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The Impact of Aphantasia on Mental Healthcare Experiences

DOI: 10.1525/collabra.127416
Mawtus, B., Renwick, F., Thomas, B. R., & Reeder, R. R. (2024). The impact of aphantasia on mental healthcare experiences. Collabra: Psychology, 10(1). doi:10.1525/collabra.127416

Abstract

Approximately 4% of the population has aphantasia, which is defined as impoverished, or absent, sensory mental imagery. Previous research suggests that people with aphantasia (aphants) may have a higher prevalence of mental health conditions and neurodivergence compared to the general population, but aphantasia presents a special challenge for diagnosis and treatment. Many mental health conditions are currently characterized by imagery-related symptomology (such as sensory flashbacks in post-traumatic stress disorder or negative body image in eating disorders), and the dominant therapeutic treatments rely heavily on imagery techniques. Thus far, little is known about how this impacts mental healthcare experiences in individuals with aphantasia. In the current study, we used a mixed-methods (questionnaire, interview) approach to comprehensively investigate the effects of aphantasia on seeking diagnoses and treatments for mental illness. Quantitative analyses on the questionnaire data revealed that virtually all psychiatric disorders manifest with a lack of imagery-related symptomology in aphantasia compared to typical imagery controls; aphants report “lack of awareness or understanding of aphantasia” as a common factor in missed- or misdiagnosis by mental health professionals, although the prevalence of missed and misdiagnoses are no different from typical imagery controls; and aphants are very likely to report that therapies involving mental imagery, especially visual imagery in CBT, are ineffective in their mental health treatment compared to controls. Two main themes were generated following qualitative analysis of interviews: Quest for Identity and Mental Health Journey. Feelings of being different, memory challenges, and self-discovery based on help-seeking contributed to the first theme. Aphants found different levels of success in their mental health journeys depending on whether they experienced anxiety and/or depression, neurodiversity conditions, or trauma and/or complex mental health conditions, with the latter group critically relying on professional empathy and understanding for positive outcomes. Together, these results point to a widespread impact of aphantasia on diverse aspects of mental healthcare.

Authors

  • Bridget Mawtus1
  • Fran Renwick1
  • Bethany R Thomas1
  • Reshanne R. Reeder5

Understanding Aphantasia and Its Impact on Mental Healthcare

Overview/Introduction

Aphantasia is a condition affecting about 4% of the population, characterized by an absence or reduction of sensory mental imagery. This study explores how aphantasia impacts mental healthcare experiences, particularly in diagnosis and treatment. People with aphantasia, known as aphants, often face unique challenges in mental health contexts, where imagery-based symptoms and treatments are common.

Methodology

Researchers employed a mixed-methods approach, using questionnaires and interviews to gather data from individuals with aphantasia. The study involved over 2,800 participants, including both aphants and those with typical imagery abilities. The aim was to understand the prevalence of mental health conditions among aphants and their experiences with mental health services.

Key Findings

  • Imagery-Related Symptoms: Aphants reported fewer imagery-related symptoms in psychiatric disorders compared to those with typical imagery abilities. For example, they are less likely to experience visual flashbacks in PTSD.
  • Diagnosis Challenges: Aphants often feel misunderstood by mental health professionals, leading to potential misdiagnoses. However, the rate of misdiagnosis is not significantly higher than in the general population.
  • Therapy Effectiveness: Therapies relying on mental imagery, such as Cognitive Behavioral Therapy (CBT), are often perceived as less effective by aphants. Non-visual imagery techniques were found to be more beneficial.
  • Identity and Mental Health Journey: Aphants' experiences are shaped by a quest for identity, with themes of feeling different, memory challenges, and varied success in mental health journeys based on conditions like anxiety, depression, and trauma.

Implications

  • Therapeutic Approaches: Mental health practitioners should consider alternative therapeutic techniques that do not rely heavily on visual imagery for aphants.
  • Professional Awareness: Increasing awareness and understanding of aphantasia among mental health professionals could improve diagnosis accuracy and treatment effectiveness.
  • Support Systems: Developing supportive environments that acknowledge the unique experiences of aphants can enhance their mental health outcomes.

Limitations

  • Sample Diversity: The study sample was predominantly from Western countries, which may limit the generalizability of findings to other cultural contexts.
  • Self-Reporting Bias: Reliance on self-reported data may introduce bias, as participants' perceptions of their mental health experiences could be subjective.
In summary, aphantasia significantly influences the mental healthcare experiences of individuals, highlighting the need for tailored approaches in diagnosis and treatment. Understanding and accommodating the unique needs of aphants can lead to more effective mental health support and improved outcomes.