March 15, 2019

Mini-lecture: alexithymia

Last updated on February 23, 2021

We recently started doing mini-lectures on autism in our Facebook group, and decided to create an Embrace ASD Soundcloud profile to upload the audio, and other podcast content on autism.

Embrace Autism | Mini-lecture: alexithymia | icon Soundcloud

Update: we have since switched to Podbean, where you can find our most recent audio (though not our mini-lectures at this point).


Lecture

In our first mini-lecture, we will talk about alexithymia, which is highly prevalent among autistic people. Listen to our lecture below.

Also, below you will find our lecture notes and some other material, which you could use to complement the audio:

  • At 11:37 min there is a reference to a video on shell shock, which you can find below in the section entitled PTSD.
  • The chart alluded to at 16:31 min can be found below in the section entitled Bodily emotions.

Feelings

As humans, we are able to be conscious of our feelings. Feelings let us make sense of the world. They tell us what we do and do not want, what gives us pleasure and pain. So it is a big problem when we don’t know what we like and don’t it gets us into trouble.

We have 6 basic feelings that are universal: happiness, sadness, surprise, fear, disgust, and anger. Guilt and shame are not universal (learned) but are also important because they trigger conflict. Conflict with our emotions is when we get alexithymia; when we have emotions that are not safe or hurt us too much we have to find a way to not feel them.

The body then alters the brain via plasticity, and sublimates the emotions into one of 3 other areas of the body.

  1. The brain where it causes ME (fatigue).
  2. Skeletal voluntary muscle (aches and pains*).
  3. Organs (autoimmune, bladder infections, etc.).

Have a look at the video of shell shock victims below in the section on PTSD.


Psychosomatization

Unexpressed emotions will never die.
They are buried alive and will come forth later in uglier ways.

Sigmund Freud is the first person that I know of that talked about psychosomatic effects. He saw young women who had hysteria. After ten years of this practice, Freud came to believe that behind every hysterical symptom—such as convulsions, paralysis, blindness, epilepsy, amnesia, or pain—lay a hidden trauma or series of traumas.

Freud figured out that the fathers were sexually molesting their daughters, and as a result, the daughters somatized their feelings and developing PTSD. Unfortunately, the men who were paying to have their daughters treated disliked that true explanation, and so Freud did huge damage to the field of psychotherapy by changing his theory to penis envy.


PTSD

In the video below, you can see how PTSD somatizes trauma in WWI soldiers. PTSD manifests in ways specific to the trauma, or indeed the war. For WWI veterans, PTSD is/was called shell shock.

1 in 3.5 autistics studied had previously experienced physical, emotional, or sexual abuse, as reported by a parent or caregiver. Seven of those youth developed Post-traumatic Stress Disorder (PTSD), a psychiatric condition that is caused by abuse and violence. To complicate matters, some signs of psychological trauma resemble symptoms common to autism, such as:

  • Repetitive behaviors.
  • Challenges with social interactions.
  • Being overly sensitive to input from one’s senses, such as sound or touch.
  • Difficulty sleeping.
  • Sudden or large changes in mood (meltdowns).
  • Alexithymia.

The reasons we develop PTSD are different than neurotypicals. Research from 2017 indicates that among autistic students, social incidents such as ostracization are much stronger predictors of PTSD than violent ones, such as war, terror or abuse. In neurotypicals the opposite tends to be the norm.[1]PTSD and autism—are they related, and how?[2]PTSD and Autism Spectrum Disorder: Co-morbidity, Gaps in Research and Potential Shared Mechanisms

Also have a look at:

The autistic brain & PTSD
The link between autism & PTSD

Bodily emotions

In the chart below—based on research from 2014—you can see a mapping of where emotions are felt.[3]Bodily maps of emotions (Nummenmaa et al., 2014) For those with anxiety, for example, it should not be a surprise that anxiety is felt in the chest, and indeed somatizes there as well. Having alexithymia, I joked how I cannot tell the difference between feeling anxious and feeling proud.

Embrace Autism | Mini-lecture: alexithymia | diagram BodilyEmotions
Bodily topography of basic (Upper) and nonbasic (Lower) emotions associated with words. The body maps show regions whose activation increased (warm colors) or decreased (cool colors) when feeling each emotion. (P < 0.05 FDR corrected; t > 1.94). The color bar indicates the t-statistic range. (Image attribution: Lauri Nummenmaa et al.)

Defense mechanisms

Not only is it hard to access our feelings, but we also use defenses. So what are feelings versus defenses? Let’s say you ask a person: What are your feelings towards your boyfriend for hitting you? The person can answer:

  1. I feel that he should not have done that: Not a feeling, but a defense of intellectualization. The person offers a thought, not a feeling.
  2. I feel that he did that because of his childhood: Not a feeling but a defense of rationalization. The person offers a reason, rather than the feeling.
  3. I feel betrayed: Not a feeling but the stimulus. He betrayed her by slapping her. Here she does not recognize the difference between the stimulus (the slap, the act of betrayal), and the feeling toward her boyfriend.
  4. I feel detached: Not a feeling, but the way the person wards off the feeling.
  5. I feel like leaving him: Not a feeling, but her intended action, her impulse.
  6. I feel tense: Not a feeling, but her anxiety—she is tense, triggered and covering the feeling
  7. I feel sad: Sadness is a feeling, but not the feeling towards her boyfriend for hitting her. The reactive feeling towards him is not differentiated from the sadness that covers it. The sadness is a feeling between you and you.
  8. I feel angry: Yes, she would feel angry towards him for hitting her. She might be afraid to be close again. She might feel sad that he hit her, but anger is what we feel when a person hits us.

Note that only one of these answers (#8) constitutes a feeling towards the boyfriend. All the other answers are defenses or an inability to access emotions.


Lack of feeling

Psychopaths can talk about feelings and understand them cognitively, but they can only feign actually experiencing them. Their brains show a lack of emotions in response to emotional stimuli.

Over the subsequent months, we tested Joe and his fellow inmates, looking specifically at their ability to categorize different images of emotion. And we looked at their physical response to those emotions. So, for example, when most of us look at a picture of somebody looking sad, we instantly have a slight, measurable physical response: increased heart rate, sweating of the skin. Whilst the psychopaths in our study were able to describe the pictures accurately, they failed to show the emotions required. They failed to show a physical response. It was as though they knew the words but not the music of empathy.[4]The neuroscience of restorative justice | Daniel Reisel | TED

People with alexithymia have emotions but are unaware that they have them. Their brain wave pattern shows that they experience emotions, but instead of it registering them as feelings, their sensory-motor cortex fires and they have somatic or emotions that manifest as physical symptoms.

Also have a look at:

Autism & empathy

Taming alexithymia

To overcome alexithymia, follow these steps:

  1. Pay attention to your feelings.
  2. Label your feelings correctly.
  3. Experience the feeling in the body correctly.
  4. Experience the action tendency toward the emotion.

Also have a look at:

Alexithymia Questionnaire results
This article
was written by:
dr-engelbrecht-and-martin-silvertant

Dr. Natalie Engelbrecht RP ND is a dually licensed registered psychotherapist and naturopathic doctor, and a Canadian leader in trauma and PTSD, and she happens to be autistic; she got diagnosed at 48.

Martin Silvertant is living up to his surname as a silver award-winning graphic designer. He also loves researching autism, astronomy, and typography. He was diagnosed with autism at 25.

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