Alexithymia: what is it in simple words, examples, reasons

What is alexithymia? Or Alexithymia as a psychological problem

Alexithymia - what is it?
If we translate this term literally from Greek (alexithymia: a - negation + lexis - speech, word + thymos - mood, feelings), we get “speechless feeling”. A strange term meaning a lack of feelings, difficulty in defining and expressing emotional states in words. So alexithymia literally refers to the inability to describe one’s emotions in words. It seems that there is nothing wrong with this, where is the psychological problem here? These are emotions, why define them in words, you have to feel them? It turns out that a person's inability to describe their own emotions in words leads to an inability to recognize them, as well as their feelings or anxiety. And the inability to realize your emotions does not allow you to understand the experiences and feelings of other people and empathize with them. In this case, the world gradually becomes poor in feelings and rich in events. They come to the fore to the detriment of internal experiences. And over time, a person ceases to be emotionally involved in an objective situation. As a result, he does not live it, does not take his personal experience out of it.

This is a limitation of sensory connections with the world. Therefore, it reduces the ability to distinguish feelings from bodily sensations and to respond adequately in stressful and conflict situations. It interferes with understanding the world in all its complexity and constructing a figurative context for the situation. Therefore, a person has the feeling that he is being haunted by failures in his activities. Perhaps real, and perhaps existing only in his mind. And these failures begin to acquire greater emotional significance and personal meaning for a person than achieving the goal. And then the motivational sphere is distorted, the semantic accents are shifted. Namely, they largely determine a person’s relationship with the surrounding reality.

Do you now see alexithymia as a psychological problem? Hope so. Now let's move on to studying its causes, signs and possibilities for “treatment”.

Alexithymia technique - myth or reality: why is it questioned?

Alexithymia
What kind of pathology is this - myth or reality? From the above it is clear that the disease really exists. But the alexithymia technique is in some sense questioned by Ryzhinsky (1987, p. 257) , who claims, in particular, that, among other things:

• “Many authors have expressed doubts about the existence of a clearly defined connection between a characteristic set of personality traits and psychosomatic illness. In particular, in recent years, the literature has emphasized the existence of unique complexes of psychological dispositions that, in a statistically significant way, tend to respond more quickly to psychosomatic diseases in general, without showing a predilection for specific diseases.”

Long-term studies by Lazovsky and Pluzhek (see Lazovsky, 1978, 1982) do not confirm the connection between alexithymia and psychosomatic diseases. At the same time, the authors object to the specificity of the connection between a certain personality type and a specific somatic disease. More details:

• They believe that the personality of a psychosomatic patient is different from that of healthy people.
• They call neuroses “psychosomatic syndrome” and cannot be cured only by specific attitudes and needs.
• One can, of course, find in him the sources of behavior described as the so-called “type A personality .

True, it was possible to find in her sources of behavior described as the so-called Type A personality, since it includes the following individual traits:

• Constantly protective attitude
• Positive self-esteem
• Self confidence
• Increased self-control
• Strong need for achievement
• Domination
• Competition
• Activity
• Affiliation
• Perseverance
• Understanding yourself and the world around you
• Caring for others

But researchers are firmly convinced that the personality of people suffering from individual psychosomatic diseases differs more quantitatively than qualitatively, in terms of the symptoms that make up the psychosomatic syndrome.

How does alexithymia manifest?

Typically, alexithymia manifests itself in this way: you “have no words” to express feelings, or you find it difficult to identify an emotionally charged situation that is significant for your inner mental life. Or you are not able to explain, tell what is happening to you at the level of feelings. Usually, with alexithymia, you rarely have dreams and they are dim and fragmentary.

What does this look like in real life? If, for example, a person who is just sitting in a chair is asked the question: “What are you feeling now?”, he will often answer: “Nothing. How can I feel if nothing happens around me? I feel that the chair is soft...” or will begin to describe his actions: “I’m sitting in a chair. I’m looking at the picture on the wall” or to the description of the situation: “The weather outside is good. There is a picture on the wall…". Instead of saying: “I feel joy because the weather outside is good and there is a beautiful picture on the wall...”

How to treat alexithymia in children, adolescents, adults, how to get rid of it: correction

Alexithymia in adolescents

Important: Treatment of alexithymia in children and adolescents should only be carried out by a clinical psychotherapist. If parents see incorrect behavior in their upbringing of children, then they can change it, but the child will still have to undergo correction, since the psyche is already broken. The mother and father of such a child should also be observed by a psychologist or psychotherapist.

How to treat alexithymia in adults, how to get rid of it? There are 3 effective tips that, if followed correctly, can alleviate the condition and eventually lead to recovery:

It is important to understand what emotions are and why they are needed:

• Emotions are psychophysiological reactions that involve not only the brain, but the entire body. They are the start of physiological changes that provide the behavior necessary in a given situation.
• For example, if the emotion of fear appears during danger, then the body’s reaction appears aimed at protecting the body from the threat and preserving life. Adrenaline is released, heartbeat and breathing quicken, muscles acquire tone and become more active.
• But a person with this disease cannot understand what these emotions are, and for example, during times of fear, when a rapid heartbeat occurs, the individual thinks that he has problems with the cardiovascular system.

Learn to recognize your emotions:

• Start with physical sensations. For example, if your legs are shaking, your heart is beating rapidly, your mouth is dry, and you want to walk from side to side, then you may be experiencing anxiety and fear.
• Start recognizing emotions from the simplest situations. Find yourself thinking about how you feel when your dog licks your hand, you eat your favorite dish, or you don’t like something.
• In the case of interpersonal relationships, it will be a little more complicated. But still catch your thoughts and feelings at the moment of communication. For example, you clench your fists, your nostrils flare, your eyebrows move, which means you are feeling angry. If, on the contrary, a smile appears on your face and warmth spreads throughout your body, it means that you enjoy communicating with this person.

Learn to express emotions verbally and non-verbally:

• Notice that people talk with emotion on their face. If you say something and your face is stony, then the interlocutor will only feel false.
• Practice in front of a mirror. Shout: “I won a million!” - once without emotion, the second - with a wide smile.
• Pay attention to the emotions as you say the phrase. If you do this with a straight face, the feelings will be strange - won’t it?

Advice: If these tips and daily exercises do not help, then consult a psychotherapist. This should be done especially if alexithymia interferes with your life. A specialist will help solve the problem in a short time.

So, despite all of the above numerous counterarguments, it is likely that for some time the myth of alexithymia will be talked about and in the future will be of interest to many researchers who want to check its real existence. Perhaps not foreseeing such a final solution to the problem, the well-known expert in this field, Tyrer (1988), in the famous monograph on personality disorders published under his editorship, does not pay any attention at all to hypothetical alexithymia. Textbooks on psychosomatics say nothing about alexithymia (cf. Tylka, 2000). It is not without reason, as it may seem, that not a single psychiatric classification system, including the most important one, i.e. ICD-10 (1992) and DSM-IV (1994) do not take this diagnostic category into account.

How do you understand what alexithymia is? How do you cope with pathology yourself?

How does alexithymia occur or Causes of alexithymia:

Alexithymia can be a permanent personality trait, or it can be a temporary reaction to depression or anxiety. If this is a human trait, then its development begins in adolescence. If you do not teach a child to talk about how he feels, how he expresses it, then he will not learn to empathize. And parents often not only do not ask the child about his feelings, but, on the contrary, teach them to hide them in every possible way, demonstrating by their example appropriate behavior. And people grow up with the ability to realize and express feelings that have not developed at the right age - people with primary alexithymia.

But alexithymia can also be secondary. It develops as a result of the predominance of defense mechanisms in the process of personality development. That is, if the expression of feelings in the past brought a negative result - pain, fear, guilt, and so on, the person received a negative traumatic experience and, as a result, came to the conclusion that it is better never to show his feelings and not to tell anyone about them. And in order not to accidentally let it slip, it is better to hide them from yourself. Unfortunately, giving up possible pain often entails the opposite side - giving up possible joy.

Treatment

The very first step is to accurately diagnose what form of alexithymia the patient has and how severe it is. To do this, the Toronto School of Alexithymia test mentioned above is used. Further treatment is complex. It is based on psychotherapy; additional medications can be prescribed to increase the effectiveness of treatment and consolidate the results.

The therapist's job is to teach the client how to correctly interpret their feelings and manage their emotions. This reduces the psychosomatic effect and reduces the risk of various diseases that it can cause. Quite often, to relieve internal tension, a person simply needs to learn to cry or get angry, releasing emotions, rather than holding them back.

Psychological makeup of a person or Signs of alexithymia

You shouldn’t think that alexithymia is a disease (that’s why we put the word “treatment” in quotes in the first part of our article), no, it’s a phenomenon, a complex characteristic of a person, a certain psychological make-up of a person. But if it is not a disease, then what is the point of us even talking about it? However, not all so simple.

This phenomenon indicates that a person is closed to new experiences and is focused on negative experiences. People with alexithymia are more prone than others to depression and the development of psychosomatic diseases (coronary heart disease, hypertension, peptic ulcer of the stomach and duodenum, bronchial asthma, etc.), the course of these diseases is, on average, more severe in them compared to other patients, and treatment takes longer and brings less results.

Alexithymia can also be a characteristic sign of a severe, ongoing stressful situation, to which a person has already become accustomed and evaluates it as normal. And the consequence of alexithymia is often loneliness. In addition, alexithymia is characterized by certain disturbances in emotional and personal processes, as well as in the sphere of thinking.

In the emotional sphere, it manifests itself as an inability to accurately recognize and describe one’s own emotional state and the emotional state of other people, insufficient emotional involvement in an objective situation (fixation to a greater extent on external events than on internal experiences), difficulties in distinguishing between feelings and bodily sensations. Such people cannot, for example, distinguish chronic fatigue from depression.

In the personal sphere, alexithymia manifests itself in a reluctance or inability to reflect (the process of a person’s self-knowledge of his internal mental acts and states, the process of thinking about what is happening in his own mind), which, in turn, leads to a simplification of life orientation, impoverishment of relationships with the outside world, sometimes – some immaturity.

In the sphere of thinking, a person prefers to use visual-effective thinking rather than abstract-logical thinking, does not use the possibilities of his imagination, as evidenced by the lack of inclination to dreams and fantasies. He also makes little use of the processes of categorization (the mental process of assigning a single object, event, experience to a certain class, that is, categorization is a process of generalization followed by classification) and symbolization of thinking.

Study of primary alexithymia: works of authors, what books?

Alexithymia
It seems appropriate to consider the motivational origins of the hypothetical concept of primary alexithymia based on the research conducted by scientists. Based on the work of many book authors, two main determinants can be distinguished:

Personality traits are closely related to psychosomatic diseases:

• It has been widely accepted among psychoanalysts for almost half a century that such a connection does exist, and even that there are personality profiles or types specific to particular illnesses (Dunbar, 1947, 1954).
• Support for this position was to be provided by observations that psychosomatic patients differ in personality characteristics from patients with psychoneurosis (cf. McLean, 1949; Marty et al, 1963; Ruesh, 1948; Shands, 1975; Voght and Ernst, 1977; Von Rad and Lolas, 1977).

The ineffectiveness of psychoanalysis as a method of treating psychosomatic diseases:

• This was mentioned in their works - Ammon, 1979; Horney, 1952; Crystal, 1983; Salminen et al, 1980; Taylor et al, 1997.
• In addition, some of the founders of psychosomatic medicine, for example Deutsch (1953, 1959) and Wittkower (1965), expressed the unanimous opinion that psychoanalytic therapy is completely futile for these types of patients.

Initially, the psychoanalytic direction sought to divide the personality into dynamic factors, including the so-called central conflict, for example, between the needs of dependence and independence. Later, expanding on Freud's understanding of the connection between physical illness and ego changes, many psychoanalysts based their ideas about psychosomatic disorders on the basic assumptions of ego psychology. They placed special emphasis on disorders in the body ego, i.e. on the image of one's own body. A good example here is the views of the authors:

• Schilder in 1924 - found a connection between psychosomatic diseases and disorders of the bodily circuit.
• Federn in 1953 - the connection between psychosomatics and the sense of the body ego.
• Schur in 1950 combined in his theory the so-called resomatization of ego functions and psychosomatics.

These and other authors were confident that the process of neutralization (desexualization) of libidinal energy is associated with the progressive desomatization of the individual’s behavior (emotions). This is due to the fact that a deficit in affective ego development leads to disruption or blocking of the processes of differentiation, verbalization and desomatization of emotions (Crystal, 1988).

Pragmatism and creativity

Is the image of a pragmatist emerging? Yes, excessive pragmatism is a consequence of alexithymia. As well as the lack of a creative attitude to life. But creativity is a manifestation of self-expression, one’s own individuality, non-standard perception, and the joy of existence. The lack of joy leads to a feeling of dullness in life, an “incomprehensible” feeling that “everything seems to be in order, but something is wrong,” to specifically unfounded displeasure and dissatisfaction with life.

In turn, our negative states cannot but affect our loved ones: spouse, children, friends, sometimes work colleagues or subordinates. In this way, difficulties and conflicts arise in interpersonal relationships, aggravated by the inability to understand the experiences and emotions of other people, and a reduced ability to sympathize and empathize.

Often, with alexithymia, people of a certain personality type easily experience short-term emotional outbursts, sharply expressed in behavior, the causes of which are poorly understood by them.

The concept of alexithymia: what is it?

An interesting position on the concept of pathology is taken by Ammon (1979), who, according to his theory of structural deficit of the “I” (“emptiness of the self”) , perceives psychosomatic diseases as a manifestation of violations of the primary “I” , caused - like the development of psychosis - by the secondary, abnormal autonomy of the symbiotic complex. What is this?

• In other words, this is an unresolved conflict from the pre-Oedipal period, resulting from a breakdown in relations with the mother in the first years of the child’s life.
• The psychosomatic symptoms of alexithymia are similar to an attempt to fill a structural deficit (they fill the ego void), protecting the weak ego from complete collapse. This is a kind of defense mechanism.

A radical opponent of linking specific forms of personality disorders with psychosomatic diseases was the founder of modern psychosomatic medicine, Franz Gabriel Alexander (1950) . This orthodox psychoanalyst, a successor of Freudian thought, assumed, among other things, the multi-causal genesis of psychosomatic diseases, expressed by the formula:

• PS = f (a, b, c, d, e, f, g, h, i, j, k, … n)

Where:

• PS - psychosomatic illness
• f - function sign
• a - constitutional factor
• b - birth trauma
• c - acquired weakness of an organ (for example, as a result of somatic diseases of infancy)
• d - nature of parental care in infancy
• e - random physical traumatic experiences in early childhood
• f - emotional atmosphere in the family and personal characteristics of parents and siblings
• g - disappointment in oral needs
• h - drive conflict
• i - physical injuries
• j - emotional experiences in interpersonal relationships
• k is a difficult situation (stress) that occurs immediately before the disease

As can be seen, this model has no place for a specific personality or a specific type of personality disorder.

Main features

Signs of emotional pathology are:

• a person’s inability to differentiate their own emotional states;
• a person experiences difficulties in verbalizing his own experiences;
• reduced pain threshold;
• craving for solitude;
• getting stuck in a situation;
• ignoring the needs of others;
• Analytical mind;
• high level of development of logical thinking;
• poorly developed imagination, poor imagination;
• lack of intuitive feeling;
• tactlessness;
• tendency to criticize the actions and statements of other people;
• categoricalness and straightforwardness in communication;
• poor development of communication skills;
• secrecy, isolation;
• the desire to control all the actions of loved ones;
• asceticism;
• inability to enjoy little things and have fun;
• reduced motivation to achieve goals;
• Human dreams are monotonous and devoid of bright moments.

Impact on the body and quality of life

Having highlighted the signs that the concept of alexithymia includes, the negative impact of this phenomenon on a person’s life becomes obvious. If there is no processing of emotions (and in this disorder there is none), then it is appropriate to talk about chronic stress.

The impact of the disease on a person and his quality of life manifests itself in many aspects.

1. Constant muscle tension, leading to distortion of posture and changes in the functioning of internal organs.
2. Changes in hormonal levels. The endocrine system continues to respond to events in the surrounding reality by releasing certain hormones into the blood, regardless of whether a person is aware of his emotional state or not. The concentration of the hormone in the blood during a stressful situation increases, but there is no reaction from the brain - the nervous system is depleted, the body does not rest.
3. Mental abnormalities. The disease often leads to anorexia or bulimia, insomnia, depression and increased personal anxiety, schizophrenia and psychopathy, and addictive behavior.
4. Pathology interferes with effective communication and the formation of healthy interpersonal relationships. Social contacts of a person with this disorder become scarce and short-lived. Communication partners get the impression of such people as cold, indifferent, and distant.

The life of an individual with such a diagnosis is darkened by the fact that he is aware of the imperfection of his psyche, he wants to experience emotions, express feelings, but he cannot do this. This often becomes the reason for the development of personal complexes.

Forms

Clinical psychologists divide the inability to talk about one’s own feelings into 2 forms:

1. Primary alexithymia. This type of personality development disorder is congenital. Difficulties in expressing emotions in this pathology are due to improper development of certain areas of the brain.
2. Secondary alexithymia. This pathology occurs during life and is associated with exposure to external negative factors. Researchers believe that “emotional dullness” can be eliminated in this case if the traumatic factor is eliminated.

Alexithymia is not always an established personality trait. Insensitivity to one's own and other people's emotions can be short-term in a person and be interpreted as a peculiar reaction of the psyche to a strong emotional shock.

Asya Rakhovich

Psychologist with more than 8 years of experience. Consultant on interpersonal and marital relationships, self-discovery.

Ask a Question

Research and Testing

The problem of alexithymia was studied in the USA. In 1985, a psychological test was developed in Toronto to determine the level of alexithymia. The term was coined by Peter Sifneos, a Harvard psychiatrist.

Also in 1985, the test began to be used in Russia with minor modifications. The Bekhterev Psychoneurological Institute has finalized the testing and remade it to suit Russian realities and domestic psychology. In 2010, at the Moscow Research Institute of Psychiatry, the test was adapted and revised again.

The relaxation stage is a kind of preparatory stage for overcoming alexithymia. Relaxation techniques can include: autogenic training, special music therapy sessions, a wide arsenal of auxiliary psycho-gymnastic techniques (such as “wax stick”, etc.).

The didactic orientation of the first stage of overcoming alexithyms is understood as follows. The inability of patients to verbalize their feelings is most clearly manifested in the difficulty of verbalizing experiences of the “here and now” type. Since the “here and now” principle is one of the main principles of non-directively oriented groups, insufficient ability to assimilate it can significantly reduce the psychocorrectional potential of the group. Because of this, one of the areas of the group’s work is training the skill of experiencing the “here and now” type, which determines the didactic orientation of the preparatory stage of work to overcome the “alexithymic barrier”. In this case, the assimilation of group norms (the list of which is given in well-known manuals on group psychotherapy, 6, 9) is, in a certain sense, the ultimate goal of group psychocorrection of alexithymic patients. Just as young children develop their senses with the help of didactic material, such as pictures, toys, split alphabet, etc., alexithymic patients at the first stage of group work also develop the ability to feel and the ability to verbalize their feelings, with “didactic material” in this case, to one degree or another, the entire methodological arsenal of group psychological correction in the appropriate modification is present.

At the same time, the basic principles of didactics are fully realized: consciousness (in the form of awareness of one’s feelings, awareness of oneself in a communication situation), visibility (the embodiment of which is a certain holographic vision in a group setting, acting as a system of mirrors providing multiple feedback), communication theory with practice (training focus of the group, for example, in the case of training the “here and now” skill).

Actualization of non-verbal methods of communication and reliance on them, being the basis for overcoming alexithymia, involves the widespread use of psycho-gymnastic techniques and techniques to the maximum extent conducive to “disinhibition” and actualization of feelings without the anxiety characteristic of patients associated with their verbalization. Not “verbalised”, not verbally formulated techniques of psycho-gymnastics seemed to prepare the ground for the subsequent verbalization of the rich and intense range of feelings released during their use. Psycho-gymnastic exercises are thus considered as a kind of “warm-up” of feelings, their relaxation and “disinhibition”. This kind of orientation also determined a certain orientation towards the perception of extralinguistic features of the verbal layer of behavior, when it is not the reasoning of the group member itself that is important, no matter how significant and confessional they may be, but the rhythmic wave that they create.

One of the indirect or bypass methods of verbalizing feelings was the “Portrait of the Artist’s Wife” technique we proposed. The group member was asked to create a verbal picture, a portrait of himself, as if he were famous and posed for the artist. The indirect nature of the technique increased its informativeness and diagnostic value. At the same time, the participants’ abilities and skills in verbalizing complex feelings and nuances of attitudes towards themselves and others were exercised and deepened. The focus on conveying in words the portrait drawn in the imagination to the maximum extent possible was supported by the desire of the group member to convey to others the essence and content of this imaginary picture as fully as possible and without distortion, so that others could “see” it to the maximum extent. The artist had a variety of “means” at his disposal: paints, frames of different sizes, arrangement objects; it was possible to create both individual and group portraits (with a child, mother, spouse, etc.).

Reliance on non-verbal means of communication creates, as it were, workarounds for overcoming alexithymia, mobilizing the internal reserves of the personality, providing support for its safe sides. The bypass nature of overcoming alexithymia in this case is determined by the fact that it is not a direct, but an indirect effect on the “defect”, which is the patient’s inability to verbalize his feelings and other alexithymic traits.

How, by stimulating nonverbal communication, can one increase the ability to verbalize feelings in psychosomatic patients? Isn't the reliance on nonverbal means of communication in the case of alexithymic patients an adaptation to the “defect”? It appears that this is not the case. On the contrary, mastering nonverbal communication is an expansion and deepening of the general range of means and methods of communication. As follows from the analysis of the group’s activities, mastery of non-verbal methods of communication, developing the ability to identify with another person, to achieve emotional consonance, ultimately led to a deepening of the empathic potential of group members, i.e. to the perception of a wider range of communicative stimuli received from other people – intonation of voice, facial expressions, body language and other “contextual factors” that complement the words. In addition, in the warm and accepting atmosphere of the group, a certain stereotype of suppression and somatization of feelings, characteristic of patients in their real lives, is initially removed.

The final stage of overcoming the “alexithymic barrier” is the actualization of “internal dialogues”. These are techniques aimed at updating hidden, incompletely conscious internal dialogues, their deployment and verbalization. This approach seems adequate to the goals of overcoming alexithymia, since its specific manifestations are based on the diffuseness and unity of experiences of somatopsychic discomfort, which presupposes the diffuseness, blurriness and unity of the internal dialogue, in which, like in a haze of fog, its two poles, two internal interlocutors, are difficult to distinguish. In this case, the internal dialogue is also repressed from consciousness due to its unsolvability in the form in which it is actually presented. Subjectively unpleasant experiences associated with internal dialogue, repressed from consciousness, contribute to an increase in general anxiety and, ultimately, chronicity of a psychosomatic illness.

To actualize the “internal dialogue”, both our own techniques and techniques taken from Gestalt therapy were used (13). They became effective only when deeply immersed in a special atmosphere of psychocorrectional contact, which presupposed an increased level of self-awareness of the group member, encouraging him to have confidential contact with the psychologist and to self-disclosure. Only in this case, the group members could hear in the speaker’s speech not just one pressing context, but their polyphony, and, as if integrating into his “internal dialogue,” from within they contributed to strengthening the contradictory moments of self-awareness.

Thus, one of the possible approaches to overcoming alexithymic traits in the personality structure of a patient with psychosomatosis in the conditions of group psychological correction consists in the implementation of three successive stages: 1) relaxation and didactic orientation, 2) reliance on non-verbal means of communication, 3) actualization of “internal dialogue” .

alexithymic traits – previous