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Alexithymia (pronounced: /ˌeɪlɛksəˈθaɪmiə/) 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 considered to be a personality trait that places individuals at risk for other medical and psychiatric disorders while reducing the likelihood that these individuals will respond to conventional treatments for the other conditions. Alexithymia is not classified as a mental disorder in the DSM IV. It is a personality trait that varies in severity from person to person. A person's alexithymia score can be measured with questionnaires such as the Toronto Alexithymia Scale (TAS-20), the Bermond-Vorst Alexithymia Questionnaire (BVAQ) or the Observer Alexithymia Scale (OAS).
Alexithymia is defined by:
- (i) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal
- (ii) difficulty describing feelings to other people
- (iii) constricted imaginal processes, as evidenced by a paucity of fantasies
- (iv) a stimulus-bound, externally oriented cognitive style.
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.
In another study, alexithymia was found to be approximately 13% of the population, with men (17%) almost twice as likely to be affected as women (10%). Specifically, men scored higher in difficulty describing feelings and for externally oriented thinking, but there was no gender difference whatsoever in difficulty in identifying feelings. 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.
Typical deficiencies may include problems identifying, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others; difficulty distinguishing between feelings and the bodily sensations of emotional arousal; confusion of physical sensations often associated with emotions; few dreams or fantasies due to restricted imagination; and concrete, realistic, logical thinking, often to the exclusion of emotional responses to problems. Those who have alexithymia also report very logical and realistic dreams, such as going to the store or eating a meal. Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterizes 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 victims of this construct 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 that is typical of the alexithymic's experience.
According to Vanheule, Desmet and Meganck (2006) alexithymia creates interpersonal problems because these individuals avoid emotionally close relationships, or that if they do form relationships with others they tend to position themselves as either dependent or impersonal, "such that the relationship remains superficial." Inadequate differentiation between self and other by alexithymic individuals has been observed by Blaustein & Tuber (1998) and Taylor et al (1997).
In a study, a large group of alexithymic individuals completed the 64-item Inventory of Interpersonal problems (IIP-64) which screens for:
- (a) Domineering/Controlling, indicating difficulties relinquishing control over others;
- (b) Vindictive/Self-Centered behaviour, which describes problems of hostile dominance and the tendency to fight with others;
- (c) Cold/Distant behaviour, which refers to low degrees of affection for and connection with others;
- (d) Socially Inhibited, which assesses the tendency to feel anxious and avoidant in the presence of others;
- (e) Non-Assertiveness, which measures problems in taking initiative in relation to others and coping with social challenges;
- (f) Overly Accommodating, which indicates an excess of friendly submissiveness;
- (g) Self-Sacrificing, which indicates a tendency to affiliate excessively; and
- (h) Intrusive/Needy, which describes problems with friendly dominance.
The study found that alexithymic individuals "had significantly higher scores on all IIP-64 subscales than did the nonclinical sample."
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.
In medical and psychiatric illness
Alexithymia frequently co-occurs with other disorders, with a representative prevalence of 85% in autistic spectrum disorders, 40% in posttraumatic stress disorder, 63% in anorexia nervosa, 56% in bulimia, 45% in major depressive disorder, 34% in panic disorder, and 50% in substance abusers.
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 involves higher risk of developing certain personality disorders, and is correlated with particular illnesses, such as hypertension, inflammatory bowel disease, functional dyspepsia, sexual disorders, substance use disorders, and some anxiety disorders. 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.
According to French psychoanalyst Joyce McDougall all infants are born unable to identify, organize, and speak about their emotional experiences (the word infans is from the Latin "not speaking"), and are "by reason of their immaturity inevitably alexithymic". Based on this fact McDougall writes, "Might it not be supposed that the alexithymic part of an adult personality is an extremely arrested and infantile psychic structure?"
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.
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. Moreover, if a parent responds with apathy, indifference, or anger to a child's natural range of emotions, the child will learn not to trust their feelings and over time may become conditioned to numb themselves to the experiences of their emotions.
- Bar-On & Parker (2000), pp. 40–59
- Taylor (1997), pp. 28–31
- Haviland MG, Warren WL, Riggs ML (2000). "An observer scale to measure alexithymia". Psychosomatics. 41 (5): 385–92. PMID 11015624. Retrieved 2007-08-10.
- Vorst HCM, Bermond B (February 2001). "Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire". Personality and Individual Differences, Volume 30, Number 3, pp. 413–434(22) DOI: 10.1016/S0191-8869(00)00033-7
- Taylor (1997), p. 29
- Fukunishi I, Berger D, Wogan J, Kuboki T (1999). "Alexithymic traits as predictors of difficulties with adjustment in an outpatient cohort of expatriates in Tokyo". Psychological reports. 85 (1): 67–77. PMID 10575975. Retrieved 2007-08-10.
- Salminen JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J (1999). "Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland". Journal of psychosomatic research. 46 (1): 75–82. PMID 10088984.
- Taylor & Taylor (1997), pp. 77–104
- Taylor (1997), p. 38
- Parker JDA, Taylor GJ, Bagby RM (2001). "The Relationship Between Emotional Intelligence and Alexithymia". Personality and Individual Differences 30, 107–115
- Taylor (1997), p. 37
- Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamäki H (2001). "Alexithymia and depression: a prospective study of patients with major depressive disorder". Psychosomatics. 42 (3): 229–34. PMID 11351111.
- Taylor (1997), p. 37
- Krystal H (1979). "Alexithymia and psychotherapy". American journal of psychotherapy. 33 (1): 17–31. PMID 464164.
- Nemiah et al (1970), pp. 432–33
- Krystal (1988), p. 246; McDougall (1985), pp. 169–70
- Taylor (1997), pp. 29, 246–47
- Krystal (1988) pp. 246-247
- Nemiah CJ (1978). Alexithymia and Psychosomatic Illness, Journal of Continuing Education, 39, 25-37
- Sifneos, PE (1967). Clinical Observations on some patients suffering from a variety of psychosomatic diseases. Acta Medicina Psychosomatica, 7, 1-10.
- Vanheule S, Desmet M, Meganck R, Bogaerts S (2007). "Alexithymia and interpersonal problems". Journal of clinical psychology. 63 (1): 109–17. doi:10.1002/jclp.20324. PMID 17016830.
- Blaustein JP, Tuber S B (1998). Knowing the Unspeakeable. Bulletin of the Menninger Clinic, 62, 351–365; and Taylor (1997) pp.26-46
- Sifneos PE (1996). "Alexithymia: past and present". The American journal of psychiatry. 153 (7 Suppl): 137–42. PMID 8659637.
- Yelsma P, Marrow S (2003). "An Examination of Couples' Difficulties With Emotional Expressiveness and Their Marital Satisfaction". Journal of Family Communication. 3 (1): 41–62. doi:10.1207/S15327698JFC0301_03.
- Hill E, Berthoz S, Frith U (2004). "Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives". Journal of Autism and Developmental Disorders. 34 (2): 229–235. doi:10.1023/B:JADD.0000022613.41399.14.
- Shipko S, Alvarez WA, Noviello N (1983). "Towards a teleological model of alexithymia: alexithymia and post-traumatic stress disorder". Psychotherapy and psychosomatics. 39 (2): 122–6. PMID 6878595.
- Cochrane CE, Brewerton TD, Wilson DB, Hodges EL (1993). "Alexithymia in the eating disorders". The International journal of eating disorders. 14 (2): 219–22. PMID 8401555.
- Cox BJ, Swinson RP, Shulman ID, Bourdeau D (1995). "Alexithymia in panic disorder and social phobia". Comprehensive psychiatry. 36 (3): 195–8. PMID 7648842.
- Taylor GJ, Parker JD, Bagby RM (1990). "A preliminary investigation of alexithymia in men with psychoactive substance dependence". The American journal of psychiatry. 147 (9): 1228–30. PMID 2386256.
- Frith U (2004). "Emanuel Miller lecture: confusions and controversies about Asperger syndrome". Journal of child psychology and psychiatry, and allied disciplines. 45 (4): 672–86. doi:10.1111/j.1469-7610.2004.00262.x. PMID 15056300. The study to which Frith refers is Hill E, Berthoz S, Frith U (2004). "Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives". Journal of Autism and Developmental Disorders. 34 (2): 229–235. doi:10.1023/B:JADD.0000022613.41399.14.
- Fitzgerald M, Bellgrove MA (2006). "The overlap between alexithymia and Asperger's syndrome". Journal of autism and developmental disorders. 36 (4): 573–6. doi:10.1007/s10803-006-0096-z. PMID 16755385. Retrieved 2007-04-11.
- Hill E, Berthoz S (2006). "Response to "Letter to the Editor: The Overlap Between Alexithymia and Asperger's syndrome", Fitzgerald and Bellgrove, Journal of Autism and Developmental Disorders, 36(4)". Journal of Autism and Developmental Disorders. 36 (8): 1143–1145. doi:10.1007/s10803-006-0287-7. Unknown parameter
- Tani P, Lindberg N, Joukamaa M; et al. (2004). "Asperger syndrome, alexithymia and perception of sleep". Neuropsychobiology. 49 (2): 64–70. doi:10.1159/000076412. PMID 14981336.
- Schizotypal, dependent and avoidant disorders are particularly indicated: See Taylor (1997), pp. 162–165
- Jula A, Salminen JK, Saarijärvi S (1999). "Alexithymia: a facet of essential hypertension". Hypertension. 33 (4): 1057–61. PMID 10205248. Retrieved 2006-12-17.
- Verissimo R, Mota-Cardoso R, Taylor G (1998). "Relationships between alexithymia, emotional control, and quality of life in patients with inflammatory bowel disease". Psychotherapy and psychosomatics. 67 (2): 75–80. PMID 9556198.
- Jones MP, Schettler A, Olden K, Crowell MD (2004). "Alexithymia and somatosensory amplification in functional dyspepsia". Psychosomatics. 45 (6): 508–16. doi:10.1176/appi.psy.45.6.508. PMID 15546828. Retrieved 2006-12-17.
- Michetti PM, Rossi R, Bonanno D, Tiesi A, Simonelli C (2006). "Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)". Int. J. Impot. Res. 18 (2): 170–4. doi:10.1038/sj.ijir.3901386. PMID 16151475. Retrieved 2007-02-02.
- Li CS, Sinha R (2006). "Alexithymia and stress-induced brain activation in cocaine-dependent men and women". Journal of psychiatry & neuroscience : JPN. 31 (2): 115–21. PMID 16575427. Retrieved 2006-12-17.
- Lumley MA, Downey K, Stettner L, Wehmer F, Pomerleau OF (1994). "Alexithymia and negative affect: relationship to cigarette smoking, nicotine dependence, and smoking cessation". Psychotherapy and psychosomatics. 61 (3–4): 156–62. PMID 8066152.
- Jones BA (1984). "Panic attacks with panic masked by alexithymia" (PDF). Psychosomatics. 25 (11): 858–9. PMID 6505131. Retrieved 2006-12-17.
- Taylor (1997), pp. 216–248
- Taylor (1997), pp. 190–216
- Taylor (1997), pp. 166–190
- McDougall (1985), p. 161
- Jessimer M, Markham R (1997). "Alexithymia: a right hemisphere dysfunction specific to recognition of certain facial expressions?". Brain and cognition. 34 (2): 246–58. doi:10.1006/brcg.1997.0900. PMID 9220088.
- Hoppe KD, Bogen JE (1977). "Alexithymia in twelve commissurotomized patients". Psychotherapy and psychosomatics. 28 (1–4): 148–55. PMID 609675.
- Lane RD, Ahern GL, Schwartz GE, Kaszniak AW (1997). "Is alexithymia the emotional equivalent of blindsight?". Biol. Psychiatry. 42 (9): 834–44. PMID 9347133.
- Tabibnia G, Zaidel E (2005). "Alexithymia, interhemispheric transfer, and right hemispheric specialization: a critical review". Psychotherapy and psychosomatics. 74 (2): 81–92. doi:10.1159/000083166. PMID 15741757.
- McDougall (1989), pp. 93, 103
- McDougall (1989), pp. 93–94