Basolateral Amygdala Functional Connectivity in Alexithymia: Linking Interoceptive Sensibility and Cognitive Empathy

•A highly homogeneous cohort comprising 297 college students.•Alexithymia mediates the relation between interoception and cognitive empathy (CE)•Amygdala-based functional connectivity served as the neural basis of alexithymia.•Interoception impacts CE through basolateral amygdala-precuneus connectivity. Emotions rely on bodily states, and perceiving the emotions of others depends on awareness of one’s own emotional state. However, the intercorrelations among interoception, alexithymia, and empathy are not well understood, and the neural mechanisms behind this connection are also largely unknown. To address these issues, 297 college students participated in this study, completing measures of interoceptive sensibility (IS), empathy and alexithymia and undergoing resting-state fMRI scans. The functional connectivity of the amygdala was analysed to identify the neural substrates of alexithymia, and mediation analyses were conducted to examine the mediation effect of alexithymia and alexithymia-specific amygdala functional connectivity on the relationship between IS and empathy. The results showed that higher levels of IS were associated with increased cognitive empathy through weakened alexithymia. Functional connectivity analysis indicated that right basolateral amygdala (BLA)-left precuneus connectivity was negatively related to alexithymia, while right BLA-left precentral gyrus connectivity was positively related to alexithymia. Furthermore, right BLA-left precuneus connectivity was found to mediate the impact of interoception on cognitive empathy. In conclusion, this study provides valuable insights into the relationships among IS, alexithymia, and empathy. The right BLA-left precuneus connectivity may serve as a shared neural substrate between interoception and cognitive empathy.