Alexithymia: the inability to identify and express emotions

What is alexithymia? 

The term "alexithymia" was introduced into medicine in 1972 by the psychiatrist Peter E. Sifneos. At the time, alexithymia mainly referred to people who had difficulty expressing the feeling of love with the help of words. It was only later that the term "alexithymia" was extended to people with difficulties with emotions in general.

Alexithymia is an emotional regulation disorder, widely observed in psychosomatic illnesses. It affects around 10% of the world's population, and more often men than women. It reflects an individual's difficulty in recognising their emotions and expressing them verbally.

An individual affected by alexithymia encounters a number of complications in everyday life that are linked to the lack of discernment of what they are feeling. For example, a lack of empathy or sensitivity, which can ultimately lead to low self-esteem and isolation.

What are the symptoms of alexithymia? 

Difficulty in recognizing one's emotions 

People suffering with alexithymia have difficulty identifying their emotions, both pleasant and unpleasant. Emotions such as sadness, joy, anger or fear are well-known terms because of their definition and the contexts in which they are experienced, but it is difficult for those affected to make a connection between their own state and the emotion.

Focusing on the exterior 

Increased heart rate, excessive sweating, muscle tension, etc. - these signs often reflect a specific emotion: anger, fear, anxiety, among others. The attention of alexithymic people is focused solely on these external signs, which become the only indicators of their inner state. As a result, they manage to develop a finer sense of all external stimuli, whether caused by their own body or their environment.

Individuals affected by alexithymia are also more vulnerable to developing somatic disorders such as eczema, high blood pressure, eating disorders or digestive problems, because their connection with their feelings is altered.

Lack of emotional empathy

People with alexithymia have a significant lack of empathy. This can often be one of the frequent criticisms of those close to them. It is nevertheless possible for the emotional charge of the speaker to be perceived through their body language and the words they use. But it is difficult to decipher the emotion involved.

Limited verbal communication 

People with alexithymia are often perceived as people who speak little, who are too serious and tend to limit their interactions with others.

However, this is mainly linked to a limitation in verbal communication. A person affected with alexithymia often lacks the words to describe a situation or an event, making it difficult to fully express their thoughts, which leads to a barrier between the person and those close to them, and sometimes results in isolation.

Low capacity for introspection 

Analysing their feelings is extremely difficult for alexithymics, as they are unable to identify and describe their emotions, making introspection complicated. These individuals are disconnected from their deep-rooted needs and real desires.

They also have:

• Difficulty forming bonds with others;
  
• Maximum avoidance of conflict but, if the situation deteriorates, a tendency to overreact;
  
• Lack of imagination, creativity, humour and flexibility.

What causes alexithymia? 

Alexithymia results from a combination of neuropsychological and psychological impairments. The causes are multifactorial, but their origins lie mainly in childhood and in early developmental deficiencies.

There are two types of alexithymia: primary and secondary.

• Primary alexithymia is the result of a childhood trauma or negative interactions with the child's carers. It is also considered to be a genetically determined personality trait, which is thought to affect the structure and function of certain brain regions.
  
• Secondary alexithymia is linked to a past traumatic event. It is a defence mechanism, with the person trying to protect themselves by cutting themselves off from their emotions, thereby avoiding suffering and confronting what they have experienced.

How is alexithymia diagnosed? 

Alexithymia is still not recognised by official classifications of illnesses. However, it can be diagnosed using various measures and scales, such as:

• the Toronto Alexithymia Scale 20: a questionnaire to be completed by the patient, in which it is possible to assess difficulties in identifying and describing emotions, and the ability to turn towards others.
  
• the Bermond-Vorst Alexithymia Questionnaire, in which two affective facets are added to measure the lack of capacity for imagination and poor emotional response.
  
• semi-structured clinical interviews based on the same principle as the questionnaires.
  

The aim of these tools is to determine the extent to which a person does or does not display alexithymic traits, and whether he or she exceeds a certain threshold that qualifies him or her as alexithymic. Based on these results, an MRI scan can be used to identify possible alterations in the neural substrates involved in alexithymia.

How can alexithymia be treated? 

Alexithymia is a neuropsychological and psychological condition requiring therapy.

Nevertheless, psychiatrists believe that treating alexithymia is not easy. Since the success of psychotherapy depends on the patient's capacity for introspection, their interest in their own psychological functioning and knowledge of their emotions, it is difficult to work efficiently with alexithymic individuals as they lack these particular skills.

In fact, the psychotherapist's main aim in treating a person affected with alexithymia, is to bring the patient out of their emotional silence. They have to gradually re-assign the language, associating emotions with what the patient feels on a physical level, and with the situations he or she has experienced.

Step by step, the patient learns to express all their emotions, to understand them and to listen to their body.

The psychotherapist is there to help the patient rebuild and manage these new sensations.

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