Alexithymia is a psychological condition characterized by differences in emotional awareness and expression. These differences can manifest in various ways, including difficulties in identifying, articulating, and comprehending one's own emotional experiences, as well as interpreting the emotional states of others. Individuals with alexithymia can also struggle to differentiate between emotional experiences and physiological responses, such as the bodily sensations accompanying their emotions.
Inconsistencies may sometimes appear in the emotional presentation of alexithymic individuals. For instance, they may display symptoms of chronic dysphoria or even emotional outbursts, such as crying or bouts of anger. However, upon closer examination, it becomes clear that those with alexithymia find it quite difficult to reflect and provide a nuanced description of their emotional state or articulate the triggers for a seemingly sudden or volatile emotional reaction.
Many people with alexithymia experience a limited differentiation of emotional experiences, which hampers their ability to understand and communicate these emotions clearly.
Historically anchored in psychoanalytical frameworks, the discourse on alexithymia has shifted toward neuropsychology, developmental psychology, and personality psychology. Studies in these fields have contributed to a more nuanced understanding of the condition, linking it to developmental stages and cognitive processes. However, there remains an ongoing debate regarding the classification of alexithymia as either a state or a trait, given that it manifests across various psychosomatic and psychiatric conditions.
A key concern is the frequent comorbidity of alexithymia with other psychiatric conditions such as Autism Spectrum Disorder, PTSD, Anorexia, and Depression. Comorbidity complicates the therapeutic landscape because the inability to recognize and describe emotions in alexithymia may mask the manifestation of co-occurring conditions, or it may exacerbate them. For example, alexithymia can reduce a patient's ability to engage in cognitive-behavioral therapies that require emotional introspection, making the treatment of PTSD or depression more challenging. When ASD is present, emotional dysregulation can be further confounded by alexithymic traits. This necessitates a multi-dimensional diagnostic and therapeutic approach that addresses the primary disorder and the layered complexity introduced by alexithymia.
Research indicates that alexithymia overlaps with about 40-70% of adults with ASD compared to an average of about 17% among those without ASD. Higher levels of alexithymia are also linked to greater PTSD severity, with 43% of veterans with diagnosed PTSD exhibiting high alexithymia compared to 11% of veterans without diagnosed PTSD.
Many individuals with Alexithymia find that expressing their feelings openly to others does not come naturally. They may find it difficult to label or recognize nuance within their own emotional experience. They may misidentify emotions or find it challenging to distinguish emotions that others seem to have little trouble describing (e.g., telling the difference between anxiety and anger).
People with alexithymia may have trouble articulating and describing their emotions to others. They may resort to using vague or generic terms when discussing their feelings, or they may find it easier to keep quiet about their feelings, which can come across as being apathetic, guarded, or withholding.
People with Alexithymia may also find it difficult to differentiate or connect body changes from emotional responses. For example, they might have trouble linking a racing heart to excitement or fear but can still acknowledge that they’re experiencing a physiological response. They may sometimes misinterpret an emotional response their body is exhibiting, attributing their physiological response to a sickness or injury (e.g., misattributing jealousy as hunger or grief as a viral cold).
Some alexithymic individuals seem to prefer to focus on external events and concrete facts rather than imagination and fantasy. They may have difficulty daydreaming or creating vivid mental images and may be more comfortable discussing factual details rather than exploring their emotions.
We use several empirically validated assessments (RMET-R, TAS-20, TEQ, and OAQ-G2) to help us evaluate the different areas and subcategories of Alexithymia that cause the most difficulty for each patient. The resultant analysis can help patients with Alexithymia identify factors that can be improved with psychoeducational and emotional awareness training. We also treat the underlying ASD, PTSD, and depression that may be contributing to their difficulty.