Alexithymia is when a person has difficulty identifying and expressing emotions. It is not a mental health disorder.
People with alexithymia may have problems maintaining relationships and taking part in social situations. They may have a co-occurring mental health condition, such as depression, or no diagnosable mental health conditions. Alexithymia also has links with autism.
Up to 13% of the population experience alexithymia, according to some research. It is more common in males than females, with one study among a prison population in China indicating that over 30% of the prisoners experienced it.
In this article, we discuss the symptoms and causes of alexithymia. We also look at its links with mental health conditions.
Researchers describe alexithymia as a construct relating to a difficulty experiencing, identifying, and expressing emotions.
It is not a clinical diagnosis, and mental health professionals do not consider it a disorder, although it may occur alongside some mental health conditions.
Peter Sifneos, a psychiatrist and professor emeritus of psychiatry at Harvard Medical School, first described alexithymia in the early 1970s. The word comes from Greek: ‘a’ meaning lack, ‘lexis’ meaning word, and ‘thymos’ meaning emotion — overall, it means having a lack of words for emotions.
People with alexithymia have:
- problems with introspection, or observing their own mental and emotional processes
- experience confusion around bodily sensations connected to emotions
- struggle to communicate their emotions to others
Alexithymia also makes it difficult for people to identify and respond to emotions in others. These issues can lead to difficulties in social settings and interpersonal relationships.
Signs and symptoms of alexithymia include:
- difficulties identifying feelings and emotions
- problems distinguishing between emotions and bodily sensations that relate to those emotions
- limited ability to communicate feelings to others
- difficulties recognizing and responding to emotions in others, including tone of voice and facial expressions
- a lack of fantasies and imagination
- a logical and rigid thinking style that does not account for emotions
- poor coping skills when it comes to dealing with stress
- behaving less altruistically than others
- appearing distant, rigid, and humorless
- poor life satisfaction
Experts do not understand the exact cause of alexithymia. Some studies suggest that it may result from one or more of the following:
- Genetics. Research on twins indicates that there is a genetic component to alexithymia. People are more likely to have alexithymia if a close relative also has it.
- Environmental factors. The same twin study also indicates that environmental factors play a role in alexithymia. Examples of environmental factors include a history of childhood trauma, the presence of a physical or mental health condition, or socioeconomic factors.
- Brain injury. Research reports that people with injury to a part of the brain known as the anterior insula experience increased levels of alexithymia.
Risk factors for alexithymia include:
- being male, with one study reporting that men experience alexithymia almost twice as often as women
- advancing age
- a low level of education
- low socioeconomic status
- low emotional intelligence
Alexithymia is not a mental health disorder, so doctors and mental health professionals cannot formally diagnose the phenomenon. However, there are questionnaires and scales that professionals can use to check for signs of alexithymia.
The Twenty-Item Toronto Alexithymia Scale (TAS-20) that assesses:
- a person’s ability to identify feelings and to separate these from physical sensations
- their ability to communicate feelings to other people
- their inclination to show externally oriented thinking (rather than an introspective thinking style)
The Bermond–Vorst Alexithymia Questionnaire (BVAQ) that is made up of 40 items within the following five subscales:
The Observer Alexithymia Scale (OAS) that is made up of 33 items in the following five-factor structure:
Alexithymia has a strong link to autism spectrum disorder (ASD), with a 2018 study indicating that approximately half of autistic people likely have alexithymia. It is especially prevalent in those with complex ASD.
Other research proposes that the social and emotional difficulties experienced by those with ASD may not be a feature of autism, but rather of co-occurring alexithymia.
Alexithymia commonly co-occurs with certain mental health conditions, including depression and post-traumatic stress disorder (PTSD).
Some results indicate that clinical features of depression are at least somewhat dependent on the presence of alexithymia. Those with co-occurring depressive disorders and alexithymia are likely to demonstrate more severe symptoms of depression, psychosis, and phobias.
Post-traumatic stress disorder
A few small studies suggest that alexithymia is higher among those with PTSD.
One study of 22 war veterans with PTSD found that 41% had alexithymia.
A 1997 study comparing Holocaust survivors with and without PTSD found that survivors with PTSD had significantly higher scores on tests for alexithymia than those without PTSD.
Attention-deficit hyperactivity disorder
A 2017 review indicates that, across the spectrum of eating disorders, people report problems being able to identify or describe their emotions. Other research links higher levels of alexithymia with poorer treatment outcomes for eating disorders.
Research links alexithymia with other conditions, including:
- neurodegenerative diseases
Alexithymia is not a condition in its own right, but rather an inability to identify and describe emotions. People with alexithymia have difficulties recognizing and communicating their own emotions, and they also struggle to recognize and respond to emotions in others.
There is no formal diagnosis for alexithymia, although several scales can help to identify its signs.
As it is not a disorder, health professionals do not currently recommend or prescribe treatment for alexithymia. However, if it co-occurs with another condition, such as depression or PTSD, people can seek treatment for those issues to avoid worsening symptoms or complications.