Alexithymia

Alexithymia is a personality trait defined as a person’s inability to recognize his or her own emotions as well as those exhibited by other people. The condition is not considered a mental disorder and is not clinically diagnosed. People with alexithymia cannot understand the subtleties and nuances of emotions, and often cannot put words to feelings. Individuals with alexithymia often confuse physical sensations with emotions. These individuals generally struggle with expressing emotions, and this often results in emotional detachment from others. People with alexithymia struggle to understand what causes feelings. The condition is also characterized by an inability to decipher facial cues in other people. Individuals with alexithymia usually have limited imaginations and a narrow way of thinking. They also have hypersensitive sensory issues. Alexithymia has been associated with a number of disorders over the years, including autism spectrum disorder, depression, schizophrenia, and somatic symptom disorders.

Background

Although the term alexithymia was not coined until the 1970s, the psychological concept of alexithymia was first described in the late 1940s. Psychiatrists observed that a number of patients experiencing post-traumatic stress were unable to verbalize emotions. Patients also found it difficult to use facial expressions to show emotion and had limited imaginations. Similar symptoms were found in the psychosomatic patients of other treatment centers. Clinicians observed that these types of patients did not respond well to psychotherapy. Early psychiatrists blamed immaturity for these issues, often describing patients as experiencing a continuation of an “infantile personality.” Others described the issue as arising from a mental deficit within patients, preventing them from creating mental representations of emotions.

This deficit was described again in the early 1950s by psychiatrists examining the effect of psychoanalytic psychotherapy in patients. A number of patients were found to receive no benefit from the technique due to a lack of emotional awareness. These patients also viewed life through rigid lenses and based their behavior on the expectations of others rather than on their own thoughts and feelings. The patients who displayed these behaviors and motivations often engaged in compulsory behaviors such as binge eating and alcoholism as a means of coping with internal conflict.

The mental health community began to notice a link between impaired emotional recognition and other psychiatric disorders in the late 1960s. Conditions associated with the inability to identify and respond to emotional stimuli included post-traumatic stress disorder, substance use disorders, and eating disorders. By the early 1970s, alexithymia had a name and a definition, and in 1976 it was selected as the main theme for the eleventh European Conference on Psychosomatic Research in Germany. That same year, American psychiatrist John Case Nemiah, who coined the term alexithymia, published an article detailing the characteristics of the condition and of those who experience it. Nemiah and his colleagues laid the foundation for future understanding of alexithymia and its core features.

Overview

Nemiah and his associates defined alexithymia as a complex personality construct with four distinct features as follows:

• Difficulty recognizing emotions and differentiating feelings from emotionally aroused physical sensations
• Difficulty explaining feelings to others
• Limited imagination and ability to fantasize
• Externally motivated style of thinking

Understanding of alexithymia continued to transform over the next few decades. Researchers began to look further into the causes of the personality trait. Early on, experts divided the condition into primary and secondary alexithymia. Primary alexithymia was described as resulting from structural and neurobiological deficits. Secondary alexithymia was viewed as a consequence of environmental factors such as developmental issues or traumatic episodes. These divisions were later dropped as researchers began to understand the complexities involved in the emergence of alexithymia. Rigorous studies exploring the causes of alexithymia emerged in the mid-1980s. By the 2000s, the scientific community had constructed standard measures for assessment. Contemporary research indicates a range of factors responsible for alexithymia development, including structural, functional, and epigenetic causes.

Experts agreed that alexithymia was not a mental disorder and therefore did not necessitate a clinical diagnosis. Rather, the condition was a personality trait that potentially affected up to 10 percent of the population. Studies suggest 8 percent of males and 2 percent of females experience alexithymia. Research also shows that alexithymia can have varying intensities, ranging from mild to moderate to severe. Alexithymia is a common feature of individuals with autism spectrum disorder (ASD). Research estimates anywhere from 50 to 85 percent of ASD individuals have varying degrees of alexithymia.

Studies in alexithymia show that the condition has two dimensions, a cognitive dimension and an affective dimension. In the cognitive dimension, the patient struggles to recognize, verbalize, and interpret feelings. In the affective dimension, the patient experiences difficulty expressing his or her own emotions as well as using his or her imagination and reacting to other people’s feelings. A lack of emotional understanding does not mean those with alexithymia do not express emotions. Although individuals with alexithymia have trouble identifying and interpreting feelings, they can still exhibit emotional responses, mainly sadness or rage. They do not understand why these feelings emerge.

A range of treatments can be utilized when dealing with alexithymia. Although psychotherapeutic treatments tend to have little effect on patients with alexithymia, skill-based psychotherapy, which focuses on skill-building, can help teach an individual how to pay better attention to his or her own personal feelings and the feelings of others. Group psychotherapy can also be effective, as it allows patients to explore feelings in a group setting, encouraging meaningful exchanges and a sense of connectedness. Other treatment options include hypnosis, relaxation training, and art and music therapy. Some therapists encourage patients to read novels to gain a better understanding of human emotion. This activity can be paired with journaling, which encourages patients to examine the thoughts and feelings they encounter.

Despite wide acceptance of its basic tenets, scholarly debate regarding the definition and assessment of alexithymia continues. Many scholars would like more scientific certainty in order to confirm the validity of alexithymia as a psychological construct.

Bibliography

Fitzgerald, Michael, and Mark A. Bellgrove. “The Overlap between Alexithymia and Asperger’s Syndrome.” Journal of Autism and Developmental Disorders, vol. 36, no. 4, 2006, pp. 573–76.

Friedman, Howard S., editor. Encyclopedia of Mental Health. Elsevier, 2016.

Mueller, Rene J. “When a Patient Has No Story to Tell: Alexithymia.” Psychiatric Times, vol. 17, no. 7, 2000, www.psychiatrictimes.com/somatoform-disorder/when-patient-has-no-story-tell-alexithymia. Accessed 16 Oct. 2018.

Serani, Deborah. “The Emotional Blindness of Alexithymia.” Scientific American, 3 Apr. 2014, blogs.scientificamerican.com/mind-guest-blog/the-emotional-blindness-of-alexithymia/. Accessed 16 Oct. 2018.

Taylor, Graeme J., et al. Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge UP, 1999.

Thompson, Jason. Emotionally Dumb: An Overview of Alexithymia. Soul Books, 2009.

Widiger, Thomas A., editor. The Oxford Handbook of Personality Disorders. Oxford UP, 2012.

Wilkinson, Lee A. “Alexithymia, Empathy, and Autism.” Living Autism Foundation, livingautism.com/alexithymia-empathy-autism/. Accessed 16 Oct. 2018.