Alexithymia refers to people who have difficulty identifying and describing emotions and who tend to minimize emotional experiences and focus attention externally. Alexithymia literally means ‘not having words for emotions’. Alexithymia is not classified as a mental disorder in the DSM-5, a classification system in which international agreements have been made about which criteria apply to a particular mental disorder based on (new) scientific insights. Alexithymia is seen as a personal problem that varies from person to person. The existence of alexithymia can be measured using a scale, such as the Toronto Alexithymia Scale (TAS). The TAS is a 20-item instrument that is one of the most commonly used measures of alexithymia.
- What is alexithymia or emotion blindness?
- Definition and meaning
- Where does the term come from?
- A little-researched phenomenon
- How often does it happen?
- Symptoms
- Development and course
- Early childhood
- Goal oriented
- Body does respond
- Interpersonal problems
- Misinterpreting physical sensations
- Association with other problems
- Link with autism
- Other psychological problems
- Chronic pain
- Causes of alexithymia
- Examination and diagnosis
- Treatment of alexithymia
Alexithymia involves difficulty understanding your emotional state / Source: MissLunaRose12, Wikimedia Commons (CC BY-SA-4.0)
What is alexithymia or emotion blindness?
Definition and meaning
Alexithymia or emotion blindness is a personality trait characterized by difficulties in describing and distinguishing feelings, a limited fantasy life and thinking that is mainly focused on the outside world and less on inner experience.
Where does the term come from?
The term alexithymia was coined by Peter Sifneos, professor of psychiatry at Harvard Medical School, who identified the phenomenon in the 1970s in epileptics who appeared emotionally blunted after a lobotomy. Emotion researchers call this phenomenon emotional illiteracy or emotional blindness, because when such people talk about feelings, it sounds like blind people are describing how beautiful a starry sky is. Emotionally blind people usually do not feel sadness or joy and this equanimity is very difficult for the social environment to tolerate.
A little-researched phenomenon
Alexithymia is a phenomenon that has not been studied much in psychology in 2023. A distinction is often made between different degrees of expression, because on the one hand there are alexithymic people who have no difficulty with it, on the other hand there are alexithymic people who show both physical and psychological pathological symptoms. One area of research is mainly concerned with representative studies of the prevalence of alexithymia in the population, while others are more focused on those affected who have to deal with problems related to alexithymia, always first clarifying to what extent alexithymia causes suffering in these people.
How often does it happen?
Alexithymia is not a disease or disorder in the strict sense of the word, but a personality trait found in approximately ten percent of the population. Most (representative) population studies come from Scandinavia, in which the TAS-20 questionnaire is administered as a measuring instrument for alexithymia. The results show that more men, but also more people with a low socio-economic status, people with a low education and the elderly are affected. However, in clinical practice, women outnumber men, especially in pain disorders, while more men are found in some diseases suspected to be caused by alexithymia, especially addictions.
Signs of alexithymia (emotion blindness) / Source: MissLunaRose12, Wikimedia Commons (CC BY-SA-4.0)
Symptoms
Symptoms and features of alexithymia include:
- difficulties in identifying feelings and emotions
- difficulty distinguishing between emotions and physical sensations associated with those emotions
- limited ability to communicate feelings to others
- difficulty recognizing and responding to emotions in others, including voice tone and facial expressions
- a lack of fantasy and imagination
- a logical and rigid thinking style with a tendency to black and white thinking that does not take emotions into account
- poor coping skills when it comes to dealing with stress
- behave less altruistically than others
- appearing distant, rigid and humorless
- dissatisfaction with life
- memphasis on external events rather than internal emotions
- stronger connection to physical sensations than emotional states
- relationship problems: challenges in understanding emotional needs of others
- difficulties in therapy: hindrance to emotional exploration and growth during therapy
Development and course
Early childhood
As a personality trait, alexithymia usually appears early in childhood, remains stable over time, and affects social behavior such as academic, occupational, and partner choice. Learning to perceive and express feelings is a long-term socially induced learning process in human development, in which a lot can go wrong. A person who suffers from emotion blindness probably did not go through all the necessary developmental steps as a child, so most undesirable developments can be traced back to the social interactions between the child and his environment.
Goal oriented
People with alexithymia think very purposefully, for example if the potential partner or father-in-law has a lot of money, this is an argument for entering into a partnership. If the woman looks like she’s not causing any problems, that’s also a rational argument for getting into a relationship. So they don’t necessarily make wrong decisions in life, but they make them differently.
Body does respond
People with alexithymia are not completely anesthetized. Rather, their bodies respond similarly in situations that evoke negative feelings in others, but they are less or unaware of the associated feelings. They have less access to their feelings, but in essence they do not have fewer feelings than others, but rather their feelings are less differentiated and they cannot distinguish them as well.
Interpersonal problems
Because they not only cannot or hardly perceive and identify their own feelings, but also cannot properly read and feel those of other people, problems can also arise in the interpersonal sphere. Many therefore quickly learn to do what others expect of them in everyday life. When they laugh, it is mainly because they know that circumstances will require it of them, but the laughter does not come from within. People with alexithymia are usually very good actors in that sense. However, they often appear a bit stiff and their facial expressions and gestures are often not very pronounced. An outward thinking style is also typical of alexithymia, that is, they are more focused on the factual, while imagination and fantasy have little meaning and are often seen as a meaningless pastime, so they develop a negative attitude towards it and thus the fictional but also the creative is rejected.
Misinterpreting physical sensations
Because alexithymes cannot attribute their physical reactions very well to feelings, but can feel them, they interpret palpitations, for example, not as a signal of anxiety, but as a symptom of heart disease. People who suffer from emotion blindness make many more mistakes in finding the cause of physical sensations. For example, more physical abnormalities such as pain are generally reported, but also because negative feelings are experienced in isolation and cannot be linked to the underlying social stress situation. They more often suffer from physical complaints without an organic cause, such as irritable bowel syndrome or other pain complaints.
Association with other problems
Link with autism
Alexithymia has a strong association with autism spectrum disorder (ASD). This is evident from a 2018 study that indicates that about half of people with ASD are likely to have alexithymia. It mainly occurs in people with complex ASD.[1]
Other research suggests that the social and emotional difficulties experienced by people with ASD (empathy deficits, difficulty recognizing emotions) may not be a hallmark of autism but rather of co-occurring alexithymia.[2]
Other psychological problems
Psychological problems are also often associated with alexithymia. People with alexithymia are more likely to regulate their feelings by suppressing all emotional impulses, which complicates social contacts and can lead to negative (interpersonal) experiences and therefore even more insecurity. It is known that talking about feelings is an important outlet for maintaining long-term mental health and people with alexithymia do not have or do not adequately control this option. In numerous studies, researchers have shown links between alexithymia and mental health problems such as eating disorders, substance abuse, depression and anxiety disorders.
Although emotion blindness is not officially a disease, it can make your life considerably more difficult and affect your quality of life. Alexithymia is a risk factor when there are stressful life events that require adequate management of feelings. In that case, the person concerned is more likely to develop depression or an anxiety disorder.
Chronic pain
Aalexithymia is also common in people with undiagnosed chronic pain.
Causes of alexithymia
The causes of alexithymia have not yet been clearly investigated in 2023. It is possible that traumatic experiences during (early) childhood can lead to emotion blindness. However, the inability to perceive feelings can also be the result of emotional neglect in early childhood, as children learn from their parents how to perceive and express feelings.
It is possible that it is partly genetic.
However, alexithymia can also be the result of brain damage to the insula, a part of the brain below the lateral sulcus. This part of the brain is known for its role in social skills, empathy and emotions, and some research associates damage to the insula lesions with apathy and anxiety.
Examination and diagnosis
People with alexithymia rarely visit a psychiatrist’s office. They do not complain about their feelings or emotions. More often they end up at the doctor’s office with unexplained physical complaints.
Alexithymia is diagnosed by a mental health professional. It is not officially recognized by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The counselor will ask questions and make a diagnosis based on your answers. The existence of alexithymia can be measured using the Toronto Alexithymia Scale (TAS). This is a 20-item instrument that is one of the most commonly used measures of alexithymia.
Another possible test is an MRI performed by a neurologist. This provides images of the insula in the brain. It can often take some time before the correct diagnosis is made.
Treatment of alexithymia
Since alexithymia is still little researched in 2023, there are not many proven treatment options available. However, a (social) skills-based intervention appears to be an effective method to treat alexithymia. A mentalization-promoting therapy (MBT) also seems to be paying off. Mentalizing means that you can understand and explain the behavior of yourself and others based on underlying feelings, thoughts and motivation. Mentalization-based treatment helps patients separate their own thoughts and feelings from those around them. This treatment is relational and focuses on gaining a better understanding and use of mentalizing skills.
Notes:
- Poquérusse, J., Pastore, L., Dellantonio, S., & Esposito, G. (2018). Alexithymia and Autism Spectrum Disorder: A Complex Relationship. Frontiers in psychology, 9, 1196. https://doi.org/10.3389/fpsyg.2018.01196
- Shah, P., Hall, R., Catmur, C., & Bird, G. (2016). Alexithymia, not autism, is associated with impaired interoception. Cortex; a journal devoted to the study of the nervous system and behavior, 81, 215–220. https://doi.org/10.1016/j.cortex.2016.03.021
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