Alexithymia

Alexithymia is a personality construct that is characterized by the (subclinical) inability to identify and describe emotions in the self. In a broad sense, it denotes emotion-processing problems.

It is my hypothesis, however, that despite alexithymia causing apparent issues in identifying and describing emotions, it can actually act as a protection mechanism. More on that later.

Broad definition

Broadly speaking, alexithymia is defined by:

1. Difficulty identifying feelings.
2. Difficulty distinguishing between feelings and the bodily sensations of emotional arousal.
3. Difficulty describing feelings to other people.
4. Difficulty identifying facial expressions.
5. Difficulty identifying/remembering faces.
6. Constricted imaginal processes, as evidenced by a scarcity of fantasies.
7. A stimulus-bound, externally oriented cognitive style.

Cognitive alexithymia

The cognitive dimension of alexithymia is characterized by difficulties in identifying, verbalizing, and analyzing emotions.

The cognitive aspects of alexithymia are #1–5 from the list above. Not all these factors necessarily apply to a person high in cognitive alexithymia, however.

Affective alexithymia

The affective dimension of alexithymia reflects the level of emotional arousal and imagination.

The affective aspects of alexithymia are #6 and #7 from the list above.

Prevalence

The prevalence of alexithymia among the general public is less than 10%, with a study from Japan indicating a prevalence of 7.1%.^[1]Alexithymic Traits as Predictors of Difficulties with Adjustment in an Outpatient Cohort of Expatriates in Tokyo The prevalence of alexithymia among autistic people was found to be 40–65%^[2]The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder^[3]Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives with some studies indicating a prevalence as high as 70%.^[4]Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development

Alexithymia is associated with heightened risk of psychopathology, and has a much higher prevalence in certain conditions/disorders—including autism.

Causes

Alexithymia can emerge from a myriad of factors—including traumatic brain injury and heavy drinking—and may be inherent to certain conditions. There is also a clear link between alexithymia and emotional trauma.^[5]Psychoanalysis and empirical research: the example of alexithymia

A research study from 2014 indicated an association between the number of traumatic experiences and alexithymia, and the influence of emotional avoidance and numbing within this relationship.^[6]Traumatic experiences, alexithymia, and posttraumatic symptomatology: a cross-sectional population-based study in Germany

A meta-analysis from 2008 which investigated the prevalence (occurrence rate) of alexithymia based on 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD) found that there was a large effect size associating PTSD with alexithymia.^[7]Meta‐analysis of alexithymia in posttraumatic stress disorder This makes sense considering PTSD stems from traumatic experiences.

Protection mechanism

Although I have not been able to substantiate this with research, I suspect that alexithymia—in particular cognitive alexithymia—can emerge as a protection mechanism to emotional trauma.

Indeed the issues with identifying and differentiating emotions can be frustrating, but it can also have certain benefits; alexithymia can cause many (seemingly) redundant emotions to fly under the radar. And although these emotions and feelings can still influence the subconscious (for instance, even when guilt is not consciously felt, it can still inform our moral framework), possibly a great many emotions don’t register consciously, and so they don’t tend to burden the alexithymic person at a time where they cannot bear feeling the emotions.

So although emotions can be useful when it comes to informing us of our surroundings and how to relate to it, sometimes it is more conducive to our wellbeing not to be aware of (all of) our emotions.

Example 1

Amy experienced a lot of emotional dysregulation during her childhood, in part due to the environment in which she was raised, where there was little patience and understanding from her parents. It was due to this lack of understanding that nothing was ever done with her emotional dysregulation; she was put down rather than validated, and as a result she started to seclude herself more, keep her emotions to herself and try to conceal her emotions as best she could, and over time the emotions seemingly disappeared, making her life a bit easier. After all, emotions cause friction.

When she left the parental home, she entered an environment that could be regarded as safe. Suddenly, she started having more emotions, and experienced them more intensely. She cried frequently. It was as if she was doing worse, despite being in a better place.

But she was not doing worse. Rather, the safer environment allowed her to start processing her emotions rather than suppress them. This environment was conducive to her processing her emotions in a healthy manner, and thus over time her alexithymia decreased. After all, there was no need for it anymore.

Example 2

Kevin is high in alexithymia. As many of his emotions seem to go unnoticed by him, he figured by drinking he could get more in tune with his emotions, and thus figured drinking had some therapeutic value. After all, after a few drinks he would become highly emotional, and when your emotions are intense enough that you can identify them despite being highly alexithymic, you can start processing those emotions, and grow from it. Right?

Yes, Kevin was able to identify his emotions after a few drinks, but what he was doing was contratherapeutic. It seems that Kevin needed his alexithymia in order to function; after a few drinks, the protection alexithymia offered decreased, and his emotions came in like a flood. When it comes to processing emotions, is it not better to take steps to deal with a trickle, rather than a flood? How much therapeutic progress is likely in an extremely emotional, dysregulated state?

When Kevin stopped drinking and had people in his life that supported him, his alexithymia decreased over time. It seems thus that alexithymia decreased when he was able to process his emotions in his own time at his own pace. That’s a lot better than suppressing alexithymia and try to deal with the flood of emotions.

Random facts

• Men tend to score higher in alexithymia (12.8%) than women (8.2%).^[8]Depression is strongly associated with alexithymia in the general population
• Alexithymia has a close relationship with depression in the general population.^[9]Depression is strongly associated with alexithymia in the general population
• Elevated levels of alexithymia are seen in a number of disorders such as anorexia nervosa, substance abuse, and PTSD.^[10]Alexithymia from the Social Neuroscience Perspective (Berthoz, Pouga & Wessa, 2011)
• Alexithymia is also associated with heavy drinking,^[11]Coping with Inner Feelings and Stress: Heavy Alcohol Use in the Context of Alexithymia and the prevalence of alexithymia among alcoholics is very high (45–67%).^[12]Alexithymia and alcohol use disorders: A critical review^[13]Alexithymia and temperament and character model of personality in alcohol‐dependent Turkish men^[14]Criterion validity of Bermond-vorst Alexithymia Questionnaire-20 Form B: A study of 63 alcoholic subjects
• People who are at high risk of developing psychosis were found to be higher in cognitive alexithymia, but significantly low in affective alexithymia.^[15]Cognitive Alexithymia Is Associated with the Degree of Risk for Psychosis (Van der Velde et al., 2015)
• The prevalence of alexithymia among autistic people was found to be 40–65%,^[16]The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder^[17]Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives with some studies indicating a prevalence as high as 70%.^[18]Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development
• Autistic people were found to have a particular type of alexithymia that results in issues in the cognitive—rather than the affective—domain.^[19]The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder
• Alexithymia among prisoners (in China) was found to be 30%. The high prevalence of alexithymia among prisoners is linked with their level of education, the experience of childhood trauma, and symptoms of negative emotions.^[20]Prevalence and associated factors of alexithymia among adult prisoners in China: a cross-sectional study

For more information on how alexithymia
manifests in autistic people, have a look at:

Alexithymia & autism