Alexithymia: When you don’t know how to recognize your feelings


What is alexithymia?

What is alexithymia

In 1973, the psychiatrist Peter Sifneos introduced the term alexithymia (from the Greek a- sin, – lexis- word, – thimos affect) to describe a set of clinical features observed in psychosomatic patients and literally means the absence of words to express emotions .

Although alexithymia is not collected by diagnostic books as a psychological disorder in itself, we can define it as:

“A psychological condition that prevents the detection and recognition of one’s own and other’s emotions, thus preventing their identification and expression”.

In this way, contrary to what may seem at first glance, it is not that these people lack emotions , but rather that they are incapable of cognitively and verbally elaborating the affective experience.

Consequently, it is not surprising that these people experience chronic emotional distress, as they are unable to adequately regulate an emotion that puzzles them. This is because they are not aware of the physiological symptoms that accompany emotions or know how to differentiate them from them (eg palpitations, muscle tension or stomach pain in stressful situations).

How does a person with alexithymia behave?

How does a person with alexithymia behave

Like any person, those with alexithymia will show their mental process in their way of proceeding. Here are the characteristics that best describe these people:

  • Low capacity for introspection and for fantasizing , as they think in immediate terms and do not feel pleasure imagining by not associating images or memories with moods (in addition, they have less access to emotional memories, especially negative ones). Lack of night dreams.
  • Difficulty differentiating emotions from bodily sensations . For example, they do not know if they are feeling anger or fear.
  • Excessive rationality and pragmatism , since they are oriented towards external and concrete objectives, giving little room to the affective. They do not greatly enjoy music or literature .
  • Rational and functional decision making, without being guided by intuition or emotional aspects. For this reason, they may require external help to make decisions quickly or when they are of a personal nature .
  • Lack of empathy by not detecting or recognizing the emotions of others, thus being indifferent and distant.

(1) – They have difficulty maintaining affective relationships.

Other manifestations.

  • Difficulty establishing and maintaining affective relationships, developing bonds characterized by emotional dependence or social isolation .
  • Apparent coldness (affective expressionlessness on a physical and verbal level). They seem serious and boring, as their communication style is monotonous (detailed and repetitive) and lacks affective nuances (eg in voice modulation or gestures).
  • Faced with conflict or emotions that they are not able to identify, they react impulsively and disproportionately , engaging in abrupt, direct and practical behaviors.
  • Possible sexual problems , mainly due to the lack of desire due to not recognizing the emotions related to pleasure.
  • Conformist attitude towards life, as they are rigid and are guided by social rules and conventions, thus relating in a very stereotyped way with others.

“The person with alexithymia reacts impulsively and abruptly to emotions and conflicts.”

Causes of alexithymia.

In most cases, alexithymia is of biological origin (for example due to neurological deficits), although it can also respond to exposure to highly traumatic situations or to a disorder in emotional learning.

Depending on the causes that have originated the alexithymia, it can be classified into:

Alexitimia primaria.

In this case, the cause is of biological origin, and may be due to:

  • Hereditary factors: It would manifest itself during childhood as happens in autism spectrum disorders.
  • Neurological diseases: For example, after suffering from multiple sclerosis or Parkinson’s disease.
  • As a result of a stroke, brain tumors or some trauma:  In such cases, it would be neurological deficits that would interfere with communication between the neocortex (rational part of the brain) and the limbic system (emotional part of the brain) or between the hemisphere left brain (producer of language) and right brain (responsible for regulating and naming emotions).

Alexitimia secundaria.

The seriousness of certain events experienced, can make you disconnect from certain areas of your own psychic reality, since it is impossible to contain the emotions that cause some experiences.

Thus, being exposed to traumatic circumstances at certain developmental moments (for example, affective deprivation) or to intense traumatic events during adult life (for example, abuse) would explain alexithymia.

What is the percentage of people with alexithymia? 

In the first place, it is necessary to emphasize that there are different degrees of alexithymia , being relatively frequent in the population at a non-pathological level. In fact, the Spanish Society of Neurology estimates that approximately ten percent of the general population is alexithymic.

“One in ten people has alexithymia.”

Are factors such as gender or culture influencing?

Alexithymia is notably more common in men . In fact, it usually affects one woman for every four men. This difference between the sexes may be due to the fact that the female brain has greater interhemispheric integration due to having a larger corpus callosum (nerve fibers that join both cerebral hemispheres).

Likewise, women have a greater register of affective-emotional vocabulary, in part because they have historically had greater freedom for emotional expression.

“Alexithymia is much more frequent in males”

Regarding the influence of culture on alexithymia, various studies have found that eastern cultures have a higher rate of alexithymia among their inhabitants. This is because, for example, the Chinese strive to avoid excess emotions and prefer to conform to social conventions.

Regarding the socioeconomic and educational level, there is no clear consensus in the literature.

(2) – There is a higher rate of alexithymia in the eastern population.

Can alexithymia predispose to a physical or psychological disorder?

Alexithymia mainly affects people with neurological deficits or psychiatric disorders, which does not necessarily imply that alexithymia is the cause of the disorder or vice versa. However, it is true that people with alexithymia show a greater tendency to suffer from the following physical and psychological disorders:

Psychosomatic disorders.

It is estimated that between twenty and fifty percent of people with disorders traditionally considered psychosomatic (bronchitis, hypertension, migraines, psoriasis, ulcers, chronic pain, asthma, chronic urticaria, cardiovascular disorders, etc.) have alexithymia.

“A high percentage of people with alexithymia have psychosomatic illnesses.”

This is due to the fact that, given the impossibility of translating their own emotions, the body looks for alternative ways of expression and, since the person is not able to differentiate emotions from bodily sensations, they tend to somatize their anxieties without giving them a solution when considering that it is a purely physical disease.

Anxiety and depression.

Alexithymia has been shown to worsen symptoms of anxiety (especially in panic disorder) and depression, assuming a risk factor, as it favors the development and maintenance of pain and hostility.

Eating Disorders.

Several studies affirm that alexithymia is a characteristic present in families with eating disorders (parents and children), although it has not been ascertained whether it is alexithymia that facilitates its appearance or if it is due to an eating disorder.

In any case, there is no doubt that alexithymia is a risk factor for these disorders, since not differentiating bodily sensations from emotional ones and poor emotional management can lead to using food as an emotional escape route.

Likewise, the rigidity and rumination inherent in people with alexithymia can lead to a poor diet in pursuit of a better physical appearance.


Alexithymia is an important risk factor for substance abuse and gambling addiction, since the limited capacity for emotional management can lead them to channel their discomfort through these channels.

How can a psychologist help a person with alexithymia?

People with alexithymia usually go to therapy under pressure from people around them , who are the ones who suffer the difficulties that this problem brings.

In fact, the person with alexithymia usually goes to the psychologist under pressure from their partner, who complains about the lack of communication and their apparent coldness.

(3) – Coldness and lack of communication in the couple.

“People with alexithymia often go to the psychologist under pressure from their partner.”

Likewise, the apparently inexplicable origin of vague and changing physical complaints can lead the doctor to undergo psychological treatment. Therefore, it is necessary to promote the development of emotional awareness, for which it is necessary to work on aspects such as:

Identify emotions.

The psychologist must address the subject’s inability to identify emotions, as well as to differentiate them from bodily sensations. Learning to self-observe the apparent low emotional activity of the brain and body (in times of stress, in the face of somatizations or involuntary bodily responses) will help to perceive and recognize the sensations in a more conscious way, being able to assign an emotional value to them (for example, having sensation tension when you get angry).

Express or communicate feelings.

The scarce emotional linguistic repertoire or the lack of understanding towards it makes it difficult to identify one’s own feelings produced by some sensations, so it is necessary to learn to express them in order to be able to assume them. In this sense, it is also important to learn to express one’s own emotions through more emotional communication (both verbally and non-verbally).

Emotional management.

Choosing an appropriate coping strategy depends on the ability to differentiate your own emotions. Unfortunately, the strategies that a person with alexithymia usually adopt are often inadequate, even using emotional repression, which makes it difficult to regulate emotions using strategies such as reevaluating them.

Possible concomitant psychological disorders.

Substance abuse, emotional dependence, anxiety or depression are some of the possible psychological disorders that must be addressed in parallel during psychological treatment so that the affected person improves their well-being on a global level.

Thus, with the help of a psychologist, the person with alexithymia will notice an improvement, not only in their ability to identify, express and manage their own emotions, but also in their ability to relate and empathize with others. In this way, your psychological improvement will have a great impact on your physical, emotional and social state.

Prevention of alexithymia during childhood.

Expression and emotional regulation are part of the child’s developmental learning process. At the beginning of his life, the human being is alexithymic due to his immaturity.

A baby is unable to speak and order his own emotional experiences, needing someone else to manage his emotional states and name them.

Once they are able to name those affects, the child begins to link them with mental representations, going on to control their emotions using psychic means .

(4) – Allow the child to express his emotions freely.

Thus, for the correct emotional development of the minor, it is important to allow the child to express his emotions freely, so that the adult can teach him to regulate his emotions in an adaptive way.

In this sense, it is convenient to indicate that the child’s coping style will depend to a large extent on what he sees at home, since children learn to interpret the world according to what they observe, imitating their attachment figures (eg If parents hide their emotions, they will tend to suppress theirs).

“Children learn to interpret external reality according to what they observe at home.”

For this reason, dysfunctional families facilitate those behaviors related to alexithymia , which leads to relate child abuse (both physical and psychological) with alexithymia.

Work tools.

With regard to education, working on emotional intelligence with minors, teaching them to identify, recognize and express their emotions in an assertive way can be very useful.

Thus, to prevent this emotional communication deficit, it is advisable to use tools such as readings related to emotional intelligence and behavior modification techniques (eg training in social skills ).

As an activity to promote emotional identification, “Emotions bingo” can be used, and the use of games that teach how to deal with complicated situations such as anger (eg “Rabid animals”) or anxiety (eg. . the turtle technique).

In any case, it is advisable to encourage the child’s creativity , so that the child learns to express and manage their emotions through creative activities such as drawing.

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Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.

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