Alexithymia from the Greek words λεξις and θυμος (literally "without words for emotions") is a term coined by Peter Sifneos in 1973 to describe a state of deficiency in understanding, processing, or describing emotions.
Alexithymia is defined by:
In studies of the general population the degree of alexithymia was found to be influenced by age, but not by gender; the rates of alexithymia in healthy controls have been found at 8.3% (2 of 24 persons) 4.7% (2 of 43), 8.9% (16 of 179), and 7% (4 of 56). Thus, several studies have reported that the prevalence rate of alexithymia is less than 10% in healthy controls. A less common finding suggests that there may be a higher prevalence of alexithymia amongst males than females, which may be accounted for by difficulties they have with 'describing feelings', but not by a difficulty in 'identifying feelings' in which males and females show similar abilities. The alexithymia construct is strongly inversely related to the concepts of psychological mindedness and emotional intelligence and M. Bagby and G. Taylor state that there is "strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress". Other opinions differ and can show evidence that it may be state-dependent.
Bagby and Taylor also suggest that there may be two kinds of alexithymia, 'primary alexithymia' which is an enduring psychological trait which does not alter over time, and 'secondary alexithymia' which is state dependent and disappears after the evoking stressful situation has changed. These two manifestations of alexithymia are otherwise called 'trait' or 'state' alexithymia.
Some alexithymic individuals may appear to contradict the above mentioned characteristics because they can experience chronic dysphoria or manifest outbursts of crying or rage. However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings.
According to Henry Krystal, individuals suffering from alexithymia think in an operative way and may appear to be superadjusted to reality. In psychotherapy, however, a cognitive disturbance becomes apparent as the patients tends to recount trivial, chronologically ordered actions, reactions, and events of daily life with monotonous detail. In general, these individuals lack imagination, intuition, empathy, and drive-fulfillment fantasy, especially in relation to objects. Instead, they seem oriented toward things and even treat themselves as robots. These problems seriously limit their responsiveness to psychoanalytic psychotherapy; psychosomatic illness or substance abuse is frequently exacerbated should these individuals enter psychotherapy.
A common misconception about alexithymia is that affected individuals are totally unable to express emotions verbally and that they may even fail to acknowledge that they experience emotions. Even before coining the term, Sifneos (1967) noted patients often mentioned things like anxiety or depression. The distinguishing factor was their inability to elaborate beyond a few limited adjectives such as "happy" or "unhappy" when describing these feelings. The core issue is that alexithymics have poorly differentiated emotions limiting their ability to distinguish and describe them to others. This contributes to the sense of emotional detachment from themselves and difficulty connecting with others, making alexithymia negatively associated with life satisfaction even when depression and other confounding factors are controlled for.
In a study, a large group of alexithymic individuals completed the 64-item Inventory of Interpersonal problems (IIP-64) which found that "two interpersonal problems are significantly and stably related to alexithymia: cold/distant and non-assertive social functioning. All other IIP-64 subscales were not significantly related to alexithymia,"
Chaotic interpersonal relations have also been observed by Sifneos. Due to the inherent difficulties identifying and describing emotional states in self and others, alexithymia also negatively affects relationship satisfaction between couples.
Research indicates that alexithymia overlaps with Asperger syndrome. In a 2004 study, Uta Frith reported an overlap and that at least half of the Asperger syndrome group obtained scores on the Toronto Alexithymia Scale (TAS-20) that would classify them as severely impaired. Fitzgerald & Bellgrove pointed out that, "Like Alexithymia, Asperger’s syndrome is also characterised by core disturbances in speech and language and social relationships". Hill & Berthoz agreed with Fitzgerald & Bellgrove (2006) and in response stated that "there is some form of overlap between alexithymia and ASDs". They also pointed to studies that revealed impaired Theory of Mind skill in alexithymia, neuroanatomical evidence pointing to a shared aetiology and similar social skills deficits. The exact nature of the overlap is uncertain. Alexithymic traits in AS may be linked to depression or anxiety; the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety.
Alexithymia is correlated with certain personality disorders, substance use disorders, some anxiety disorders., and sexual disorders, as well as certain physical illnesses, such as hypertension, inflammatory bowel disease, and functional dyspepsia. Alexithymia is further linked with psychosomatic disorders such as migraine headaches, lower back pain, irritable bowel syndrome, asthma, nausea, allergy, and fibromyalgia.
An inability to modulate emotions is a possibility in explaining why some alexithymics are prone to discharge tension arising from unpleasant emotional states through impulsive acts or compulsive behaviors such as binge eating, substance abuse, perverse sexual behavior, or the self-starvation of anorexia nervosa. The failure to regulate emotions cognitively might result in prolonged elevations of the autonomic nervous system (ANS) and neuroendocrine systems which can lead to somatic diseases. Alexithymics also show a limited ability to experience positive emotions leading Krystal (1988) and Sifneos (1987) to describe many of these individuals as anhedonic.
It is unclear what causes alexithymia. Some neuropsychological studies indicate that alexithymia may be due to a disturbance to the right hemisphere of the brain, which is largely responsible for processing emotions. Other studies show evidence that there may be an interhemispheric transfer deficit among alexithymics; that is, the emotional information from the right hemisphere is not being properly transferred to the language regions in the left hemisphere, as can be caused by a decreased corpus callosum, often present in psychiatric patients who have suffered severe childhood abuse. In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex. These studies have some shortcomings, however, and the empirical evidence about the causes of alexithymia remain inconclusive. A biochemical etiology is suggested by the cross-relationships with post marijuana use,post ecstasy chronic use, major depression and bipolar depression. Joyce McDougall objected to the strong focus by clinicians on neurophysiological at the expense of psychological explanations for the genesis and operation of alexithymia, and introduced the alternative term 'disaffectation' to stand for psychogenic alexithymia. For McDougall, the disaffected individual had at some point "experienced overwhelming emotion that threatened to attack their sense of integrity and identity," to which they applied psychological defenses to pulverize and eject all emotional representations from consciousness.
Although physiological effects are important to determine, the first language of an infant is nonverbal facial expressions. The mother's emotional state is important for determining how any child might develop. Neglect or indifference to varying changes in a child's facial expressions without proper feedback can promote an invalidation of the facial expressions manifested by the child. The parent's ability to reflect self-awareness to the child is another important factor. If the adult is incapable of recognizing and distinguishing emotional expressions in the child, it can influence the child's capacity to understand emotional expressions.
Although environmental, neurological, and genetic factors are each involved, the role of genetic and environmental factors for developing alexithymia is still unclear. The results from a large population-based sample of Danish twins suggest that genetic factors have a noticeable and similar impact on all facets of alexithymia. While the results suggested a moderate influence of shared environmental factors, results are in concordance with the general finding that environmental influences on most psychological traits are primarily of the nonshared rather than the shared type.
Alexithymia and Psychiatric Symptoms in a Population of Nursery Workers: A Study Using the 20-Item Toronto Alexithymia Scale
Jan 01, 2001; This study investigated Alexithymia in a sample of professional nursery workers in Huddinge community, Sweden. In a...