BEYOND “EMOTION BLINDNESS”: DISSOCIATING EMOTION LABELING, CONFIDENCE, AND FAIRNESS CHOICE IN ALEXITHYMIA

Alexithymia, difficulty identifying and verbalizing one’s emotions, affects up to 10% of the general population and over 50% of autistic individuals, and has been implicated in the social difficulties often attributed to autism itself. While alexithymia has been linked to altered interoception and atypical self-evaluation of emotional states, existing evidence relies on self-report; moreover, few studies have separated performance-based emotion labeling from confidence, or relates either to social decision-making. To address this, we combined multimodal (music, images, audio–visual) mood induction (happiness, sadness, anger) with forced-choice emotion labeling and confidence ratings while recording physiological responses (Empatica smart wristband). Participants (N=42) completed this; a subset also completed an Ultimatum Game (UG) task under similar induced states . Participants completed the standard alexithymia questionnaire, TAS-20 (DIF/DDF/EOT), along with a short autistic quotient questionnaire, AQ-10. Contrary to a global-deficit account, alexithymia was not associated with uniformly reduced emotion-labeling accuracy. Instead, effects emerged most consistently in confidence and response dynamics, consistent with preserved performance but altered subjective interpretation or readout. In the UG task, rejection behavior was better predicted by labeling performance than by TAS-20 scores, suggesting greater sensitivity of emotion-labeling ability to alexithymia-related changes in social decision-making behavior, compared to self-reports. Physiological recordings provided a participant-specific window on autonomic engagement to distinguish between altered signal strength and altered signal interpretation. By integrating mood induction, emotion labeling, metacognitive confidence, physiology, and social choice, this work advances a mechanistic framework to dissociate sensitivity, readout, and objective-subjective mismatch accounts of alexithymia