All About Alexithymia, or Difficulty Recognizing Feelings

Alexithymia is a broad term to describe problems with feeling emotions. In fact, this Greek term used in Freudian psychodynamic theories loosely translates to “no words for emotion.” While the condition is not well-known, it’s estimated that 1 in 10 people has it.

While Freudian theories are largely considered dated, this condition seems to be increasing in awareness. It’s often seen as a secondary diagnosis in other preexisting mental health conditions and disabilities, including depression and autism.

However, this does not mean that everyone with these conditions has problems expressing with and identifying emotions. In fact, studies show that it only affects a small percentage.

People who do have alexithymia may describe themselves as having difficulties with expressing emotions that are deemed socially appropriate, such as happiness on a joyous occasion. Others may furthermore have trouble identifying their emotions.

Such individuals don’t necessarily have apathy. They instead may not have as strong of emotions as their peers, and may have difficulties feeling empathy.

Read on to learn more about the possible causes of alexithymia, as well as treatments and therapies for this condition.

Causes

Alexithymia isn’t well understood. There’s a possibility it may be genetic.

The condition may also be a result of brain damage to the insula. This part of the brain is known for its role in social skills, empathy, and emotions, with some studies linking insula lesions to apathy and anxiety.

Links to autism

The symptoms of autism spectrum disorder are wide-ranging, but there are still some stereotypes associated with this condition. One major stereotype is a lack of empathy, something that has largely been debunked.

At the same time, some research indicates that up to half of people with autism also experience alexithymia. In other words, it’s alexithymia that causes the lack of empathy, and not autism itself.

Emotions and depression

It’s also possible to experience alexithymia with depression. It has been noted in major depressive and postpartum disorders, as well as schizophrenia. Research indicates that between 32 and 51 percent of people with depressive disorders also have alexithymia.

Possible trauma

Additionally, this condition has been noted in people who have experienced trauma, especially during early childhood. Trauma and neglect at this stage may cause changes in the brain that can make it difficult to feel and identify emotions later in life.

Other associated conditions

Research also indicates that this condition may be present in certain neurological diseases and injuries. These include:

  • Alzheimer’s disease
  • dystonia
  • epilepsy
  • Huntington’s disease
  • multiple sclerosis
  • Parkinson’s disease
  • stroke
  • traumatic brain injury

Symptoms

As a condition marked by lack of feelings, it can be difficult to recognize the symptoms of alexithymia. Since this condition is associated with an inability to express feelings, an affected person might come across as being out of touch or apathetic.

However, a person with alexithymia might personally experience the following in social contexts:

  • anger
  • confusion
  • difficulty “reading faces”
  • discomfort
  • emptiness
  • increased heart rate
  • lack of affection
  • panic

This condition may also make it difficult for a person to interpret body changes as emotional responses. For example, you might have trouble linking a racing heart to excitement or fear, but are still able to acknowledge that you’re experiencing a physiological response in the moment.

Diagnosis

Alexithymia is diagnosed by a mental health professional. It’s not officially recognized by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Instead, your mental health provider will likely ask you questions and provide a diagnosis based on your answers. You may also be asked to provide a self- reported questionnaire.

Another possible test is an MRI performed by a neurologist. This will provide images of the insula in the brain.

There’s no one single test for alexithymia, much like neurological disorders and mental illnesses in general. It can take time to receive the right diagnosis.

Treatments

To date, there isn’t a single individual treatment for alexithymia. The exact treatment approach depends on your overall health needs. For example, if you have depression or anxiety, taking certain medications for these conditions could also help mental health symptoms.

Therapies may also be helpful for this condition. These allow you to participate in exercises to help improve mental health.

Possible therapy options include:

  • cognitive behavioral therapy (CBT)
  • group therapy
  • psychotherapy (also known as “talk therapy”)

Tips to cope

One possible step towards emotional recognition is to start being mindful of your own physiological responses. Some research has suggested the importance of beginning with your heart rate.

Notice whether your heart rate goes up in certain situations, and explore the possibilities of why this could be. A heart rate monitor or fitness watch can also help. With practice, you may become better able to distinguish anger from excitement and fear, for example. A journal can also help you document your physical responses and emotional patterns.

It’s also important to keep in mind that negative emotions are just as important as positive ones. Learning how to identify these emotions and work with them (not against them) can help you lead a more fulfilling life.

When to see a doctor

Alexithymia can cause frustration for people who experience it, as well as friends and loved ones. If you think you’re having trouble with recognizing or describing feelings, consider talking to a doctor about it. They can help guide you to the right therapy options to help improve on these important life skills.

If you don’t already have a mental health professional, our ishonest FindCare tool can help you connect to doctors in your area.

The bottom line

Alexithymia isn’t widely known, but this condition has been studied for more than four decades. It’s presented in individuals who have difficulty recognizing and expressing feelings, and it often coincides with another underlying neurological condition or mental health disorder.

While not inherently dangerous, this condition may inadvertently lead to interpersonal and relationship issues. The good news is that there are therapies available that can help you improve on mental health skills. Not only will this help with relationships with others, but more importantly, you may feel better, too.

Read this article in Spanish.

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