During my clinical training as a psychiatrist, I had access to the emotional worlds of my patients in every aspect. This could be challenging, as the person may not always recognise what they have, emotionally, going on. In this article, I will try to explain what it means for some people to be unable to recognise or express their emotions, a diagnosis called ‘Alexithymia’.
One of the most common questions psychiatrists ask their patients is "How are you?". This question may appear trivial, but when we ask a person how they truly feel, we attempt to gain access to their daily life and emotional world. As much as we try to tiptoe into this dimension the “how-are-you-question” can sometimes be a source of distress, especially when someone struggles to access their feelings.
Not having access to their emotions frequently leads to a lack of words to express what is happening. Therefore, the response to the question “How are you?” might be “I don’t know”.
This inability to grasp what they are feeling or why they are experiencing certain feelings can lead to somatising the emotions. This means feeling emotional states through bodily symptoms. For example, when asked: "How are you?", they may respond with: "I always have headaches". This difficulty in recognising and expressing emotions can become a persistent condition: alexithymia.
So, what is alexithymia?
Alexithymia, or emotional blindness, is a term coined by John Nemiah and Peter Sifneos in the early 1970s to describe a set of characteristics found in "psychosomatic" patients – i.e. patients whose organic pathology (e.g., headache, difficulty swallowing) is a symptom of unexpressed psychological distress.
The word alexithymia comes from the Greek “a-“ (“lack”), “lexis” (“word”), and “thymos” (“emotion”), which literally means “lack of words to express emotions”. Alexithymia is the inability to recognise and verbally describe one's own emotional states and those of others, as well as to distinguish emotional states from physiological perceptions.
People with alexithymic traits often struggle to identify their emotional states, express their feelings, or comprehend the emotional condition of others. Failure to characterise emotional states can result in a decline in imaginative, dreamy, and introspective capacities. For this reason, people with alexithymia tend to have behaviours that conform to the masses. They mirror the emotions of the crowd and experience these emotions physically in their bodies.
Experiencing an emotion purely on a physical level prevents its cognitive processing, making it difficult to articulate or fully understand. As a result, the emotion is perceived, but not recognised, which may loop back around to further feeling emotions through physical symptoms.
Not a disorder, but a personality trait…
Alexithymia is a common personality trait in conditions where the expression of mental pain and discomfort also passes through the body, such as post-traumatic stress disorder, eating disorders, dyspepsia (a feeling of fullness or bloating during and after meals), dysphagia (difficulty in swallowing), certain sexual disorders (e.g., erectile dysfunction), anxiety disorders, and substance abuse.
Another aspect of alexithymia is the difficulty in showing empathy toward others. The less a person is aware of their own emotions, the less they will be able to be empathetic. This should not be confused with the clinical deficit of empathy, which could be present in other disorders. In fact, alexithymic individuals can sense empathy. However, they understand empathy through physicality and, thus, cannot directly recognise it.
Is alexithymia spreading in our generation?
From a broader, more global perspective, it's hard not to notice how recognition and expression of emotions have changed dramatically in the age of the internet.
In the presence of a screen, and the possibility of starting or interrupting communication at any time, people are less concerned about how they are perceived – in other words, they are more likely to establish superficial relationships. Additionally, interactions often only occur between two persons, displacing people from group dynamics which have differing emotional loads. Considering these factors, the quality of online connections differs from that of connections formed offline.
The importance of “reconnecting” with ourselves
Alexithymia may have significant impacts on the lives of those experiencing it. Therefore, therapeutic interventions geared at recognising and improving emotional processing may be powerful tools. A first step towards emotional recognition could be to start being mindful of physiological responses (for example, to concentrate on the heartbeat and recognise its variations during different situations).
Psychological treatments such as cognitive behavioural therapy (CBT), group therapy, and psychoeducation can aid the recognition and verbalisation of one's emotions, resulting in increased emotional awareness, more meaningful relationships, and a higher quality of life.
For example, a study on a psychoeducational intervention found that teaching adolescents in a school environment to recognise their emotions can assist in reducing bullying, racism, and homophobic behaviours and attitudes. One suggested reason for this is empathy; when kids are taught to experience and recognise emotions, they gain different perspectives on reality and a greater understanding of the consequences of their actions, particularly how they impact others.
Furthermore, several factors have been identified to assist clinicians in supporting individuals in exploring emotional themes. Psychotherapy incorporating specialised strategies to promote emotional awareness and use symbolic components of emotional systems could help reduce alexithymic features. Changes in alexithymia appear to be connected with assigning meaning to emotional experience, relating feelings to events, or accessing new perspectives.
A message to keep in mind: "negative" emotions are just as important as "positive" ones. So, learning ways to identify emotions doesn’t mean working against "negative ones" but working with them to live a life we can feel (and recognise) in every aspect.