — perception of internal bodily signals such as heart rate, temperature, respiration, hunger, muscle tension, and also “awareness of one’s current internal state.”

Under normal conditions, the AIC transforms these bodily signals into emotional feelings — fear, sadness, pride, shame — by linking physical data to interpretations in the prefrontal cortex and anterior cingulate cortex (ACC).
In this sense, the insula is the “bridge” between body and mind.

When underconnectivity occurs — that is, the links between insula and ACC or prefrontal cortex are weakened — the bodily signals are “stuck halfway,” so the person only knows that something is happening inside (heaviness in the chest, shortness of breath, stomach discomfort) but the brain cannot label it as “stressed, afraid, or angry.”
This is the neurobiological reason why people in this group can say only “I don’t feel so good” instead of naming a clear emotion.

The AIC is also involved in the sense of emotional ownership and self-awareness.
When this circuit is weakened, people often feel “detached from themselves” or as if they are “watching their life from the outside” (a depersonalization-like experience).
There is also evidence that the insula of people with alexithymia responds less to emotional images or sounds and shows EEG signatures indicating slower emotional processing compared to control groups.

🧠 2) Salience Network and Insula–ACC Connectivity

The Salience Network (SN) is one of the brain’s three major networks controlling mode switching of the mind, alongside the Default Mode Network (DMN) and Central Executive Network (CEN).
The SN consists mainly of the anterior insula (AI) and anterior cingulate cortex (ACC), and its function is to detect what is “important” both internally and externally — a racing heart, pain, tension, or an angry facial expression.

When the SN functions normally, it “switches” the brain from resting mode (DMN) to decision/response mode (CEN).
In alexithymia with insula–ACC underconnectivity, however, this system often works suboptimally → the brain cannot clearly detect emotional signals or cannot evaluate whether “what I am feeling is important enough to interpret.”
As a result, feelings are overlooked or suppressed without conscious awareness.

fMRI studies show that connectivity between insula and ACC is negatively correlated with alexithymia levels measured by the TAS-20 (Toronto Alexithymia Scale).
The higher the alexithymia score, the lower the SN connectivity. In some cases, the insula may also be unsynchronized with the amygdala (the raw emotion center), so people experience strange emotional states with no clear reasons — feeling “heavy” or “like I’m sad but don’t know why.”

🧩 3) Underconnectivity in Alexithymia

Numerous neuroimaging studies support the underconnectivity concept:

• Resting-state fMRI: Reduced functional connectivity between insula and ACC, medial prefrontal cortex, and precuneus (part of the DMN), associated with difficulty identifying emotions.
• Task-based fMRI: When shown emotional images or sounds, the anterior insula of alexithymic individuals shows weaker activation, especially for positive emotions.
• EEG studies: Longer latencies in brain responses to emotional stimuli, consistent with the idea of “late-coming emotions” or “feeling only afterward.”

Overall, the “emotion-interpretation circuit” in these individuals shows inconsistent coordination between the limbic system (amygdala, insula) and cognitive control systems (ACC, prefrontal cortex).
What the body feels is therefore not translated into “emotion with a name” in time.

🌡️ 4) Interoceptive Deficits & Insula

Interoception is the process of perceiving internal bodily states — knowing that the heart is beating fast, breathing deeply, or muscles are tense. This perception underpins emotional awareness.
In typical individuals, the anterior insula links signals from the visceral system (heart, lungs, gut, etc.) to emotional interpretations. In alexithymia, however, insula activity is inconsistent.

Some people show underactive insula — low responsiveness, leading to “not knowing what is being felt in the body.”
Others show overactive insula with poor prefrontal connectivity → excessive bodily sensations (dizziness, faintness, stomach pain) without understanding that they stem from stress or emotions.

Research shows that heartbeat detection accuracy is lower in alexithymic individuals, reflecting dysfunction in the insula and the broader interoceptive system.

🧠 5) Other Relevant Networks

• Amygdala: The hub of basic emotions (fear, anger). When communication with the insula is impaired, the brain detects threat or stress either too slowly or too intensely, leaving the person confused about why their body is reacting so strongly.
• Prefrontal Cortex: Evaluates the reasoning and context of emotions. If prefrontal activity is overly dominant, logic can override emotion, leaving a person who “knows what happened” but “doesn’t know how they feel about it.”
• Cingulate Cortex: Governs emotional regulation and empathy. Weak ACC–insula connectivity makes it difficult to process one’s own and others’ feelings.
• Default Mode Network: When the DMN is dominant at rest, the mind tends to ruminate about the past. In alexithymia, poor integration with the SN leads to “thinking a lot without feeling.”

🧩 Mechanistic Summary

Body → sends signals via internal nervous systems → anterior insula detects them → passes them to ACC and prefrontal cortex for emotional meaning.
But with underconnectivity, emotional signals never complete the circuit → the person perceives the body but not the heart.

This brain-wide picture shows in depth why “feeling” is a matter of neural networks, not just a choice to feel or not feel.

🧩 Causes & Risk Factors 

The development of Alexithymia–Anterior-Insula Underconnectivity usually results from an interplay of biological, experiential, and cultural factors that shape brain circuits from childhood into adulthood.

🧬 1) Genetic and Brain-Structural Foundations

Twin studies show that alexithymic traits are about 30–40% heritable, especially genes related to the serotonin transporter (5-HTTLPR) and dopamine receptors (DRD2/DRD4), which regulate emotional response and reward learning.
Structural differences in the brain, such as thinner cortex in the anterior insula or ACC, are also associated with higher alexithymia levels.

Some studies find that the right insular volume is smaller in alexithymic groups than in controls, possibly reflecting reduced white-matter pathways connecting to the emotional salience network.

👶 2) Childhood Care and Emotional Experiences

The brain learns to “feel” through mirroring from caregivers in early life. When a crying child is consistently soothed, the brain learns to link bodily signals with emotional labels.
In contrast, a child raised in an environment where emotions are ignored, forbidden, or punished learns that feeling is unsafe. The brain then develops a habit of “cutting off from emotions” as a defense mechanism.

Over time, the insula–ACC circuit weakens because it is not used frequently — like a neural pathway overgrown with grass because no one walks it.

⚡ 3) Trauma & Chronic Stress

Emotional trauma — particularly emotional neglect or abuse — teaches the brain to “shut down the feeling system” to survive.
When the body is repeatedly activated by stress, the HPA axis releases cortisol and adrenaline continuously, altering the balance between limbic systems (amygdala, insula) and the prefrontal cortex.
The insula, as the emotional perception hub, may downregulate its response to prevent overload, and over the long term this becomes underconnectivity.

In PTSD, for example, the insula often shows abnormal activity alongside the amygdala and ACC, closely linked to dissociation and emotional numbing.

🧠 4) Neurodevelopmental Conditions (ASD, ADHD, PTSD, MDD)

Alexithymia is highly prevalent in ASD (Autism Spectrum Disorder), especially high-functioning autism. Neuroimaging shows reduced functional connectivity in the salience network and insula, consistent with difficulty in understanding one’s own and others’ emotions.
In ADHD, emotional regulation is unstable because prefrontal function is inconsistent, which affects its joint processing with the insula.
In MDD (Major Depression) or Anxiety Disorders, insula activity may be dampened by limbic hyperactivation, leaving people feeling “numb” or “cut off from feelings.”

🌍 5) Cultural and Social Factors

Cultures that emphasize reason, endurance, and emotional control — such as many East Asian societies — tend to show higher rates of alexithymia than Western countries.
Teaching children to “endure, don’t cry, don’t get angry” may lead them to learn that emotions should not be spoken. When this pattern is repeated over decades, the brain builds shortcuts that bypass direct emotional awareness and jump straight into analytical thinking.

🔄 6) Lifestyle & Modern Stress

In the digital age, people are stimulated more by information than by bodily experience. The brain is constantly in cognitive mode — analyzing, planning, replying — which reduces opportunities for body–mind connection.
When interoceptive signals are chronically ignored, the anterior insula becomes desensitized from lack of use, eventually leading to emotional blindness.

🧩 Etiological Summary

Alexithymia–Anterior-Insula Underconnectivity emerges from overlapping influences of:

• Genetics related to emotional processing
• Upbringing that limits emotional language
• Emotional trauma and wounding
• Social and cultural environments that suppress emotional expression

Together, these shape brain pathways that lack integration between “body–emotion–language” and crystallize into a pattern of “feeling without knowing that one is feeling.”

Final Summary:

The brain of a person with Alexithymia–Anterior-Insula Underconnectivity is not “empty,” but in a state where “the inner emotional voice is too faint to hear.”
All therapies that focus on restoring interoception or the salience network share the same goal — to gradually turn up that inner volume until it is loud enough to recognize, “This is what my feelings are.”

🛠 Treatment & Management

The goal is not to “eliminate alexithymia entirely,” but to
“gradually clarify the pathways between body–emotion–words and learn to live with oneself more gently.”

1) Psychoeducation (Education about Brain–Emotion)

• Explain that alexithymia and anterior insula issues are matters of “brain circuits and learning,” not personal failure.
• Help reduce shame and self-blame (“Why am I so stupid that I can’t feel anything?”).

• Understand that “not knowing what one feels” is a symptom, not an identity.

2) Interoceptive Training (Systematic Training in Reading Bodily Signals)

Practice noticing:

• Heartbeat
• Breathing
• Tension in shoulders, abdomen, chest

Example techniques:

• Body scan
• Mindfulness focusing on sensate experience (e.g. “Do I feel warm or cold? Heavy or light right now?”)

Recent studies are beginning to experiment with insula stimulation using HD-tDCS to enhance interoception and emotional processing (still at the research level, not a standard treatment). Frontiers+2onlinelibrary.wiley.com+2

3) Emotion Labeling & Vocabulary Training

Exercises that pair:

• Situational images with feelings
• Bodily signals with emotion words (e.g. fast heartbeat and shaking hands → fear/excitement)

Practice using more nuanced emotion words, from just “good/bad” to “relaxed, worried, annoyed, hurt, disappointed.”
Emotion wheels or emotion cards can be used to help identify feelings.

4) Therapies that Focus on Relationship with Emotion

Such as:

• Emotion-Focused Therapy (EFT) – helps people access, process, and transform emotions.
• Mentalization-Based / Psychodynamic Therapy – builds self-reflection and links thoughts–feelings–experiences.
• CBT / DBT adapted to emphasize interoception – adds modules that train noticing and naming emotions before shifting into cognitive reasoning.

5) Trauma-Informed & Attachment-Focused Work

If trauma or emotional neglect is present, work must be done in a “safe” context that gives careful space to emotions.

Focus on creating new experiences opposite to the past, for example:

• When “something” begins to be felt, it is not immediately criticized or dismissed.

6) Self-Management

Keep a “mind–body log,” noting:

• Events
• Bodily symptoms
• Thoughts
• Guessed emotion words (write them down even if unsure)

Practice checking in with oneself 2–3 times a day with simple questions:

• How does my body feel right now?
• If my emotion had a color / temperature / shape, what would it be?

Use art, writing, or music as a medium instead of direct verbal expression in the early phases.

📝 Notes

• Not everyone with alexithymia must have anterior insula underconnectivity; likewise, not everyone with abnormal brain connectivity will have obvious symptoms in daily life.
• This model helps us “see the wiring in the brain” that explains why some people experience “feeling something but being unable to speak it,” without blaming their intentions.
• In real clinical work, diagnosis focuses more on symptoms and history than brain data (because fMRI/EEG are not routine), but the model helps plan interventions targeting interoception and emotional awareness more precisely.
• For writing, content creation, or psychoeducation, you can use “Alexithymia–Anterior-Insula Underconnectivity” as one brain-based subtype of alexithymia, distinct from personality-based or trauma-based subtypes.

📚 References

Craig, A. D. (2009). How do you feel—now? The anterior insula and human awareness. Nature Reviews Neuroscience, 10(1), 59–70.

Gu, X., & FitzGerald, T. H. (2013). Interoceptive inference: Homeostasis and decision-making in the anterior insula. Frontiers in Neuroscience, 7, 340.

Meza-Concha, N. et al. (2017). Towards a neurobiological understanding of alexithymia. Frontiers in Psychology, 8, 1736.

van der Velde, J., Servaas, M. N., Goerlich, K. S., et al. (2013). Neural correlates of alexithymia: A meta-analysis of emotion processing studies. Neuroscience & Biobehavioral Reviews, 37(8), 1774–1785.

Motomura, Y. et al. (2023). Alexithymia characteristics are associated with salience network activity and connectivity. Scientific Reports, 13, 10421.

Wiebking, C. et al. (2015). Neural activity during interoceptive awareness and alexithymia. Human Brain Mapping, 36(10), 3914–3926.

Goerlich, K. S., & Aleman, A. (2018). Neuroimaging studies of alexithymia. In The Oxford Handbook of Alexithymia (pp. 129–148). Oxford University Press.

Menon, V. (2024). Insular cortex: A hub for saliency, cognitive control, and interoceptive awareness. Progress in Neurobiology, 235, 102945.

Bird, G., Silani, G., Brindley, R., White, S., Frith, U., & Singer, T. (2010). Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain, 133(5), 1515–1525.

Shah, P., Hall, R., Catmur, C., & Bird, G. (2016). Alexithymia, not autism, is associated with impaired interoception. Cortex, 81, 215–220.

Moriguchi, Y., & Komaki, G. (2013). Neuroimaging studies of alexithymia: Physical, affective, and cognitive perspectives. BioPsychoSocial Medicine, 7(1), 8.

Herbert, B. M., & Pollatos, O. (2012). The body in the mind: On the relationship between interoception and embodiment. Topics in Cognitive Science, 4(4), 692–704.

Liemburg, E. J. et al. (2012). Reduced connectivity in the salience network and its relation to alexithymia in schizophrenia. Psychiatry Research: Neuroimaging, 201(1), 48–56.

Terasawa, Y., Moriguchi, Y., Tochizawa, S., & Umeda, S. (2014). Interoceptive awareness and insula activity associated with alexithymia. Social Cognitive and Affective Neuroscience, 9(7), 1088–1096.

Menon, V. & Uddin, L. Q. (2010). Saliency, switching, attention and control: A network model of insula function. Brain Structure and Function, 214(5–6), 655–667.

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