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No general pathological significance of aphantasia: An evaluation based on criteria for mental disorders

DOI: 10.1111/sjop.12887
Monzel, M., Vetterlein, A., & Reuter, M. (2023). No general pathological significance of aphantasia: an evaluation based on criteria for mental disorders. Scandinavian Journal of Psychology, 64(3), 314–324. doi:10.1111/sjop.12887

Abstract

As awareness of the phenomenon of aphantasia (= lack of voluntary imagery) has increased in recent years, many psychotherapists ponder its clinical implications. The present study investigates whether aphantasia meets the criteria for mental disorders, i.e. statistical rarity, impairment in activities of daily living, violation of social norms and inappropriate behavior and personal distress. Prevalence of aphantasia was determined meta‐analytically based on 3,543 participants. An international sample of 156 participants with aphantasia (58.3% male; Mage = 35.23) and 131 controls (65.6% male; Mage = 28.88) was assessed with the Reading the Mind in the Eyes Test, the Questionnaire for the Assessment of Everyday Memory Performance and the Aphantasia Distress Questionnaire, as well as measures of depression, anxiety and well‐being. The prevalence of aphantasia was estimated at 3.5 to 4.8%. Participants with aphantasia scored significantly lower than controls on every day and autobiographical memory, but not on theory of mind. A subgroup of 34.7% of participants with aphantasia reported distress significantly associated with lower well‐being and high levels of anxiety and depression. The level of distress increased with poorer performance in autobiographical memory and theory of mind. Although aphantasia meets the criterion of statistical rarity, the impact on activities of daily living and personal distress is too weak to justify a classification as a mental disorder. In a subgroup, however, distress can reach clinically relevant levels. In individual cases, it is therefore advisable to conduct a psychological assessment, for example by means of the Aphantasia Distress Questionnaire.

Authors

  • Merlin Monzel23
  • Annabel Vetterlein4
  • Martin Reuter15

Understanding Aphantasia: A Study on Its Impact and Classification

Overview/Introduction

Aphantasia is a condition where individuals lack the ability to voluntarily create mental images. As awareness of this phenomenon grows, questions arise about its implications for mental health. This study explores whether aphantasia should be classified as a mental disorder by examining its prevalence and impact on daily life and mental well-being.

Methodology

The research involved a meta-analysis of 3,543 participants to estimate the prevalence of aphantasia. An international sample of 156 individuals with aphantasia and 131 without was assessed using various tests, including:
  • Reading the Mind in the Eyes Test: Evaluates the ability to understand others' emotions.
  • Questionnaire for the Assessment of Everyday Memory Performance: Measures memory function in daily life.
  • Aphantasia Distress Questionnaire: Assesses personal distress related to aphantasia.
Additional measures for depression, anxiety, and well-being were also included.

Key Findings

  • Prevalence: Aphantasia affects approximately 3.5% to 4.8% of the population.
  • Memory Performance: Individuals with aphantasia showed lower scores in everyday and autobiographical memory compared to controls.
  • Emotional Understanding: No significant differences were found in the ability to understand others' emotions.
  • Personal Distress: About 34.7% of those with aphantasia reported significant distress, linked to lower well-being and higher anxiety and depression levels.

Implications

  • Mental Health Classification: While aphantasia is statistically rare, its impact on daily life and personal distress does not justify classifying it as a mental disorder. However, for a subset of individuals experiencing significant distress, psychological assessment may be beneficial.
  • Therapeutic Considerations: Therapists should be aware that traditional methods relying on mental imagery may be less effective for individuals with aphantasia. Alternative strategies should be considered.

Limitations

The study acknowledges that the distress experienced by some individuals with aphantasia may be influenced by factors unrelated to the condition itself, such as underlying mental health issues or personality traits.
Further research is needed to explore the potential compensatory strategies used by those with aphantasia and to understand the full range of its impact on mental health.
In conclusion, while aphantasia presents unique challenges, it is not inherently a mental disorder. Understanding and addressing the needs of those affected can improve their quality of life and ensure appropriate support is provided.