Alexithymia

Alexithymia is a disturbance with normal experiencing of emotions. Alexithymia often cooccurs 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” (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.

​​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” (2015, location 1855).

​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” (location 4606).

​​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” (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” (2021). Those suffering from alexithymia distribute little of no ability to differentiate emotions through words. The person suffering from alexithymia’s emotional world fails to integrated with conscious experience. The conscious mind and felt experience appear to operate on different plains, disconnected and unrelated.

​Spectrum of Emotional Disorders

Those inflicted with alexithymia may describe themselves as having difficulties with expressing emotions. Others may struggle to identify their emotions. Symptoms of alexithymia, like most disorders, are measured on a spectrum. Humans experience emotions differently. Some very intensely (empaths) and others appear largely disconnected from internal feeling affects.  Those suffering from alexithymia may not necessarily experience complete apathy. They instead may experience emotions with much less arousal than their peers, and struggle to feel empathy. 

​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” (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.
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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).

​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.

Mindfulness:

We practice mindfulness by purposeful giving attention to inner experiences. By shining the light of awareness on inner movements of energy, we see areas that we previously missed. We integrate emotions through the key practice of mindfulness.

​See Focus on Feelings for more on this topic

Emotion Focused 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. A particularly helpful style of therapy is emotion focused therapy.

​​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.

​A Few Words from 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.

References:

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

David, S. (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.

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

Panayiotou, G., Leonidou, C., Constantinou, E., & Michaelides, M. (2020). Self-Awareness in alexithymia and associations with social anxiety. Current Psychology, 39(5), 1600-1609.

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

Van der Kolk, B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. ‎Penguin Publishing Group; Reprint edition. 

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

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