Alexithymia: Building Relationships Out of Nothing

 
People with alexithymia are unable to distinguish facial expressions.

People with alexithymia are unable to distinguish facial expressions.

Understanding and expressing emotions are essential parts of human interaction that unfortunately may be confusing for some people. Alexithymia is characterized by the inability to identify, differentiate, and describe emotions. These abilities are important for social interactions, well-being, and, consequently, for overall health. Peter Sifneos introduced the term alexithymia in the 1970s, which was derived from Greek: lack, lexis, meaning word, and thymos, meaning emotions. Literally put, alexithymia means having no words for emotions. Alexithymia is not technically a clinical diagnosis, but rather a personality construct that is useful for characterizing patients who not understand the feelings they must experience, and patients who do not have the words to describe these feelings to others, whether it be their friends and family, or their therapist or medical provider.

What is Alexithymia

Alexithymia is prevalent in approximately 10% of the US population and is known to be comorbid with a number of psychiatric conditions. According to researchers, approximately 8% of males and 2% of females experience alexithymia, and it can vary in intensity from mild, moderate to severe. Alexithymia has also proven to have two dimensions: a cognitive dimension, where the person struggles to identify, interpret and verbalize feelings, and an affective dimension, where the person is unable to react, express, feel and imagine things. The cognitive dimension pertains to the thinking part of our emotional understanding, and the affective dimension is considered the experiencing part of our emotional understanding.

There are also two types of alexithymia: trait and state. State alexithymia has a specific cause, such as a traumatic event and is often a temporary condition. Trait alexithymia is believed to be a characteristic inherent in a person’s personality. Trait alexithymia may be caused by genetics or events in early childhood such as neglect or abuse.

People who have been diagnosed with autism, depression, schizophrenia, eating disorders, substance abuse, post-traumatic stress disorder, or brain injuries have been observed to also have alexithymia. The main features of alexithymia are emotional unawareness, lack of social attachment, and poor interpersonal relating. Alexithymia also creates interpersonal problems. Individuals with alexithymia tend to exhibit philophobia and avoid emotionally close relationships. If they do form relationships, they usually position themselves as either dependent, dominant, or impersonal, and keep the relationship superficial.

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Causes of Alexithymia

Researchers are still unsure of what actually causes alexithymia. However, it has been deduced that it is most likely caused by both genetic and environmental factors. Children whose parents have alexithymia are most likely to have alexithymia as well. Also, children with no regular interaction with others, or who learn about feelings from their parents may struggle with alexithymia in their adult life. Alexithymia often occurs along with, or is a symptom of, other mental health disorders. It is not simply a lack of interest in making emotional connections, but is rather rooted in psychological and neurological foundations. To receive a diagnosis of alexithymic symptoms, the patient first needs to receive an evaluation and diagnosis of a primary mental health condition.

Early studies have shown that the cause may come from when the right hemisphere of the brain (where emotional information is stored) is not communicating with the language regions in the left hemisphere. This can be caused by a deficiency in the corpus callosum, which can be found in patients who have ACEs, or adverse childhood experiences.  The parent’s emotional state is important for how any child develops. As infants haven’t developed their speech abilities yet, neglect or indifference to changes in a child’s facial expressions without any or the correct feedback can invalidate the child’s facial expressions, and in turn, their emotions. Another important factor in emotion development is the parent’s ability to reflect self-awareness to their child. If the parent cannot distinguish and recognize their child’s emotional expressions, it can influence their capacity to understand the emotional expressions of others.

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There is also evidence proving that those who have suffered a traumatic brain injury are six times more likely to exhibit symptoms of alexithymia.

Symptoms of Alexithymia

The symptoms of alexithymia all center around the inability of the person to understand the intricacies of feelings and emotions for both themselves and other people. These symptoms include:

  • 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
  • A lack of impulse control
  • Violent or disruptive outbursts
  • Detached or tentative connection to others
  • Difficulty identifying feelings and distinguishing between feelings and the bodily sensations.
  • Difficulty describing feelings to other people.
  • Limited imagination and, therefore, little or no fantasies and limited dreams.
  • An unawareness of what is happening in their own mind and a very concrete way of thinking.
  • Disorders that may cause/present with alexithymia

Historically, alexithymia was thought to be a psychosomatic disorder. Psychosomatic disorders are physical symptoms manifesting in a person’s body that are created and intensified by their mind. For example; a person who is very angry or upset might develop a stomachache. The condition as a psychosomatic disorder often manifests in the form of bodily symptoms when a person is unable to effectively express their emotions.

Alexithymia

It can be difficult trying to treat someone with alexithymia when they cannot tell you how they feel.

Treating Alexithymia

Since alexithymia is often a part of other mental health issues, treating it should be a part of the overall treatment of the person’s broader condition. Once the person seeks therapy or mental health treatment, a psychological evaluation will give an idea of how their alexithymic symptoms may be associated with one or more mental health conditions. A formal diagnosis and treatment should always be given by a mental health professional with expertise in the area. A medical professional can suggest the correct treatment for each patient. Treatments like Short Term Interpersonal Therapy, Dialectical Behavior Therapy, and Cognitive Mindfulness Training can be helpful to learn how to be more attentive to your own feelings, and how to identify emotions in others.

The main thing to remember when dealing with someone with alexithymia is patience. Being unreactive, missing social cues, and the lack of emotional recognition is not intentional, but is actually based on neurological and psychological causes. When living with alexithymia, your goal should be to strengthen your ability to identify and understand feelings in yourself, as well as others. This can be helped by things like group therapy, journaling, counseling, or even immersing oneself in the expressive arts, such as books and movies.

 

References:

Bermond, B. et. al. (2007). A cognitive and an affective dimension of alexithymia in six languages and seven populations. Cognition and Emotion, 21: 1125-1136.

Blanchard, E.B ; Arena, J.G. & Pallmeyer, T.P. (1981). Psychosomatic properties of a scale to measure alexithymia. Psychotherapy and Psychosomatics, 35, 64-71.

Fitzgerald, M. (2004). Overlap Between Alexithymia and Asperger’s Syndrome. American Journal of Psychiatry, 161(11), 2134-2135. doi: 10.1176/appi.ajp.161.11.2134

Hoppe KD, Bogen JE (1977). Alexithymia in twelve commissurotomized patients. Psychotherapy and psychosomatics. 28(1–4): 148–55. doi:10.1159/000287057. PMID 609675.

Kennedy, M. & Franklin, J. (2002). Skill based treatment for alexithymia: An exploratory case series. Behavior Change, 19(3):158-171.

Lumley, M. A., Neely, L. C., & Burger, A. J. (2007). The Assessment of Alexithymia in Medical Settings: Implications for Understanding and Treating Health Problems. Journal of Personality Assessment, 89(3), 230–246. http://doi.org/10.1080/00223890701629698

Nemiah, J.C. ; Freyberger, H. & Sifneos, P.E. (1976). Alexithymia: A view of the psychosomatic process. In: Hill OW, editor. Modern trends in psychosomatic research, Vol. 3. Buttersworth; London: 1976. pp. 430-439.

Vanheule S, Desmet M, Meganck R, Bogaerts S (2007). Alexithymia and interpersonal problems. Journal of clinical psychology. 63(1): 109–17. doi:10.1002/jclp.20324. PMID 17016830.

Williams C, Wood RL (2009). Alexithymia and emotional empathy following traumatic brain injury. J Clin Exp Neuropsychol. 32(3): 1–11. doi:10.1080/13803390902976940.

Elsie is a public health professional working in education and research. She is a lifelong learner, and is especially interested in mental and behavioral health. She loves travelling and spending time with her dog.