Alexithymia: Definition, Symptoms, & Examples

When someone constantly has difficulty identifying or describing their own emotions, they are experiencing alexithymia (Sifneos, 1973). The word alexithymia combines several words from the Greek language – a for “no”, lexi for “words”, and thymia for “emotions” – and was created when a Greek doctor started to notice that many of his psychiatric clients had trouble describing their emotions (Sifneos, 1973).
 
What does alexithymia look like?
Many people with this condition have trouble explaining why they took certain actions. For example, if I am short-tempered with my partner, or yell at the car in front of me in traffic, I can usually (at least eventually!)  identify an emotion by my actions – perhaps anger, or frustration – and an event that triggered the anger – perhaps an argument with a housemate or receiving bad news on the phone.

By contrast, people with alexithymia may lash out at somebody but not be able to identify a reason why they yelled or the feelings associated with it. In their mind, the event sort of just happened, and the connection between an earlier event or an emotion and their behavior is not clear to them.

People with alexithymia are also less tuned in to other aspects of their internal experience; for example, they have fewer fantasies and less complex dreams and use their imagination less than other people (Taylor et al., 1997). Since people with alexithymia are less aware of what’s going on in their own heads, they tend to see the world as being a place where things happen to them (Taylor et al., 1997). 
 
While alexithymia is not recognized as a specific disorder, it is a condition that many people experience as part of other mental health challenges they face, such as depression (Hemming et al., 2019). Additionally, since working with emotions is typically at the heart of psychotherapy, people with alexithymia may find therapy more difficult and less effective (Krystal, 1979).
 
If you’re wondering whether you or somebody you know has alexithymia, or worrying about what can be done about it, I encourage you to read on. In the rest of this article, I will describe common situations in which people experience alexithymia, what may cause alexithymia, how it can be treated, and how you can help yourself or others deal with alexithymia.

As I noted above, alexithymia means trouble understanding and articulating one’s own emotions. There are many ways people can experience this lack of language for emotions and many ways it can impact their lives. In this section, I’ll briefly describe some of the more common contexts where alexithymia is most impactful.

Alexithymia in Relationships
Simply put, communicating emotions, particularly positive emotions, is essential to feeling close to another person (Floyd, 2006). People with alexithymia may avoid relationships because they are not sure how to relate, and then they have difficulty expressing and self-disclosing important feelings when they do try to relate (Montebarocci et al., 2004; Qualter et al., 2009). The inability to recognize emotions often extends to other people’s emotions, too, making it hard to develop and maintain healthy relationships (Hesse & Gibbons, 2019; Humphreys et al., 2009). As a result, they have more difficulty keeping and building connections, especially for romantic relationships (Eid & Boucher, 2012; Humphreys et al., 2009).

You, like most people, have probably had moments when you thought, “It’s hard to tell my partner what I’m feeling!” The difference between those moments and the experience of people with alexithymia is that you likely knew what you were feeling but weren’t sure how to say it in an effective or tactful way. People with alexithymia, as much as they might want to communicate their feelings and participate in their relationship, will not be able to identify and describe their feelings.

Alexithymia in Autism 
About half of people with autism may also have alexithymia (Kinnaird et al., 2019). After lots of research, it has become clear that alexithymia may partially cause some of the social difficulties people with autism face, such as having difficulty recognizing other people’s emotions and understanding other people’s internal experiences (Kinnaird et al., 2019). Therefore, people with autism and alexithymia may need lots of help learning and practicing interpersonal skills. To hear one person with autism describe how alexithymia has affected her – but can also affect people without autism – check out the video below.

Normative Male Alexithymia 
Men in most English-speaking cultures have been socialized to suppress or ignore most of their emotions (Levant, 1995). Over time, this can mean that men get less practice paying attention to and voicing their feelings, particularly feelings they are not “supposed” to experience (Levant et al., 2014). Unsurprisingly, then, men experience alexithymia at higher rates than women do – so much so that we use the term normative male alexithymia to describe this pattern (Levant, 1995; Levant et al., 2009). Men experiencing this kind of alexithymia find it harder to relate to others and may have fewer satisfying close relationships (Karakis & Levant, 2014). 

Speaking personally, I can attest that I have sometimes recognized only after the fact, or if somebody pointed it out to me, that I was having an emotional reaction to an event in my life. Often, I’ve had the thought, “I shouldn’t feel that way”, in a moment like this, which might be proof of normative male alexithymia in action. For me, and for many men, noticing and naming emotions can often be more effortful than it is for other people.

Alexithymia in Depression
Many people who are depressed are also experiencing alexithymia, and the worse their alexithymia is, the worse their depression is (Bamonti et al., 2010). Think about it – if you are struggling to identify emotions, or feeling numb, you may not realize that you need help. People with depression experience fewer positive moods in the first place, too, making it hard to know when they are having positive emotions. 
 
While there are other contexts in which people experience alexithymia, these are some of the most common experiences where alexithymia seems to be a major factor. If you recognize yourself or someone you care about in these examples, keep reading to learn what can be done to help in these situations.

Alexithymia may be caused in part by genetics (Picardi et al., 2011), meaning that people whose parents have alexithymic traits are more likely to have those traits themselves (Grabe et al., 2008). Alexithymia also seems to develop as a reaction to stressful or traumatic life events (Krystal, 1979; Zeitlin et al., 1993). For many people, these events happened in childhood, but they can happen at any life stage. People who develop alexithymia at an earlier age may have a harder time overcoming it, probably because their brains were still developing at the time, or the events happened again and again over many years (Freybarger, 1977). 
 
Let’s think about an example of each of these. Imagine a child growing up in a home where one or both parents rarely talk about emotions, display emotions, or respond effectively when the child shows emotion. Such a child would grow up with very few skills for understanding emotions. 
 
On the other hand, imagine that same child growing up in a household with an abusive parent who did not tolerate any displays of emotion, or a neglectful parent that did not meet their basic needs. As you can imagine, a child might cope with either environment by tuning out their emotions as much as possible. 
 
Finally, we can compare that child to an adult who, after experiencing a traumatic event such as a sexual assault, becomes numb to their feelings as a way to cope with post-traumatic stress, or to avoid getting close to other people and possibly being victimized again.

The question, “what does alexithymia feel like?”, is likely a very difficult one to answer for someone experiencing alexithymia! Alexithymia, after all, is often an absence of identifiable feeling. People with alexithymia are often articulate, likeable, and high functioning in many other ways – they just cannot talk about their own emotions. People with alexithymia may experience sensations in their body, such as tension or pain, but not be able to associate that with a feeling, such as feelings of anxiety or anger.
 
To take our understanding a little further, try this for a thought experiment: imagine making decisions without any emotions involved. Now, some of you may be thinking, “That sounds great! My emotions influence my decisions too much as it is.” But our emotions provide invaluable information about how we will likely respond to future situations. Emotions tell us what we want, what will make us feel safe. Lacking that guidance might be like living in a country whose language you don’t speak.

Alexithymia Quiz
​The Toronto Alexithymia Scale (Bagby et al., 1994) is a survey you can take to better understand how much alexithymia affects you. You can take the alexithymia quiz here.

Thankfully, therapeutic interventions designed to address alexithymia are effective in reducing symptoms (Cameron et al., 2014). Treatment for alexithymia may include reading scripts about highly emotional situations, imagining emotional situations, learning social skills and how to recognize emotions in others, relating bodily sensations to emotions, or receiving general education about how emotions work (Beresnevaite, 2000; Gay et al., 2008, Levant et al., 2009; Melin et al., 2010).
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Additionally, when people who are experiencing alexithymia get treatment for a mental health disorder they are experiencing, they may see their alexithymia improve at the same time (McGillivray et al., 2019). Do you see how this makes sense? In therapy, we often try to become more comfortable with other emotions, to see how they guide us in understanding what is important to us. As we develop skills of regulating emotions, it becomes easier to recognize them and acknowledge that they are there.

Although eliminating alexithymia is difficult and rare, many people have successfully reduced the severity of their alexithymia, improving their quality of life (Cameron et al., 2014). So while for most people with alexithymia, it will always be present for them to some degree, it is possible to overcome alexithymia in the sense of becoming more attuned to one’s emotions, able to connect with other people, and respond to emotions effectively. ​

If you or someone you know is experiencing alexithymia and wants to change, here are some suggestions for how to address it on your own. The goal is to reduce symptoms of alexithymia by:

1. learning to identify and describe your emotions
2. becoming more connected with other people, and
3. simply getting to know yourself better. 

It likely will not be easy – most people developed alexithymia because at some point it was not safe for them to have emotions. But there are many things you can do to start getting more familiar with this side of yourself:

1)    Use techniques from Cognitive-Behavioral Therapy (CBT). With CBT, you can learn about and practice observing the associations between certain thoughts and certain feelings. You might learn that you believe some feelings – or maybe most feelings – are not okay to feel. This is a common experience, and whether alone or with a therapist, you can find ways to challenge those assumptions about emotions.

2)    Learn about how physical sensations and emotions are connected to each other. For example, if you know a racing heartbeat means that a person might be afraid or excited, you can ask yourself why you might be afraid or excited the next time you notice your heartbeat is faster than usual. Somatic therapy can be especially helpful in this regard.

3)    Learn mindfulness skills. Activities like mindfulness meditation can help us become more aware of what we are experiencing, especially if we’ve been deliberating trying to ignore it. Several research studies have shown that mindfulness skills can help reduce symptoms of alexithymia (Norman et al., 2019).

4)    Learn and practice all these skills and activities in groups. It can be helpful to have the example of other people getting to know their emotions at the same time.
Remember that if you are experiencing a lot of distress because of alexithymia or you are experiencing other mental health issues at the same time, it may be more effective to consult with a mental health professional sooner rather than later.

Want to learn more about alexithymia? Here are some related articles that might be helpful.

To keep building your knowledge and skills related to alexithymia, here are some books to explore:

• Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The Twenty-Item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.
• Bamonti, P. M., Heisel, M. J., Topciu, R. A., Franus, N., Talbot, N. L., & Duberstein, P. R. (2010). Association of alexithymia and depression symptom severity in adults aged 50 years and older. The American Journal of Geriatric Psychiatry, 18(1), 51–56. 
• Beresnevaite, M. (2000). Exploring the benefits of group psychotherapy in reducing alexithymia in coronary heart disease patients: a preliminary study. Psychotherapy and Psychosomatics, 69, 117–22.
• Cameron, K., Ogrodniczuk, J., & Hadjipavlou, G. (2014). Changes in alexithymia following psychological intervention: a review. Harvard Review of Psychiatry, 22(3), 162-178.
• Floyd, K. (2006). Communicating affection: Interpersonal behavior and social context. Cambridge, England: Cambridge University Press.
• Freyberger, H. (1977). Supportive psychotherapeutic techniques in primary and secondary alexithymia. Psychotherapy and Psychosomatics, 28, 337–45. 
• Gay, M., Hanin, D., & Luminet, O. (2008). Effectiveness of a hypnotic imagery intervention on reducing alexithymia. Contemporary Hypnosis, 25, 1–13.
• Grabe, H. J., Mahler, J., Spitzer, C., & Freyberger, H. J. (2008). Familial transmission of alexithymia. European Journal of Psychiatry, 23.
• Hemming, L., Haddock, G., Shaw, J., & Pratt, D. (2019). Alexithymia and its associations with depression, suicidality, and aggression: an overview of the literature. Frontiers in Psychiatry, 10, 1-7.
• Hesse, C., & Gibbons, S. (2019). The longitudinal effects of alexithymia on romantic relationships. Personal Relationships, 26, 566-585.
• Humphreys, T. P., Wood, L. M., & Parker, J. D. (2009). Alexithymia and satisfaction in intimate relationships. Personality and Individual Differences, 46, 43–47. 
• Karakis, E. N., & Levant, R. F. (2014). Is normative male alexithymia associated with relationship satisfaction, fear of intimacy and communication quality among men in relationships? Journal of Men’s Studies, 20(3), 179-186.
• Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: a systematic review and meta-analysis. European Psychiatry, 55, 80-89.
• Krystal, H. (1979). Alexithymia and psychotherapy. American Journal of Psychotherapy, 1, 17-31.
• Levant, R. F. (1995). Toward the reconstruction of masculinity. In R. F. Levant & W. S. Pollack, (Eds.). A new psychology of men. (pp. 229-251). New York: Basic Books.
• Levant, R. F., Allen, P. A., & Lien, M.-C. (2014). Alexithymia in men: How and when do emotional processing deficiencies occur? Psychology of Men & Masculinity, 15(3), 324-334. 
• Levant, R. F., Hall, R. J., Williams, C. M., & Hasan, N. T. (2009). Gender differences in alexithymia. Psychology of Men & Masculinity, 10(3), 190-203.
• Levant, R. F., Halter, M. J., Hayden, E. W., & Williams, C. M. (2009). The efficacy of alexithymia reduction treatment: a pilot study. Journal of Men’s Studies, 17, 75–84.
• McGillivray, L., Becerra, R., & Harms, C. (2019). Alexithymia stability and therapeutic outcome in an Australian psychiatric outpatient sample. Clinical Psychologist, 23, 37-46.
• Melin, E. O., Thulesius, H. O., & Persson, B. A. (2010). Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20. Biopsychosocial Medicine, 4(5).
• Montebarocci, O., Codispoti, M., Baldaro, B., & Rossi, N. (2004). Adult attachment style and alexithymia. Personality and Individual Differences, 36, 499–507.
• Norman, H., Marzano, L., Coulson, M., & Oskis, A. (2019). Effectiveness of mindfulness-based interventions on alexithymia: a systematic review. Evidence-Based Mental Health, 22(1), 36-43.
• Qualter, P., Quinton, S. J., Wagner, H., & Brown, S. (2009). Loneliness, interpersonal distrust, and alexithymia in university students. Journal of Applied Social Psychology, 39(6), 1461-1479.
• Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2-6), 255–262. 
• Taylor, G. J., Bagby, R. M., and Parker, J. D. (1997). Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press. 
• Zeitlin, S. B., McNally, R. J., & Cassiday, K. L. (1993). Alexithymia in victims of sexual assault: an effect of repeated traumatization? American Journal of Psychiatry, 150, 661–3. ​