When Weak Imagery is Worse Than None: Core Aphantasia and Hypophantasia Relate Differently to Mental Health, Mediated by Subjective Interoception and Alexithymia

Aphantasia, characterized by absent or reduced visual mental imagery, has been associated with alexithymia and negative mental health outcomes. However, the underlying mechanisms driving these associations remain unclear. Since mental health is closely linked to interoception, we examined whether interoceptive processing plays a role in these relationships, assessing self-reported imagery vividness (VVIQ), subjective interoceptive accuracy and attention, alexithymia, and mental health, including anxiety and depression, in individuals with (n = 153, VVIQ = 16–32) and without aphantasia (n = 680, VVIQ = 33–80). The results revealed distinct patterns between these groups. In the aphantasia group, higher VVIQ was associated with greater alexithymia and poorer mental health outcomes, suggesting that individuals with weak imagery (hypophantasia) exhibited more emotional difficulties than those with almost no imagery (core aphantasia). In contrast, in the non-aphantasia group, VVIQ correlated negatively with alexithymia and positively with mental health, aligning with previous research indicating a protective role of vivid imagery. Structural equation modelling confirmed that alexithymia strongly mediated the link between VVIQ and negative mental health outcomes in both groups, reinforcing alexithymia as a mediator between imagery ability and well-being. Another key factor in these relationships was the ratio between subjective interoceptive accuracy and attention, which mediated the relationship between VVIQ and alexithymia and mental health outcomes. These findings highlight the heterogeneity within aphantasia, distinguishing hypophantasia from core aphantasia and revealing distinct interoceptive and mental health profiles.