Exploring Alexithymia: A Disturbance in Emotional Experience

Alexithymia is a disturbance with normal experiencing of emotions. Alexithymia often co-occurs with other mental health and developmental issues such as autism, schizophrenia, somatoform disorders or depression, and is not seen as a separate condition in itself.

People who have alexithymia can’t put words to their feelings and thoughts. It’s not that they don’t want to experience feelings or even defensively protect against feeling– it’s an ailment that prevents them from feeling. Susan David PhD., a psychologist on the faculty of Harvard Medical School, explains, “People with this condition are also more likely to report physical symptoms like headaches and backaches. It’s as if their feelings are being expressed physically rather than verbally” (David, 2016).

While alexithymia is not completely understood, as of yet, there is little research available on the condition. There is a growing body of evidence suggesting that the condition, at least in part, is genetic.

​​Alexithymia Basics

Research identifies three main components of alexithymia. “Alexithymia is conceptualized as a multifaceted construct involving several components: difficulty identifying one’s own feelings, difficulty describing one’s own feelings, and externally oriented thinking” (Adamowicz, 2024). Basically individuals suffering from alexithymia have limited somatic awareness. Moreover, when they do experience feeling affect, they struggle to describe the internal feelings. Consequently, because they fail to recognize emotion and describe the feeling states, they tend to focus on external causes rather than internal experiences.

The Stress-Alexithymia Hypothesis

Alexithymia is associated with increased stress. Accordingly, individuals suffering from alexithymia experience a higher probability of episodes of depression. Yinghan Xie and colleagues explain “Individuals with alexithymia tend to make negative and exaggerated assessment of the environment due to difficulties in emotion recognition and description and have a reduced ability to deal with stress.” They continue, “this improper assessment of challenges and threats of the external environment eventually led to individuals with alexithymia in a state of stress. The interaction between alexithymia and stress perception can prompt the development of depression” (Xie, et al., 2024).

Basically, the hypothesis states that alexithymia motivates an externalized, negative attribution style. The negative attribution style then contributes to episodes of depression.

​​Emotional Differentiation and Alexithymia

​Alexithymia is the inability to recognize emotions, differentiating their subtleties and textures.  David wrote that, “Trouble labeling emotions is associated with poor mental health, dissatisfaction in jobs and relationships, and plenty of other ills” (David, 2016).

T. Franklin Murphy wrote, “Emotion differentiation also known as emotion granularity is the process of putting feelings into words with a high degree of complexity” (Murphy, 2021). Those suffering from alexithymia distribute little of no ability to differentiate emotions through words. The emotional world of a person suffering from alexithymia fails to integrated with conscious experience. The conscious mind and felt experience appear to operate on different plains, disconnected and unrelated.

​Spectrum of Symptoms

Those afflicted with alexithymia often describe themselves as having significant difficulties when it comes to expressing their emotions. This struggle can manifest in various ways; some individuals may find it challenging to articulate their feelings, while others might have a hard time even recognizing the emotions they are experiencing. The symptoms of alexithymia vary widely among individuals and are measured on a spectrum. Human emotional experiences differ greatly, with some people—often referred to as empaths—experiencing emotions very intensely, while others appear largely disconnected from their internal emotional states. This disconnect does not necessarily equate to complete apathy; rather, those suffering from alexithymia may experience emotions but at a much lower intensity than their peers.

Furthermore, individuals with alexithymia frequently encounter challenges related to empathy—the ability to understand and share the feelings of others. Because they struggle with identifying and articulating their own emotions, they may find it difficult to relate to or interpret emotional cues from those around them. As a result, these individuals might miss vital social signals that would typically foster connection and understanding in relationships. Consequently, this limitation can hinder their capacity for developing deep interpersonal bonds or navigating emotionally charged situations effectively. Understanding this nuanced spectrum of emotional experience is crucial for fostering compassion towards those affected by alexithymia and acknowledging the unique hurdles they face in both personal and social contexts.

​Perceiving Emotion in Others

People with alexithymia also have difficulty perceiving emotion in others. Lisa Feldman Barrett describes alexithymia with this example; “if a person with a working conceptual system saw two men shouting at each other, she might make a mental inference and perceive anger, whereas a person with alexithymia would report perceiving only shouting” (Barrett, 2018, p. 107). 

People who suffer from alexithymia encounter difficulties processing social situations, missing the subtle and sometimes obvious clues of emotion motivating and energizing the interaction. Many times, because their inability to experience emotion, they see emotion as a non-essential element that confuses rather than improve relationships. Yet, their emotion blindness is exactly why so many of those suffering from alexithymia fail to build intimate relationships with others.

Externally Oriented Thinking

Research has found associations between alexithymia and external oriented thinking, which is the extent to which people focus on details of external events instead of internal feelings about an event (Panayiotou, et al., 2020; Kaya & Aydemir, 2021). A simple question posed to a person inflicted with alexithymia such as how did you enjoy your daughter’s wedding may be answered with expressionless details of the event instead of feelings about the event. A man suffering from alexithymia explains, “from an inner-feeling point of view, anything I do that requires an emotional response feels like a fake. Most of my responses are learned responses. In an environment where everyone is being jolly and happy, it feels like I’m lying. Acting. Which I am. So it is a lie” (Young, 2019).

​What Alexithymia Looks Like?

Sufferers of alexithymia may exhibit the malady in many different ways. Some, like the man just quoted, is aware of their deficiency, many people, with alexithymia, however, are blind to their condition, relying on maladaptive defensive reactions to compensate for their inability to connect to their inner world and the inner world of others.

The condition may be manifest in many ways:

• Difficulty identifying different types of feelings
• Limited understanding of what causes feelings
• Difficulty expressing feelings
• Difficulty recognizing facial cues in others
• Limited or rigid imagination
• Constricted style of thinking
• Hypersensitive to physical sensations
• Detached or tentative connection to others (Serani, 2014).

​Causes of Alexithymia

Alexithymia may be a result of brain damage to the insula. This insula is substantially involved in social skills, empathy, and emotions. Research has linked insula lesions to apathy and anxiety. While these findings correlate well with the symptoms of alexithymia, specific pathways for the disorder are still under investigation.

​Bessel van der Kolk, M.D., founder and medical director of the Trauma Center in Brookline, Massachusetts and professor of psychiatry at Boston University School of Medicine, suggests that trauma can dull awareness of emotion, leading to states of alexithymia. He wrote that, “Many traumatized children and adults simply cannot describe what they are feeling because they cannot identify what their physical sensations mean” (van der Kolk, 2015).

Van der Kolk explains, “Being constantly assaulted by, but consciously cut off from, the origin of bodily sensations produces alexithymia: not being able to sense and communicate what is going on with you” (van der Kolk, 2015).

Treatment for Alexithymia

Research strongly supports the well-being benefits of journaling. To use journaling to increase awareness of emotions, daily entries focusing on inner experiences rather than external oriented details of events is suggested. Journaling provides a non-threatening path to our treasured inner-worlds. The effectiveness of treatment for alexithymia depends on the cause. If alexithymia is a maladaptation to trauma, as suggested by van der Kolk, then we can unlearn the learned defense. If the alexithymia is a manifestation of lesions or damage to the insula than most treatment plans will fail. For most, whether specifically diagnosed with alexithymia or simply suffering from limited feeling experience, we can improve integration of feelings.

Here are a few ways to broaden and expand your emotional awareness:

Journaling

Research strongly supports the well-being benefits of journaling. To use journaling to increase awareness of emotions, we make daily entries focusing on inner experiences rather than external oriented details. Journaling provides a non-threatening path to our treasured inner-worlds.

See Journaling for more on this treatment

Mindfulness

Mindfulness is a practice that involves intentionally focusing our attention on our inner experiences, allowing us to cultivate a deeper awareness of our thoughts, feelings, and bodily sensations (Murphy, 2023). By purposefully directing this focus inward, we can illuminate aspects of ourselves that may have previously gone unnoticed or unacknowledged. This heightened awareness enables us to observe the subtle movements of energy within us—whether they manifest as emotional fluctuations, physical sensations, or mental patterns. Through this process of exploration and observation, we create space for greater self-understanding and acceptance. As we become more attuned to these internal experiences, we also develop a clearer perspective on how they influence our behavior and interactions with others.

Integrating emotions through mindfulness is essential for fostering emotional intelligence and enhancing overall well-being. When we engage in mindful practices—such as meditation or reflective journaling—we equip ourselves with the tools necessary to recognize and articulate our feelings more effectively. This integration allows us to move beyond mere surface-level reactions and delve into the complexities of our emotional landscape. By acknowledging both positive and negative emotions without judgment, we empower ourselves to respond thoughtfully rather than react impulsively. Ultimately, cultivating mindfulness not only enriches our personal growth but also enhances our relationships by promoting empathy and understanding toward others’ emotional experiences as well.

​See Focus on Feelings for more on this topic

Therapy

​There are many skilled based therapies to help clients better work with their emotions. Therapy can be effective in either individual or group sessions. Several therapeutic approaches can be beneficial in treating alexithymia, which is characterized by difficulty in identifying and expressing emotions. Here are some of the therapy styles that have shown effectiveness:

• Cognitive-Behavioral Therapy (CBT): CBT helps individuals recognize and change negative thought patterns and behaviors. It can increase insight into emotional patterns and improve emotional awareness.
• Psychodynamic Therapy: This therapy explores underlying emotional conflicts and may help individuals with alexithymia understand the root causes of their difficulties with emotions.
• Dialectical Behavior Therapy (DBT): This therapy is designed for disorders of overcontrol and can be helpful for individuals with alexithymia by enhancing emotional expression and social connectedness.
• Emotion Focused Therapy: This therapy is built around the theory that emotions are essential components in psychotherapeutic change. EFT works with clients to be aware of emotional experiences and create narratives around emotions that help emotions motivate productive action.

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These therapies aim to improve emotional awareness, understanding, and expression, which are core challenges for individuals with alexithymia. It’s important to work with a therapist who has experience in treating alexithymia to determine the most suitable approach for an individual’s needs.

​​Increasing Vocabulary to Describe Emotions:

A simple hack to improve emotion differentiation is to increase our emotional vocabulary, expanding from simple terms of sadness and anger to more granular descriptions. With expanded vocabulary, our feeling experience also expands.

See Emotion Differentiation for more on this topic

Associated Concepts

Alexithymia is related to several psychological concepts that share its focus on emotional processing and regulation. Here are some of the concepts that are similar to or associated with alexithymia:

• Emotional Intelligence: This refers to the ability to perceive, use, understand, and manage emotions. Alexithymia can be seen as a deficit in emotional intelligence, particularly in the areas of understanding and managing emotions.
• Emotional Regulation: This is the process by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions. Alexithymia involves difficulties in regulating emotions due to problems with identifying and describing them.
• Affect Dysregulation: This concept describes difficulties in managing emotional responses, often leading to intense, rapidly fluctuating, or inappropriate emotions. Alexithymia can contribute to affect dysregulation by impairing the awareness and understanding of emotional states.
• Somatic Awareness: This is the ability to perceive and interpret bodily sensations. Individuals with alexithymia often have a reduced capacity to recognize and describe physical sensations associated with emotions.
• Mindfulness: Mindfulness involves being fully present and engaged in the moment, aware of one’s thoughts and feelings without judgment. Alexithymia can make it challenging for individuals to achieve mindfulness due to their limited emotional awareness.
• Attachment Theory: This theory suggests that early relationships with caregivers shape an individual’s expectations and interactions in later relationships. Alexithymia may be related to insecure attachment styles, which can affect emotional awareness and expression.
• Interpersonal Relations: Alexithymia can affect the quality of interpersonal relationships by hindering effective communication about emotions and reducing empathy.
• Cognitive-Behavioral Constructs: Alexithymia is associated with certain cognitive-behavioral patterns, such as concrete thinking and difficulty with introspection, which can impact emotional processing.

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These concepts are interconnected with alexithymia, as they all play a role in how individuals understand, process, and communicate their emotions. Understanding these related concepts can provide a more comprehensive view of the challenges faced by individuals with alexithymia and inform more effective treatment approaches.

​A Few Words by Psychology Fanatic

Emotions play a significant role in living a rich, flourishing life. When disconnected from this flavorful piece of life, we struggle to find meaning. Life becomes a dreadful dullness of greys. After all, emotions bring vibrant colors into our living experience. Sorrow and joys in all their wonderful flavors make each experience a treat. Sadly, some miss out on this experience. Research suggests, surprisingly, that the number can be as high as one in ten people suffering from alexithymia. We must be patient and offer understanding to those (others or ourselves) suffering from this condition.

Last Update: May 19, 2025

References:

Adamowicz, J., Sirotiak, Z., & Thomas, E. (2024). Childhood Maltreatment and Somatic Symptoms: Examining the Role of Specific Types of Childhood Maltreatment and Alexithymia. Psychological Trauma Theory Research Practice and Policy, 16(S1), S2-S9. DOI: 10.1037/tra0001315

Barrett, Lisa Feldman (2018) How Emotions Are Made: The Secret Life of the Brain. Mariner Books; Illustrated edition.

David, Susan (2016). Emotional Agility: Get Unstuck, Embrace Change, and Thrive in Work and Life. Avery; First Edition.

Kaya, E., & Aydemir, O. (2021). Correlation of Alexithymia with Grief and Depression Symptom Severity in Persistent Complex Bereavement Disorder. Journal of Rational-Emotive & Cognitive-Behavior Therapy, OnlineFirst, 1-18. DOI: 10.1007/s10942-021-00388-1

Murphy, T. Franklin (2021) Emotion Differentiation. Psychology Fanatic. Published: 9-16-2021; Accessed: 2-7-2022.

Murphy, T. Franklin (2023). Embracing Mindfulness: Cultivating Clarity and Serenity. Psychology Fanatic. Published: 6-19-2023; Accessed: 5-19-2025.

Panayiotou, G., Leonidou, C., Constantinou, E., & Michaelides, M. (2020). Self-Awareness in alexithymia and associations with social anxiety. Current Psychology, 39(5), 1600-1609. DOI: 10.1007/s12144-018-9855-1

Serani, D. (2014). The Emotional Blindness of Alexithymia. Scientific American. Published: 4-3-2014; Accessed: 9-22-2021.

Van der Kolk, Bessel (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books; Illustrated edition.

Xie, Y., Ma, D., Duan, Y., Cao, J., & Wei, J. (2024). The association among negative life events, alexithymia, and depressive symptoms in a psychosomatic outpatient sample. BMC Psychiatry, 24(1)/ DOI: 10.1186/s12888-024-05902-0

Young, E. (2019). For people with alexithymia, emotions are a mystery. Spectrum. Published: 2-22-2019; Retrieved: 9-22-2021.