Alexithymia is a disorder of emotional regulation, widely observed in psychosomatic diseases. It is characterized by great difficulty in identifying and describing one’s feelings and those of others. Alexithymia is also involved in a wide variety of psychological problems, such as depression and schizophrenia. The disease affects about 10% of the general population.
What is alexithymia?
Definition of alexithymia
Alexithymia is a disorder of emotional regulation, widely observed in psychosomatic diseases. It is characterized by great difficulty in identifying and describing one’s feelings and those of others.
Alexithymia can be summarized in four main manifestations:
- Inability to verbally express emotions or feelings;
- Limitation of fantasy life;
- The tendency to resort to action to avoid and resolve conflicts;
- Detailed description of facts, events, physical symptoms.
types of alexithymia
Two types of alexithymia can be distinguished:
- State alexithymia has a specific cause and is often a temporary condition. Post-traumatic stress disorder, caused by a horrific event, is an example known to trigger this type of alexithymia.
- Character alexithymia is considered an inherent characteristic of a person’s personality. It can be primary or secondary – caused by events that occur in a person’s early childhood, such as neglect or abuse.
Alexithymia is also understood to have two components:
- A cognitive component where people may face challenges with thinking and feeling while trying to name, understand and talk about their feelings;
- An affective component where people may have difficulty sharing, responding to and feeling their emotions.
Causes of alexithymia
In the past, alexithymia was classified and limited to psychosomatic disorders – disorders involving physical symptoms of the body but created and exacerbated by the mind. For example, a person who is very angry, but does not express that anger, may have a stomach ache.
Yet alexithymia is implicated in a wide variety of psychological problems, such as depression and schizophrenia. Emotional deficits in autism spectrum disorders can largely be attributed to it.
But alexithymia is also associated with changes in the activity of the sympathetic nervous system – one of the three components of the autonomic nervous system that manages visceral organ activity and automatic body functions such as breathing and heartbeat – the immune system and brain activity.
Some researchers link alexithymia to insecure parental attachment or negative childhood experiences.
Other research on alexithymia in dermatology shows that it appears to be associated with alopecia areata, an autoimmune disease that causes hair loss, psoriasis, atopic dermatitis, a type of eczema, vitiligo or chronic urticaria.
Diagnosis of alexithymia
Alexithymia is still not recognized by official disease classifications. But its diagnosis can be made by means of different measures and scales.
This scale is composed of 20 items, which investigate three dimensions:
- Difficulty identifying one’s emotional states;
- Difficulty in describing one’s emotional states to others;
- Operative thinking.
Responses range from 1 to 5 from complete disagreement to complete agreement.
There are other instruments for measuring alexithymia:
- The Beth Israel Questionnaire (BIQ) or the Beth Israel Psychosomatic Questionnaire;
- The Bermond-Vorst Alexithymia Questionnaire (BVAQ);
During an assessment, the clinician will also talk to the patient for a period of time and ask him or her to complete additional surveys and psychological tests.
People affected by alexithymia
Alexithymia affects about 10% of the general population.
Some research suggests that alexithymia is predominant in men and in physicians.
Factors favouring alexithymia
Various factors can promote or amplify alexithymia:
- Eating disorders;
- Substance abuse;
- Certain brain injuries;
- Post-traumatic stress disorder;
The symptoms of alexithymia
Difficulty communicating feelings
The first characteristic of alexithymia is the difficulty in communicating feelings to others. The alexithymic is unable to express his or her emotions verbally.
Inability to identify feelings
People with alexithymia are unable to identify their feelings and distinguish them from their bodily sensations. The patient repeatedly describes physical symptoms in place of attempts to express feelings.
Poverty of the imaginary life
Alexithymics dream little – or remember very little – and when the dream exists, its content is poor, factual and realistic. Moreover, the difficulty to verbalize the dream is real. Fantasies are rare and memories appear very disturbed. Alexithymia leads to a lack of imagination and a cognitive style that is focused on external stimuli and influences.
Thoughts with pragmatic content
The thoughts of alexithymics are directed outward rather than inward. The patient gives a very detailed description of the facts, events or physical symptoms that produced the emotions but does not express the emotions themselves.
Misinterpretation of physical sensations
The inability to adequately identify physical sensations as somatic manifestations of emotions can make alexithymic individuals susceptible to misinterpreting their emotional arousal as signs of illness, leading them to seek medical attention for symptoms for which no clear medical explanation can be found.
- Poverty of words and phrases used;
- Emotional discourse absent;
- Paucity of feeling in speech;
- Factual narrative pattern, without fantasy or symbolism;
- Lack of impulse control;
- Violent or disruptive outbursts;
- Indifference to others;
- Difficulty identifying emotions expressed by others;
- Increased sensitivity to sights, sounds or physical touch.
Treatments for alexithymia
For people with alexithymia, a mental health professional will often focus on establishing a foundation for naming emotions and appreciating a range of feelings. The process will include both considering the experiences of others and self-reflection via:
- Group therapy;
- Daily journaling;
- Skills-based therapy;
- Engagement in the creative arts;
- Various relaxation techniques;
- Reading books or moving stories;
Over the past four decades, alexithymia has inspired a great deal of research that has shed light on many aspects of the illness but has not yet resulted in new evidence-based treatments to improve the lives of people with alexithymia. Nevertheless, behavioral, linguistic, and neuroscientific research on alexithymia appears to have progressed to the point where it may result in effective treatments for people with alexithymia.
These treatments may be offered in innovative forms, such as Internet-based programs: online communication provides a means of keeping interpersonal contact to a minimum, thereby reducing the need to share emotions openly.
Learning to verbalize one’s feelings and emotions from a young age can help limit the occurrence of alexithymia.