Alexithymia—When a Person Doesn't Speak the Language of Emotions

Alexithymia (from the Greek a- lexi- thymia, meaning “no words for feelings”) is a trait found in a mild, moderate, or severe form in about 8% of men and 2% of women (Blanchard, Arena & Pullmeyer, 1981). It manifests as difficulty in recognizing and expressing specific emotions. According to Bermond (2007) , alexithymia has two dimensions: the cognitive dimension, in which a person struggles to identify, understand, and name feelings (the “thinking” part of the emotional experience) and the affective dimension, which involves difficulties with reacting to, expressing, feeling, and imagining emotions (the “experiential” part of the emotional experience). Other symptoms of alexithymia include:

• Reduced understanding of how feelings arise
• Difficulty reading facial expressions and nonverbal communication
• Limited imagination
• High sensitivity to bodily sensations
• Distant relationships with others

Alexithymia is not considered a disorder in and of itself, but it is often associated with various mental disorders, ranging from autism, depression, and schizophrenia to eating disorders and addictions. In contrast to the poverty of their emotional world, people with alexithymia tend to have rich bodily experiences. The lack of emotions can make the psychotherapy process more difficult. Here are two examples of patients in whom a doctor or therapist observed alexithymia (Lumley, Neely & Burger, 2007):

Mr. A., a 50-year-old obese man with hypertension, experienced an atypical panic attack in his primary care physician’s waiting room. It seemed to him that the walls around him were closing in and voices were turning into a buzzing sound. He told his psychotherapist that he felt neither fear nor anxiety during the episode, had no images associated with the event, and had no idea what triggered the attack. Mr. A is college-educated and married, but has few close friends; he is detail-oriented and finds it difficult to imagine the world from other people’s perspectives. Aside from mild irritability, he expresses very few emotions and has minimal insight into his own mental life. He tends to view external circumstances (weather, work, his wife, diet, etc.) rather than internal experiences as the triggers for his states. In psychotherapy, he takes careful notes, but discussions about feelings seem distant and boring to him.

Ms. B, a 45-year-old woman, came to see her doctor for chronic pain, chronic fatigue syndrome, and other health problems, including depression. During psychotherapy, various emotional themes emerge (e.g., harsh punishments in childhood), and strong emotions—primarily sadness, shame, and fear—but she is unable to name her emotions or connect them to memories and experiences. She finds it particularly difficult to identify anger. When her negative emotions intensify, she typically shifts her attention to her body and speaks only of physical pain without mentioning her psychological distress. Interestingly, however, Ms. B is attuned to the feelings of others and is able to recognize them well. This, too, will help Ms. B in therapy to get in touch with her inner world, learn to express anger, and thereby alleviate her chronic pain and dysfunction.

If you recognize someone close to you in the description of alexithymia, it’s important to realize that misunderstood signals, cold reactions, or difficulties expressing positive emotions have neurobiological and psychological origins. When communicating, try to explain your needs directly: “I’m tired today; I don’t feel like cooking. Let’s go out for dinner tonight.” Or help them identify their feelings: “You look upset. Is something bothering you?” Or help them identify potential stressors simmering beneath the surface: “High school graduation is coming up—are you worried about it?” Recognizing that your loved one may not perceive emotions the same way you do is helpful in resolving conflicts and misunderstandings.

Although psychotherapist Peter Sifneos coined the term “alexithymia” as early as 1973, it’s still unclear how it develops. Is it a stable personality trait? Or is it a “disconnection” from emotions resulting from past traumatic experiences? Is alexithymia hereditary, and can it be influenced by upbringing? And is emotional intelligence the opposite of alexithymia? Some research suggests that the ability to recognize and understand feelings can be developed. Here are a few examples of how to do so:

1. Journaling: expressing oneself through writing can be good practice for developing the ability to recognize emotions (Paes, Velasco & Gonzalez, 1999). It is generally recommended to write in a journal every day. It’s important to try to include more than just a factual description of the day’s events—for example, observations about what’s going on inside me and around me.
2. Reading short stories and novels: this is where you’ll find rich descriptions of thoughts, feelings, and experiences. Thanks to them, you can learn to express emotions using various linguistic formulations and better understand other people’s thought processes (Kidd & Castano, 2013).
3. Artistic activities: theater, dance, painting, or body-oriented therapy. According to research (Levy, 1995) , these activities help people with alexithymia recognize their feelings and “bring them to the surface.”
4. Psychotherapy: certain types of psychotherapy (e.g., mindfulness-based cognitive-behavioral therapy) teach you how to be more attuned to your own emotional states and how to identify the emotions of others (Kennedy & Franklin, 2012). Group psychotherapy, in turn, deepens the ability to connect emotionally with others through interactions with them (Beresnevaite, 2000).
5. Relaxation techniques and hypnosis: While most psychotherapies use narrative as a means to alleviate alexithymic symptoms, hypnosis and relaxation use guided imagery and mentalization to enhance emotional understanding (Gay, Hania & Luminet, 2008). In its simplest form, it is enough to engage in any activities that foster imagination and creativity.

Sources:

• Beresnevaite, M. (2000). Exploring the benefits of group psychotherapy in reducing alexithymia in coronary heart disease patients: A preliminary study. Psychotherapy & Psychosomatics, 69:117-122.
• 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.
• Gay, M.C.; Hanin, D. & Luminet, O. (2008). Hypnotic imagery intervention in reducing alexithymia. Contemporary Hypnosis, 25: 1-13.
• Kennedy, M. & Franklin, J. (2002). Skill-based treatment for alexithymia: An exploratory case series. Behavior Change, 19(3):158-171.
• Kidd, D. C. & Castano, E. (2013). Reading literary fiction improves theory of mind. Science, 342, 377–380.
• Levy, F. (1995). Dance and other expressive therapies. When words are not enough. New York: Routledge.
• 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.
• Paez, D.; Velasco, C. & Gonzalez, J.L. (1999). Expressive writing and the role of alexithymia as a dispositional deficit in self-disclosure and psychological health. Journal of Personality & Social Psychology, 77:630–641.
• https://blogs.scientificamerican.com/mind-guest-blog/the-emotional-blindness-of-alexithymia