Alexithymia: When There are No Words for Feelings

If you ask someone with Alexithymia, “How would you feel if you were stuck on railroad tracks and a train was barreling toward you?”

They would respond with, “I’d get out of the way.”

For most of us, our response would have immediately been that we’d feel terrified. However without having words for feelings, their response is focused on logic and action. In 1972, Peter Sifneos introduced the term Alexithymia, which, derived from Greek, literally means having no words for emotions (a=lack, lexis =word, thymos=emotions). According to Serani (2014), there are two dimensions present: “a cognitive dimension, where a child or adult struggles to identify, interpret, and verbalize feelings…and an affective dimension, where difficulties arise in reacting, expressing, feeling, and imagining.“

Serani also lists how Alexithymia manifests in individuals:

• Difficulty identifying different types of feelings
• Limited understanding of what causes feelings
• Difficulty expressing feelings
• Difficulty recognizing facial cues in others
• Limited or rigid imagination
• Constricted style of thinking
• Hypersensitive to physical sensations
• Detached or tentative connection to others

Alexithymia Scenarios

According to Van der Kolk (2014), most Alexithymics would respond to the railroad tracks scenario the same way, focusing on action rather than emotion. Typically, physical problems are how emotions register in the body, not so much as signals that something requires the client’s attention. Logic and linear thinking are prevalent in clients like the example above, as is a lack of intuitiveness.

A client who struggles with identifying and expressing feelings will most frequently present symptoms of depression, autism, schizophrenia, post-traumatic stress disorder, or somatoform disorders. According to Muller (2000), Alexithymia is not a diagnosis, but rather a “construct used to characterize patients who seem not to understand the feelings they obviously experience.” Professionals can try to determine if the lack of words and awareness is organic, inherent to the individual as a result of genetics, biochemistry, or irreparable injury or as a result of some stimulus that has a temporary effect on the individual. The question becomes, is this marked dysfunction in emotional awareness, social attachment, and interpersonal relating a state or a trait?

Karger describes states as “temporary, situation dependent behaviors”, whereas traits are defined as “pervasive patterns of behavior that endure across time and situations…considered by some therapists to have a biological basis.” The trait of alexithymia seems to manifest in many clients with depression, autism, and schizophrenia, where the state of alexithymia may be present for clients diagnosed with depression, PTSD, or somatoform disorders. There is obviously some overlap, as many of the diagnoses mentioned present with comorbidity.

Survivors of trauma often report not having the words for feelings. Researchers believe traumatic memories are stored in the right side of the brain, and our language center is on the left side of the brain. Our emotions are also housed on the right side of the brain, which can explain the disconnect between feelings and words, especially if trauma complicates the processing and integrating of the two. Some trauma also occurs pre-language prior to the child developing a schema to attach to a feeling, thus leaving the trauma stuck and unprocessed on the right side of the brain. Through different treatment modalities, these experiences can be integrated (Mourning, 2015).

Conclusion

Working with a skilled therapist to develop awareness and strengthen the connections between language, body sensations, and emotions is generally part of the treatment associated with these disorders. Gaining insight into the experiences of others is important as well, as there can be a deficit for social cues and empathy in people experiencing Alexithymia. Suggested practices for such tasks include journaling, reading novels (which allow readers intimate access into the emotional experiences of the characters), expressive arts or creative arts therapy, skill based, psychotherapy, Dialectical Behavior Therapy, mindfulness, group therapy, and psychodrama (Serani, 2014).

References

Mourning, Robyn. MS, MFTC. (2015, March 7). Alexithymia: How Trauma Dims Emotions. Retrieved February 6, 2017 from http://metropolitancounselingllc.com/2015/03/07/alexithymia-how-trauma-dims-emotions/

Muller, Renee, J. PhD. (2000, July 1). When a Patient Has No Story To Tell. Retrieved February 6, 2017, from http://www.psychiatrictimes.com/somatoform-disorder/when-patient-has-no-story-tell-alexithymia

Serani, Deborah. (2014, April 3). The Emotional Blindness of Alexithymia. Retrieved February 6, 2017, from https://blogs.scientificamerican.com/mind-guest-blog/the-emotional-blindness-of-alexithymia/

Taylor, G. J., Bagby, R. M., & Parker, J. A. (1993). Letter To The Editor: Alexithymia - State and Trait. Psychotherapy and Psychosomatics, 60, 211-212. Retrieved February 6, 2017, from http://www.karger.com/Article/PDF/288695

Van der Kolk, Bessel, M.D. (2014). The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.