Alexithymia: Do You Know What You Feel?

As human beings, our lives are profoundly influenced by how we experience, handle, and express emotions. At some point in our lives, we all experience extreme sadness, fear, stress, joy, and love. When something good happens to us, we feel lightness and joy in our hearts. When we experience losses and defeats, we have a sinking feeling at the bottom of our stomachs.

But imagine not being able to do that. What if you could never identify if you are sad or happy? What if you are indeed grieving or depressed but don’t even know it yourself? Can you imagine how confusing that is?

That is the world that a person with alexithymia dwells in.

Living with Alexithymia

Alexithymia, derived from the Greek language, means "no emotions for words." This psychological construct is used to describe people who struggle with feeling and expressing emotions. It represents a reduced ability, or sometimes a complete inability, to be connected with the internal emotive signals your body sends you.

If you have alexithymia, you do not only have trouble knowing how you feel, and you also struggle to tell how others feel. This can make you socially anxious as you cannot read non-verbal cues. You may come across as socially awkward or lacking in humour. Even when others empathize with difficult things you are going through, you cannot take it and may come across as eerily stoic. Deep down, you may be a highly sensitive and empathic person, but because of this particular difficulty, others may misunderstand you as being someone cold, aloof and arrogant. As a result, you are more likely than most to suffer from social isolation and loneliness.

If you struggle with alexithymia, the following may represent some of your day-to-day challenges:

• You have no idea what you are feeling inside. When others ask how you are, you draw a blank. Even in a therapist’s office, you cannot get in touch with what is going on inside.
• Most of the time, you can only tell if you are feeling "good" or "bad," "happy" or "unhappy," and not much nuance beyond that.
• Rather than explaining how your feelings or instincts drive you to a particular action, you tend to define yourself with logic. You may speak in a monotone, and the way you narrate stories may include so many factual, sequential details that some people find it hard to follow.
• You are disconnected from your own needs and desires. Because you are confused yourself, others around you also do not know what you want, leading to relationship and interpersonal frustrations.
• You may have sudden, unpredictable physical symptoms like racing heartbeat, difficulty breathing, bodily pain and headaches but have no idea where they have come from. To the extreme, you may even have suicidal ideation and self-harm behaviours but are disconnected from the reasons behind them.
• You have limited imagination and are not able to enjoy anything that has to do with the fantasy world.
• You are not able to communicate any emotion even to family and close friends, but you may suddenly show disruptive behaviour like bouts of anger.
• Not knowing why, you have lost all drive and motivation. You procrastinate at work and do not find much joy in any leisure activities. Only getting through the day becomes a difficult chore.
• You do not have a solid sense of self, experience identity confusion and don’t know what you want for the future.
• Sometimes you feel like you are a distant observer of your own life. Deep down, however, you are anxious that you are just wasting your life away.
• You do not like feeling out of control, especially when it comes to relationships. Therefore, even you crave companionship and kinships, and you avoid close relationships.

It’s important to note that having alexithymia does not mean you are completely apathetic. You may still feel things inside, but you struggle to feel connected to your feelings, or you are not able to express them to others.

The Diagnosis of Alexithymia

Alexithymia is not considered a mental disorder on its own. It was first introduced into psychiatry by Peter E. Sifneos, a psychiatrist and professor at Harvard Medical School in 1976. Yet even today, there is a lack of information on the underlying causes and recommended therapies.

Various psychometric tools have been developed to identify alexithymia; such as the Toronto Alexithymia Scale 20 (TAS-20, Bagby, Parker & Taylor, 1994). Depending on the outcome of your initial assessment, an MRI may be suggested to assess any damage to the insula in the brain.

Certain social demographic factors are more likely to put a person at risk of alexithymia. While it’s estimated that 13 percent of the population suffers from alexithymia, the prevalence among men is almost twice (17 percent) than women (10 percent).

Alexithymia can occur at two levels — as a primary trait and as a secondary state. Primary Alexithymia implies that the individual is born with a genetic abnormality that hampers the ability to feel and express emotions and empathize. It’s also linked to brain damage, particularly to the anterior insula (responsible for the visceral sensory and motor responses and somatic sensory reactions, especially in the face, tongue, and upper limbs). The brain defect can be a congenital condition or the result of an injury that occurs later in life.

In the alexithymia literature, “secondary alexithymia” is defined as alexithymia that is a state reaction to physical illness (Freyberger, 1977) or other major or extraordinary life change.

Research has found links between alexithymia with other disorders including:

• Substance Use Disorder
• Post-traumatic Stress Disorder
• Psychosomatic Disorders
• Anxiety Disorders
• Depressive Disorders
• Eating Disorders
• Personality Disorders
• Obsessive-Compulsive Disorder

Alexithymia and Autism

An alexithymic person’s failure to recognize the intense feelings (such as confusion or danger) in others and their lack of expression of emotions means that alexithymia is often misinterpreted as autism.

While individuals on the autism spectrum are much more likely also to exhibit traits of alexithymia, research on the correlation between the two conditions is inconclusive. The existing consensus seems is that alexithymia often occurs with autism and is not caused by autism (or vice-versa).

Alexithymia and Depression

A person with alexithymia is twice as likely also to experience depression. But at the same time, research shows that symptoms of alexithymia decline with a reduction of symptoms of depression. It is not clear whether alexithymia is a cause or consequence of depression.

Alexithymia and Trauma

People who experience PTSD are more likely to develop alexithymia. A study of Vietnam veterans with post-traumatic stress disorder revealed that 41 percent of them were alexithymic. A similar survey of holocaust survivors revealed that those with PTSD had significantly higher scores when tested for Alexithymia than those without PTSD.

Alexithymia and Neurological Disease

Patients with neurological diseases and conditions such as traumatic brain injury, stroke, dystonia, Huntington’s disease, multiple sclerosis, Parkinson’s disease, and epilepsy are more likely to exhibit alexithymia.

Alexithymia and Early Childhood Emotional Trauma

More than likely, alexithymia is a result of the disruption in your emotional development in your younger years. If your parents suffered from mental illnesses, were emotionally immature or cold, they might have failed to provide you with the mirroring and attunement that you had needed. They might have very limited capacity to feel and could tolerate little emotion, so they shut you down when you tried to express yourself. If they were not emotionally literate themselves, they would not be able to model healthy expression for you.

Some of us are born more sensitive, intense, and emotional. However, if your family members were wired differently, they may scapegoat you as being "too sensitive," "too dramatic," or simply "too much." Thus the message you received from a young age was that any honest expressions from you were inconvenient to the grown-ups. If you were to express things like anger or hurt, your family may threaten to reject you, abandon you, or punish you. Sometimes, even your natural exuberance was punished, and no one had ever shared your joy or excitement.

Growing up in such an environment, your feelings were never validated. It is only natural that you eventually learn to disown or bury them.

Healing from Alexithymia

The treatment approach for alexithymia should be tailored. Traditional approaches such as psychoanalysis, in which the therapist presents an emotional "blank screen," for instance, has not been found to be a good match. (Lesser, 1981; Sifneos, 1975; Taylor, 1984). However, since alexithymia often occurs along with other mental disorders, the treatment of these conditions can also help reduce the alexithymia.

The first step towards healing is guiding you to identify and express your feelings. Alongside work on building emotional literacy, Dialectical behavioral therapy can help you build self-awareness alongside emotional regulation skills. Mentalization-based treatment, which focuses on building a connection between thoughts and emotions, can also be helpful. On your own, you may expand your introspective awareness by practicing daily journaling, enrolling in expressive arts classes (such as acting, dance, art, music, or movement therapy class), listening to emotive music, and even reading novels (especially ones that describe a personal narrative).

Another powerful healing agent for alexithymia is having a therapeutic relationship with someone you trust. This is especially true if what has caused your alexithymia was early childhood trauma or the lack of attunement from a mature caregiver. In the best-case scenario, your therapist will work with you to co-create a space in which you feel safe enough to get in touch with the deeper layers of your buried feelings. This may take some time, but if there is enough trust, the buried feelings will gradually surface. In this process, a skilled therapist will gently guide you and empower you to give words to what was unexpressed. This process cannot be arbitrarily sped up before you are ready. Your therapist ought to have an understanding of your limit and be patient with the stuckness you face without blaming you.

It is important that your therapist can model for you, not just what it means to be emotionally verbal, but also what being authentic in a relationship looks like. In healthy relating, emotions are not one-dimensional. Sure, joy, warmth, and affection are essential aspects of a relationship, but feelings such as disappointment, anger, and frustrations should also be allowed. If your therapist is not emotionally resourced or equipped enough, they may subtly shut you down or punish you for expressing these "negative" feelings, thus dysfunctionally replicating what your parents had done to you.

If, on the flip side, you can find an emotionally mature, nurturing therapist who is comfortable with uncertainty and is able to withstand the emotional storms that you bring up, your ability to relate to yourself and others can forever be changed. The new strength and assertiveness you gain can then be brought to other aspects of your life, allowing you to build new relationships and intimacy, to love and feel loved, and feel more fully alive in the world.

Alexithymia is not something you cannot change. This may be counterintuitive, but more likely than not, what is trapped under an alexithymic exterior is an excruciatingly sensitive and empathic soul. If you give yourself a chance, and courageously embark on the path to reclaim your emotional sensitivity and intensity, the reservoir of aliveness is within grasp.

To find a therapist, visit the Psychology Today Therapy Directory.

Facebook image: Jaem Prueangwet/Shutterstock