Aphantasia and alexithymia predict complex PTSD symptoms

Abstract

Aphantasia is characterised by a complete, or almost complete, absence of visual imagery. Prior work has hinted that these individuals may experience qualitative alterations in posttraumatic stress disorder symptoms (PTSD) in contrast to neurotypicals. However, higher levels of alexithymia (i.e., difficulties identifying one’s own emotions) and trauma exposure have been linked to PTSD and possibly aphantasia. We therefore wondered if aphantasia would be associated with the most widely used PTSD symptom measures (i.e., the PTSD Checklist for DSM-5: PCL-5; and the International Trauma Questionnaire: ITQ) when alexithymia, trauma levels, sex at birth and age were considered. We replicated prior work in finding alexithymia positively predicts symptoms across all PTSD and complex PTSD measures, their subscales, and their related functional impairments. By contrast, aphantasia was not clearly linked to PTSD symptoms in global PCL-5 or ITQ scores, nor in any of the PCL-5 subscales. Despite this, aphantasia was associated with a reduction in the ITQ’s re-experiencing of traumatic events subscale, and an increase in complex PTSD symptoms, i.e., disturbances in self-organization and its related functional impairments, negative self-concepts, and difficulties in interpersonal relationships. Given their elevated levels of complex PTSD symptoms, those with aphantasia may require greater support than is currently considered. Moreover, these findings support suggestions that the disturbances in self-organisation associated with complex PTSD may be partially distinct from the core symptoms of PTSD.