Is aphantasia a real condition and how is it diagnosed?

Aphantasia Diagnosis and Assessment

Aphantasia is a real condition characterized by the self-reported absence of voluntary visual imagery, but it should be considered an individual difference rather than a pathological disorder requiring formal medical diagnosis. 1

Diagnostic Approach

Primary Assessment Method

• Self-report questionnaires are the primary method for identifying aphantasia:
  • The Vividness of Visual Imagery Questionnaire (VVIQ) is the most commonly used assessment tool 1, 2
  • Individuals scoring <25 on the VVIQ are typically classified as having aphantasia 3
  • Those with the most severe aphantasia typically score 16 or lower 3

Supplementary Assessment Methods

• Objective testing can help confirm subjective reports:
  • Binocular rivalry paradigm testing shows almost no imagery-based rivalry priming in aphantasics 2
  • Mental rotation tasks may show increased response times (but similar accuracy) in severe aphantasics 3
  • One Touch Stocking of Cambridge task may reveal longer response times (but similar accuracy) when mental manipulation demands increase 3

Distinguishing Features

• Key characteristics of true aphantasia include:
  • Complete absence of voluntary visual imagery
  • Normal spatial imagery abilities (often above average) 2
  • Preserved cognitive functioning in most domains 3
  • Possible impacts on dream frequency and memory performance 4

Important Considerations

Prevalence

• Self-reported prevalence is approximately 8.9% of the general population
• When using strict questionnaire criteria, prevalence drops to approximately 1.5% 4

Diagnostic Challenges

1. No standardized diagnostic criteria exist for aphantasia 1, 5
2. Inconsistent cutoff scores are used across studies, making cross-study comparisons difficult 1
3. Mixed samples in research often include both individuals with no imagery and those with low imagery 1
4. Self-diagnosis concerns exist due to non-validated online tests that may lead to false self-identification 1

Clinical Implications

• Aphantasia is generally not associated with significant cognitive deficits 3
• People with aphantasia may prefer written instructions over visual demonstrations for learning new tasks 4
• The condition should not be pathologized, as it represents a variation in cognitive experience rather than a disorder 1

Differential Diagnosis

Aphantasia should be distinguished from:

• Visual agnosia (inability to recognize visual stimuli)
• Visual memory deficits associated with neurological conditions
• Cognitive impairments in dementia or other neurological disorders 6

Recommendations for Clinicians

• Use validated questionnaires like the VVIQ for assessment
• Consider supplementing with objective cognitive tasks when available
• Avoid labeling aphantasia as a "disorder" or "condition" requiring treatment
• Provide reassurance that aphantasia represents a normal variation in human experience
• Be aware that some individuals may experience health anxiety after self-diagnosis 1

Aphantasia research is still evolving, with ongoing debates about definition, measurement, and theoretical frameworks. Future research is needed to refine diagnostic criteria and better understand the neurological basis of this phenomenon 5.