When someone has alexithymia, they struggle to distinguish between emotions and bodily sensations. Certain conditions, such as depression, neurological conditions, and brain injury, can also cause this condition.

What is Alexithymia? 

Alexithymia, a term coined by psychoanalytic psychiatrist Peter Sifneos in 1972, refers to difficulty identifying and describing emotions. Sifneos observed this phenomenon in his patients, who struggled to perceive and articulate their emotions. Born on the Greek island of Lesbos, Sifneos borrowed from his native language to create the term; in Greek, it means “without words for emotion.”

When someone has alexithymia, they find it challenging to distinguish between emotions and bodily sensations. This condition exists on a spectrum, with individuals exhibiting mild to severe alexithymic traits.

While not classified as a medical diagnosis, alexithymia is widely recognized as a personality trait. Moreover, it is associated with various medical and mental health conditions.

Alexithymia Symptoms

The literature broadly considers the following dimensions as core features of the condition. It’s important to note that individuals may exhibit high traits in one area while showing low traits in others.

Difficulty In Identifying Feelings

Individuals who struggle to identify emotions often experience confusion regarding their internal experiences, including emotions. They may find it challenging to differentiate between emotions and bodily sensations, such as distinguishing between hunger and anxiety. 

The capacity to recognize emotions is crucial for emotional regulation. Difficulties in this aspect have been associated with depression, non-suicidal self-harm, and suicidal behavior.

Difficulty In Describing Feelings

Difficulty describing feelings encompasses challenges in:

• Finding words for one’s feelings.
• Expressing these feelings to others.

Individuals facing this difficulty often have trouble labeling emotions and finding appropriate words to describe their feelings. Their emotional descriptors may be vague, general, and diffuse. 

Moreover, difficulty in describing emotions is associated with increased relationship challenges.

Externally Oriented Thinking

Externally oriented thinking refers to a mental process where an individual’s focus is primarily on external factors rather than internal ones. 

Those who exhibit externally oriented thinking tend to direct their attention toward external events and may avoid introspection or focusing on their inner experiences.

It has also been associated with a diminished capacity to experience positive emotions, potentially contributing to depression and other mood-related issues.

Vicarious Interpretation of Feeling

Experiencing emotions vicariously means feeling the emotions of others alongside them. For instance, you might feel a strong emotion when you learn about something happening to someone else, mirroring the emotion they felt. 

These experiences are commonly referred to as affective empathy, where you feel alongside the other person. Understanding what others are going through plays a crucial role in building relationships and fostering strong interpersonal connections. (Note: Vicarious interpretation of feelings isn’t always considered a core aspect of alexithymia, but it’s often associated with its main dimensions).

Restricted Imaginative Processes

Many individuals (though not all) exhibit a reduced fantasy life and limited imaginative abilities. They typically lean towards the concrete realm of facts and practicality, showing little inclination towards fantasy or imaginative pursuits. 

This lack of interest may extend to creative endeavors, artistic pursuits, and daydreaming. (Note: This aspect is not always regarded as a core characteristic).

Interpersonal Relationship Difficulties

(Note: These last two subscales, problematic interpersonal relationships, and sexual difficulties/disinterest, aren’t specifically part of the formal definition of alexithymia but often correlate with it). 

Alexithymia has been associated with challenges in empathy (difficulty perceiving others’ perspectives and understanding their feelings and intentions), which can negatively impact relationships (the ability to form and deepen connections). 

Sexual Difficulties and Disinterest

Although not a primary characteristic of alexithymia, it is frequently linked to decreased sexual satisfaction and increased emotional detachment from potential sexual partners. Additionally, it is associated with sexual shyness and nervousness. 

Several factors contribute to this connection: firstly, alexithymia is correlated with experiencing more negative emotions, which can influence sexual attitudes. Secondly, it often results in a heightened and more avoidant/detached attachment style, contributing to a more avoidant sexual approach. 

Individuals are also more likely to identify as asexual, which may partially explain the higher prevalence of asexuality within the autistic population.

Primary And Secondary Alexithymia

A person can exhibit primary (trait), secondary (state situational, temporary), or both.

Primary alexithymia

It is also known as trait alexithymia, which is an inherent and stable personality trait that is present from birth and remains consistent across various situations and over time. It is considered an integral aspect of an individual’s baseline personality, likely influenced by both environmental and genetic factors.

Secondary alexithymia

It is also referred to as state alexithymia and is temporary and situational. It often arises due to specific life circumstances or recent medical diagnoses. For example, individuals may experience this following traumatic events such as post-traumatic stress disorder (PTSD), where they undergo a period of alexithymia.

What Causes Alexithymia?

It is mainly seen as a personality trait, influenced by both nature and nurture.

Nature (Genetics)

Differences in brain development, problems with understanding bodily sensations, and sensory issues can make it hard for someone to notice and understand their emotions. Problems with sensing what’s going on inside the body, known as interoception, are a big part of alexithymia. Some experts even say it’s mainly an interoception problem (Brewer, Cook, and Bird, 2016).

Nurture

Early experiences also matter. How much emotional support was available from caregivers, how much emotions were talked about at home, and the overall mood of the home all affect how well someone can recognize and handle emotions.

Diagnosis

A mental health professional diagnoses alexithymia. It’s not officially recognized by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Instead, your mental health provider will probably ask you questions and diagnose based on your answers. You might also fill out a questionnaire.

There’s no single test for alexithymia, just like with neurological disorders and mental illnesses in general. It might take time to get the correct diagnosis.

Alexithymia Test: Do You Have alexithymia?

Two commonly used online measures for assessing are:

The Toronto Alexithymia Scale (TAS-20)

It is widely accepted in medical research and has been normed in clinical trials. However, its feedback may not offer very detailed results.

Online Alexithymia Test

It provides visual results, showing your scores on bars and offering results in seven different areas. However, it is not as commonly used in medical research.

Therapy For Alexithymia

Currently, there is no single specific treatment for alexithymia. The treatment approach depends on your overall health requirements. For instance, if you’re experiencing depression or anxiety, medications tailored for these conditions might also alleviate symptoms related to mental health.

Therapies can also be beneficial for managing alexithymia. These involve engaging in exercises aimed at enhancing mental well-being. Possible therapy options include cognitive behavioral therapy (CBT), group therapy, and psychotherapy (also known as “talk therapy”).

Summary

Approximately 10% of people experience alexithymia, but its prevalence is higher among individuals with ADHD, autism, depression, and other mental health conditions. Although not widely recognized, it has been studied for over four decades, presenting in individuals who struggle to recognize and express their feelings, often alongside other neurological or mental health disorders.

While not inherently harmful, alexithymia may contribute to interpersonal and relationship difficulties. Fortunately, therapies are available to enhance mental health skills, potentially improving relationships and overall well-being.

References

1. Cherney, K. (2021, September 9). Alexithymia: Causes, symptoms, and treatments. Healthline. https://www.healthline.com/health/autism/alexithymia
2. Hogeveen, J., & Grafman, J. (2021). Alexithymia. Handbook of clinical neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456171/
3. Neff, M. A. (2023, September 8). What is alexithymia?. Insights of a Neurodivergent Clinician. https://neurodivergentinsights.com/blog/what-is-alexithymia-alexithymia-defined-and-explained