Alexithymia: Do You Have It?

Posted by J Huffine, Ph.D., Clinical Director and Therapist at Cascades on February 21, 2019

Alexithymia is not something you “have” and cannot change. It is a term used to describe a relative inability to process one’s emotional experience. Alexithymia is not all or nothing; it is a matter of degree. Some people are very adept at emotional processing, others are not. But what does it mean to “process” one’s feelings? Why is this ability important? Alexithymia is not uncommon in the general population, but is much more prevalent in people who experience emotional and behavioral problems. Can it be improved?

Alexithymia is a word that has been around for some time. It was first used in 1973 by Peter Sifneos. He worked with patients who had psychosomatic disorders and had difficulty engaging in insight-oriented therapy. The word literally means unable to read feelings. It is conceptualized as difficulty identifying feelings, difficulty describing feelings to others, being externally oriented in one’s thinking, and/or having a limited imaginative capacity.

There are other concepts that are similar but may be more familiar. In 1990, Yale psychologists John D. Mayer and Peter Salovey used the term Emotional Intelligence, or EQ as it became commonly known. Psychological mindedness is another concept that is similar and is defined as “a willingness to talk about one’s problems, access to one’s feelings, capacity for behavioral change, and an interest in why people behave the way they do.”

Alexithymia literally means “not reading feelings.” It is a relatively low ability to have an awareness of one’s own feelings or emotions, to understand them, and to manage them in effective ways. There is a process that one must go through to do this well. The first step is an awareness of feelings in the first place. Feelings are sensations in our body. There are some basic survival feelings like physical pain, thirst, fatigue, hunger, etc. Each feeling lets the person know there is something important that is needed for basic survival. Awareness of these feeling motivates a person to act, resulting in the need being met.

Then there are higher level needs such as safety, self-esteem, relationships, and self- fulfillment that are extremely important to the quality of life. It is important to be aware of emotions relating to these needs just as it is to be aware of the more basic survival feelings. To the degree that one is aware of and understands the feelings like anxiety, sadness, confusion, helplessness, overwhelmed, lonely, hurt, shame, etc., one can actively and directly work on managing them.

Managing feelings allows for more effective problem solving and more effective communication with others. One has a higher sense of control when one understands his/her feelings and perceives options rather than believing that one is merely a victim of circumstance. Our thoughts, beliefs, and perceptions determine to a large extent our emotions. Sometimes difficulties in life are unavoidable, and nothing can be done to change a particular outcome. Having the ability to understand one’s feelings and simply talk with others about these feelings provides an opportunity to be validated, heard, and supported.

This may seem obvious to those for whom this comes naturally. But, for many, it is not obvious at all.

Research has shown that people who experience mental health problems have a much higher rate of alexithymia than the 10% reported in the general population:

psychosomatic disorders (approximately 40%−60%)
anxiety disorders, (prevalence of 13%−58%)
depressive disorders (32%−51%)
eating disorders (24%−77%)
addictive disorders (30%−50%)
obsessive-compulsive disorder, (11%−36%)
autism spectrum disorder (40%−60%)

There are only a few longitudinal studies that demonstrate the causal relationship between alexithymia and mental health problems, but it is clear that people develop emotional and behavioral symptoms when adverse situations occur and resulting emotions are not worked through satisfactorily. To do so requires some internal awareness. Otherwise it is like “flying blind,” i.e., no instrument panel. No awareness of altitude, speed, or direction. It is like being a witness to one’s life rather than the agent.

The opposite of alexithymia is emotional literacy. Again, with some people, emotional literacy develops naturally. With others, it does not. However, it can be learned and developed. Many therapeutic approaches incorporate some form of emotional literacy development. Wilderness therapy is a powerful model for this development.

Wilderness therapy is fundamentally experiential therapy in nature where there are constant activities, interactions, problems to solve. Clients experience feelings in very real and concrete ways rather than just in the abstract. When it is apparent that someone is experiencing uncomfortable emotions and struggling with what is happening, that person has an opportunity to call a group to discuss and process what he or she is experiencing.

Often at the beginning of the wilderness program, clients may not be aware enough of their own feelings to process them. Staff or peers may notice feelings coming out indirectly, perhaps in the form of anger or isolating, avoidance or shutting down. Other clients will then call a group to provide space for the individual to “check in”, to verbalize what he or she is thinking, how they are feeling. Initially, there is often limited knowledge of even the names of all the feelings. Information is supplied to the client in the form of charts and lists. At first, it may be more of a “multiple choice” answer than “fill in the blank.”

In wilderness therapy, there is a culture of openness and vulnerability, and honesty with one’s self and others is encouraged. More experienced clients become quite skilled in emotional literacy and role model this skill for newer clients. Emotional literacy allows one to consciously choose responses to difficulties rather than react as if one is a helpless and passive victim. It allows for people to better understand how events in their lives have affected them, e.g., trauma, loss, failure, abuse. Developing emotional literacy allows people to do the therapeutic work necessary to recover from difficulties. It also allows people to better manage life’s difficulties as these difficulties occur.

Many of the clients with whom I work are on the autism spectrum. Alexithymia is much more prevalent with these individuals than in the general population (40-60%). That is a big reason why there are higher rates of anxiety and depression, as well as social and other emotional difficulties in people on the spectrum. Alexithymia is due, in part, to differences in brain physiology and anatomy. These differences make it harder for an individual to understand and process feelings, but, as with anyone, emotional literacy can be improved and developed, allowing for increased effective functioning.

There are tests designed to measure alexithymia. One frequently used in the literature is the Toronto Alexithymia Scale – II. There is a less scientific, but, nevertheless, useful online test available http://oaq.blogspot.com/ This brief test offers information on exactly what alexithymia is and provides an estimate of one’s emotional literacy.

Even though the term alexithymia is not known to many people, the detrimental effects of it are real. Alexithymia is not primarily innate (although processing emotions can be inherently harder for some) and can be greatly improved with the proper treatment. There is quite a lot written on the subject which can be researched online. For additional information I recommend an article titled “The only emotions I can feel are anger and fear” https://mosaicscience.com/story/life-without-emotions-alexithymia-interoception/

Sifneos PE: The prevalence of 'alexithymic' characteristic mechanisms in psychosomatic patients. Psychotherapy Psychosomatic 1973; 21:133–136

Lucia Ricciardi , M.D., Ph.D., Benedetta Demartini M.D., Aikaterini Fotopoulou, Ph.D. and Mark J. Edwards , M.D., Ph.D. Alexithymia in Neurological Disease: A Review Journal of Neuropsychiatry 2015: 27: 179-187

Dr. J Huffine is a Licensed Psychologist and the Clinical Director at Evoke Cascades Therapeutic Wilderness Program. He works with adolescent males. Dr. Huffine has worked as a wilderness therapist for over 20 years.