Alexithymia: Causes, Symptoms, & Treatment

What Is Alexithymia?

Alexithymia is a personality trait that affects emotional awareness and emotional intelligence. Its exact prevalence is unknown, but one small and somewhat dated study in Finland found that 13% of the general population experienced it.² In this study, men exhibited alexithymic symptoms at twice the rate as women.

People with alexithymia generally display pervasive problems with self-awareness and emotional introspection. They may be unaware of the relationship between their feelings, thoughts, and bodily sensations. If asked how they feel, they generally will not know. Alexithymia can also result in people struggling to understand or attune to emotions in others.

What Does Alexithymia Feel Like?

Some people with alexithymia feel a sense of complete numbness or detachment from their emotions. Others may present as overly intellectual. They may be able to talk about how they’re feeling without actually experiencing the feelings. They might also present as consistently even-keeled to the outside world. Their flat affect tends to persist even in stressful situations.

How Long Does Alexithymia Last?

Because alexithymia isn’t well-researched, there isn’t enough information about its origin or how long symptoms last. It’s possible that alexithymia is genetic, which means that people are born with this personality trait. However, the environment and individual temperament might also shape its development. With that said, certain mental health symptoms or personal triggers could also exacerbate its intensity.

Causes of Alexithymia

Alexithymia may be caused by various genetic, neurological, and psychological factors. As mentioned, the exact origin of this symptom is unknown. Research shows that alexithymia rarely exists on its own- instead, it’s often co-occurring with various mental health disorders, including depression, anxiety disorders, substance use disorders, eating disorders, and more. It can also coincide with health conditions like diabetes and hypertension.³

Some possible causes of alexithymia include:

Trauma

There is a correlation between alexithymia and trauma. Childhood trauma, in particular, may predict alexithymia later in life. For instance, emotional abuse can significantly distort someone’s sense of reality, and it can stunt their ability to form emotional intelligence during the appropriate developmental phases. Similarly, when sharing emotions is not safe, people may learn to automatically conceal or suppress them.⁴ This can translate into difficulties with emotional expression throughout the lifespan.

Autism

Research shows a relationship between autism and alexithymia. Although alexithymia is not always present in autism, it occurs in about 50% of autistic individuals. With that said, some researchers postulate that autistic people with alexithymia represent their own specific subgroup.⁵ In general, autism spectrum disorder is associated with challenges with emotion processing, although this can emerge in many different forms.

ADHD

Although there is not much research on the relationship between ADHD and alexithymia, some studies show there is a link between both conditions. One small-scale study found that approximately 22% of 142 individuals with ADHD presented as ‘highly alexithymic.’ This phenomenon may speak to some of the difficulties with emotional regulation and social skills that can underpin ADHD.⁶

Medical Conditions

Certain medical conditions, neurological diseases, or acute injuries may coincide with alexithymia. Research on these relationships is still emerging, but it’s important to be aware of the mind-body connection in how it pertains to emotional processing. The alexithymia may result from specific brain changes associated with each particular health condition.

Some medical conditions associated with alexithymia include:⁷

• Alzheimer’s disease
• Epilepsy
• Traumatic brain injury
• Hypertension
• Inflammatory bowel disease
• Diabetes
• Parkinson’s disease
• Huntington’s disease
• Multiple sclerosis
• Tourette syndrome

Symptoms of Alexithymia

Primary alexithymia symptoms include difficulty identifying emotions, inability or problems with understanding the relationship between feelings and bodily sensations, limited imaginative skills, and reliance on concrete thinking. These alexithymia symptoms are not inherently “bad,” but they can affect one’s self-esteem, relationships, ability to enjoy emotional intimacy, and overall quality of life.

Some people with alexithymia present as apathetic in everyday situations. They may only show a limited range of emotions, even during heightened experiences. Others show more of a range of emotional expression, but they may not be able to adequately articulate how they feel (or how it might be manifesting within their body sensations or thoughts).

How Alexithymia Is Diagnosed

Alexithymia itself is not a mental health disorder. Therefore, the symptom is not diagnosed as a condition. Instead, healthcare professionals may evaluate the presence of alexithymia to assess for other mental or physical health conditions. This is especially true in cases of secondary alexithymia, particularly if symptoms emerge suddenly or without warning.

Healthcare practitioners may use the Toronto Alexithymia Scale, a 26-item self-report scale, or the 20-item revision (TAS-20) to evaluate the presence of alexithymia. They may also defer to a newer measure, the Bermond-Vorst Alexithymia Scale (BVAQ), a scale that specifically assesses whether someone becomes emotionally aroused by emotion-inducing events.⁸ These scales are generally used in conjunction with other clinical observations.

Alexithymia Impacts on Mental Health & Relationships

Alexithymia may be a feature of depression, anxiety, and stress. Sometimes it can result in people questioning how they feel (or discounting their feelings altogether). This may contribute to impulsive or problematic behavior, including disordered eating, self-harm, substance use, and more. Some people with alexithymia may also have uncomfortable somatic symptoms without recognizing how their emotions impact their physical feelings.

Alexithymia can also impact relationships in various ways. Relationships, in general, require mutual emotional reciprocity. It’s important for people to have a sense of shared safety and respect for one another, and this entails attuning to one another’s needs. Alexithymia can interrupt this process and lead to emotional withdrawal or interpersonal misunderstandings.

Treatment for Alexithymia

There is currently no cure for alexithymia, but certain therapies can help people better understand their emotions. People are not always aware of their alexithymia, but a trained therapist can recognize its symptoms and structure treatment to best support their client’s needs. Therapies generally focus on a combination of psychoeducation, mindfulness, emotional awareness, and interpersonal skill building.

Some therapies used to treat alexithymia include:

• Cognitive behavioral therapy (CBT): CBT can help alexithymia by helping people understand the connection between automatic thoughts and associated feelings and behaviors. This may help increase insight into emotional patterns.
• Art and music therapy: Creative therapies, including art therapy and music therapy, can help someone with alexithymia. Some people find they can better tap into their emotional states via creative expression instead of talking.
• Dialectical behavior therapy (DBT): DBT helps people strengthen skills in interpersonal effectiveness, distress tolerance, emotional regulation, and mindfulness. This may support clients to better understand their emotions.
• Group therapy: Group therapy can help people with alexithymia practice important social skills and support their peers. This, in turn, can strengthen emotional awareness.
• Interpersonal therapy (IPT): IPT focuses on helping people increase their relationship satisfaction. Such skills may also target emotional intelligence.
• Trauma-informed therapy: Trauma-informed therapy focuses on how past trauma may impact current functioning. Resolving trauma symptoms can expand emotional awareness and overall coping.

How to Develop Emotional Awareness & Communication Skills

Developing emotional awareness is a gradual process. The initial work often starts with simply practicing identifying and labeling emotions. You can defer to a feelings wheel if you need help examining the different types of emotions. Check-in with yourself regularly to determine how various emotions might present themselves somatically or relationally. Over time, you may develop insight into certain emotional patterns.

Mindfulness can also help. People with alexithymia may keep themselves busy enough during daily life that they don’t have much time to reflect on how they feel. Devoting a few minutes to meditation can help you strengthen your introspection and self-awareness. This can translate to deeper emotional insight. You can also practice mindfulness with others by actively listening to their needs and being receptive to feedback.

Where to Find Professional Help for Alexithymia

If alexithymia is affecting your well-being, working with a therapist can help. You can find a therapist using an online therapist directory, asking your physician for a recommendation, or seeking referrals from trusted loved ones. Look for a provider who specializes in the specific mental health condition you’re experiencing (i.e. depression, eating disorders, or substance use disorder), as they are well-versed in understanding and treating your specific symptoms.