Characteristics of alexithymia: symptoms, causes and treatment

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Many people are clear about when they are sad, angry, excited or scared and are able to put into words and share what they feelHowever, some people experience their emotions as a kind of background noise: they notice something happening inside, perhaps their heart races or they get a knot in their stomach, but they don't know what it is or how to explain it. That, precisely, is what we mean when we talk about alexithymia.

Alexithymia has even been called “emotional illiteracy” Because it's not just about feeling little or strangely, but about not having an "internal language" to recognize, name, and share what you feel. This can greatly complicate relationships, physical health, and psychological well-being, although with appropriate support, you can learn to better understand your own emotional world.

What exactly is alexithymia?

The term alexithymia comes from Greek and literally means “speechless for the emotions” (a, absence; lexis, word; thymus(affection or emotion). It was coined by the psychiatrist Peter Sifneos in the 70s when he observed that many patients with psychosomatic problems had serious difficulties putting into words what they felt.

When we talk about alexithymia, we are referring to a marked difficulty in identifying, understanding and describing one's own emotions And often, it also helps in recognizing the emotions of others. This doesn't mean the person doesn't have feelings, but rather that there's a significant disconnect between what happens emotionally and the ability to translate it into thoughts, words, gestures, or decisions.

Clinically, alexithymia does not appear as an independent disorder in manuals such as the DSM-5but is considered rather a personality trait or emotional style which can manifest itself to a greater or lesser degree and which often interacts with other psychological or neurological problems.

For this reason, many authors talk about continuous or alexithymic gradientThere are people with slight difficulties in expressing what they feel, and others in whom the emotional disconnection is so intense that it clearly affects their social, work, and relationship life, as well as their health.

Emotional illiteracy and “digital alexithymia”

Alexithymia has been linked to what Daniel Goleman called “emotional illiteracy”That is, the inability to recognize, understand, and manage one's own emotions and those of others. People with this profile often show little emotional empathy and a certain emotional detachment, even though they may function seemingly normally in everyday life.

In practice, a person with emotional illiteracy can naturally state phrases like “I don’t feel anything for anyone” or “I don’t know why people cry so much” and wondering things like “Why can’t I cry?” or “Why can’t I have feelings like everyone else?” This feeling of being weird or “emotionally defective” is more common than it seems.

The philosopher and psychoanalyst Umberto Galimberti has also reflected on this phenomenon in relation to contemporary culture and the role of technology, going so far as to speak of “digital alexithymia”In a context of hyperconnectivity on social networks, while the information available increases, emotional depth is diluted and a form of communication that is fast, superficial, and disconnected from what is really felt is reinforced.

Intensive screen use, the immediacy of messages, and constant exposure to stimuli can contribute to a decreased empathy and an impoverishment of emotional language, especially if there is no real space for face-to-face encounters, listening, and the expression of vulnerability.

Characteristics of people with alexithymia

A simple way to understand alexithymia is to ask yourself “What does a person with this difficulty experience internally?”Far from being cold or insensitive, they often experience significant psychological suffering because they don't fully understand what is happening to them or why they react the way they do.

Among the most frequent characteristics are:

• Difficulty identifying and naming one's own emotionsThe person notices physical sensations (muscle tension, palpitations, a lump in the throat…), but finds it difficult to know if they are sad, angry, disappointed, ashamed, or scared.
• Difficulty describing feelings to othersWhen they try to explain themselves, they remain descriptive ("yesterday I argued with my partner, he said this and then the other thing happened") without ever saying how they felt.
• Limited emotional vocabularyThey tend to use generic words like "good", "bad", "normal", "weird", without richer affective nuances.
• Highly rational and practical cognitive styleThey handle data, facts, and concrete tasks better than conversations about internal states or relationships.
• Poverty of imagination, fantasy, and dream lifeThey dream little or barely remember their dreams, they find it difficult to fantasize, play symbolically, or enjoy highly emotional literature and music.
• Limited capacity for introspectionThey find it difficult to stop and think about what they feel, why they react that way, or what they need emotionally.
• Little facial and body expressivenessMimicry, gestures and psychomotor skills are usually discreet, with a serious, inexpressive or "flat" appearance.
• Tendency to resort to action in the face of conflictsInstead of talking or internally processing what they feel, they act impulsively, start doing things, or flee from the situation.
• Difficulty understanding other people's emotions: affective empathy is reduced; they have difficulty reading the non-verbal language of others or putting themselves in their shoes.
• Rigid or superficial social relationshipsThey may find it difficult to initiate intimate relationships, maintain deep conversations, or manage the emotional demands of friends and partners.
• Inclination towards isolation without intense experience of loneliness: they may be quite lonely, but not feel the lack of emotional contact in the same way as other people.
• Difficulty differentiating emotions from bodily sensationsFor example, confusing anxiety with "a stomach problem" or anger with "muscle tension", without seeing the emotional component.
• Disproportionate emotional reactionsThe accumulated tension can erupt in fits of rage, crying spells, or intense fear seemingly "for no reason," because there has been no prior regulation.

All of this often leads to these people being perceived as cold, distant, overly analytical, or even selfish, when in reality they often feel quite lost and confused about what is happening inside them.

Alexithymia, emotions and other related concepts

A key idea is that alexithymia It does not mean an absence of emotionsThe person feels, and in many cases feels a lot, but does not have the tools to translate those internal experiences into a language that allows them to understand themselves and communicate.

Sometimes what appears is called parathymia or affective incongruenceEmotions are expressed that do not fit the context. For example, someone might laugh in a sad situation or remain indifferent to very positive news, such as a promotion or the birth of a child, generating misunderstanding among those around them.

It is also common for them to ask “Why can’t I cry?” in situations where other people get emotional easily or describe themselves as someone who is "unaffected by anything", when in reality the emotion is there but is not clearly perceived.

Difference between alexithymia and anaffectiveness

It is important to distinguish alexithymia from anaffectivenessIn anaffectiveness, a almost total inability to feel emotionsIn other words, the person actually has an extremely reduced affective register, as if the emotional volume were almost turned off.

In alexithymia, on the other hand, emotions are presentBut the problem lies in the lack of awareness and emotional languageIt's as if there were a short circuit between the emotional system and the verbal/cognitive system.

Difference between alexithymia and anhedonia

Another common confusion is with the anhedonia, Which is the inability to feel pleasure in the face of activities that were previously rewarding (eating, socializing, playing sports, enjoying hobbies...).

A person with anhedonia can identify emotions like sadness or apathy and know that they no longer enjoy things as before, while someone with alexithymia Yes, you can experience pleasure or displeasure.but he has trouble with to recognize and express those emotional feelingsThey are distinct phenomena, although they can appear together, for example in complex depressive episodes.

Causes and types of alexithymia

There is no single cause that explains alexithymia; in fact, it is often said to be a multifactorial origin where biological vulnerabilities, genetic factors, and life experiences, especially during childhood, are mixed.

In general, two main types are distinguished: primary alexithymia y secondary alexithymia, which provide guidance on whether the biological or experiential component predominates.

Primary alexithymia: biological and neurological bases

Primary alexithymia is considered a relatively stable trait, linked to genetic, neurobiological or neurological factorsIn these cases, emotional difficulty may be present from an early age or appear associated with injuries or diseases of the nervous system.

• Hereditary component and neurodevelopmental traits: a higher frequency of alexithymic traits has been observed in people with autism spectrum disorderespecially in Asperger's syndrome, although not all autistic people are alexithymic or vice versa.
• Alterations in brain areas involved in emotion: the insula, the anterior cingulate cortex, and other related regions empathy, body awareness, and emotional integration They can be altered by injuries or malfunctions.
• Neurological diseases such as Parkinson's disease, multiple sclerosis, Alzheimer's disease, Huntington's disease, or dystonias, where higher rates of alexithymia have been described.
• Temporal lobe epilepsy, stroke, and traumatic brain injuryIn these cases, the difficulty in identifying emotions may appear after the neurological event.

In primary alexithymia, the person may have always been "like this": Not very expressive, very logical, with practical tastes and little imaginative lifeAnd it is the environment that notices that "something is missing" in the affective realm.

Secondary alexithymia: emotional experiences and trauma

Secondary alexithymia is usually understood as a adaptive response (even if it later becomes maladaptive) to harmful or invalidating emotional contexts. Here the focus is on the upbringing environment and traumatic experiences.

Some situations that favor this type of alexithymia are:

• Families where emotions are not discussed: very cold homes, focused only on performance, where "no crying", no comforting or ridicule of vulnerability.
• Inconsistent, neglectful, or violent attachment figures: unpredictable parents, with outbursts of anger, abuse, abandonment or emotional neglect.
• Contentious parental separations or environments of continuous high tension, where the child learns to "switch off" what he feels in order to survive emotionally.
• Traumatic episodes in childhood or adulthoodDomestic violence, abuse, serious accidents, unprocessed losses, in which a [something] may be activated emotional dissociation to cushion the pain.

When this disconnection persists over time, a pattern of detachment from emotions which makes it difficult to learn to name and manage them, leading to alexithymic traits. In these cases, there is usually more room for change with appropriate therapy, because it works on emotional wounds and learned patterns.

Relationship with other disorders and health problems

Alexithymia rarely occurs alone; it is frequently observed alongside other psychological disorders, psychosomatic conditions or mental health problemsThis does not mean that it always causes them, but it does mean that it interacts with them.

Some associations described in clinical research are:

• Depressive disorders (including postpartum depression): It is estimated that between 32% and 50% of people with depression also exhibit alexithymic traits, which complicates the identification of distress and the search for help.
• Anxiety disordersThe difficulty in recognizing fear, worry, or emotional tension favors an experience focused on physical symptoms (palpitations, shortness of breath, dizziness, etc.).
• Schizophrenia and other psychotic disordersHigh levels of alexithymia have been documented, possibly linked to alterations in emotional processing and self-awareness.
• Personality disorders, especially the narcissisticwhere a very limited ability to understand one's own emotions and those of others has been observed, favoring cold relationships focused on self-image.
• Substances treated (alcohol, drugs, sex, gambling): some people resort to addictive substances or behaviors as a quick way to modulate emotions that they do not know how to identify or regulate.
• Psychosomatic disordersHeadaches, gastrointestinal problems, chronic muscle pain, and other frequent somatizations when the emotion does not find a psychological outlet.

At first, it was thought that alexithymia was a characteristic almost exclusively of the psychosomatic illnessesbut today it is considered more of a nonspecific vulnerability factor which increases the risk of multiple physical and mental problems linked to “emotional anesthesia”.

Effects of alexithymia on personal relationships

Life as a couple, friendship, or family relationships are based, to a large extent, on the ability to sharing emotions, empathizing, and regulating each otherTherefore, alexithymia can have a very significant impact in this area.

In affective relationships, a person with alexithymia may:

• Showing little emotional initiative: He/She finds it difficult to say "I love you", to express affection spontaneously, or to detect when the other person needs support.
• Responding in a cold or disconcerting manner in the face of important news (good or bad), what the other person experiences as a lack of interest or love.
• Having trouble resolving conflictsIt focuses on facts and practical solutions, avoiding talking about how each person feels, which can leave the other person feeling unheard.
• To experience profound inner lonelinessAlthough he may not always be aware of it, because he does not feel that his emotions are understood by himself or others.

Studies on alexithymia and romantic relationships have found that high levels of this trait are associated with more loneliness, less intimate communication, and worse marital qualityFurthermore, a connection has been observed between alexithymia and sexual difficultiessuch as problems with arousal or erection, which are sometimes explained by a lack of emotional connection or by confusion between physical and affective sensations.

Alexithymia, sexuality and couple intimacy

In the sexual sphere, alexithymia can lead to:

• Difficulty expressing desire or to share fantasies and preferences, which impoverishes the erotic life of the couple.
• Confusion between sex and affectionSome people seek sexual relations to calm anxiety or emptiness without being fully aware of what they are trying to compensate for.
• Sexual response problems, such as lack of arousal, erectile dysfunction or anorgasmia, associated with emotional disconnection and unprocessed psychological tension.

Addressing these difficulties often requires collaborative work between sex therapy and emotional interventionhelping the person understand what they feel and how it relates to their way of experiencing intimacy.

Alexithymia in daily life: functional impact

Beyond theory, living with alexithymia means moving through the world with a poorly tuned emotional radarThis is noticeable in various everyday areas.

In social terms, the following may appear:

• Difficulties making and keeping friendsbecause the interaction remains focused on superficial or practical matters.
• Frequent misunderstandings: comments perceived as cold, responses that do not fit the emotional climate of the moment, lack of comfort when the other person needs it.
• Dependence on external standards to know "what to do" in each situation, since they cannot be guided by intuition or their own feelings.

Internally, a person may have:

• Feeling of emptiness or disconnectioneven though I don't always know how to label it.
• Accumulated tension which erupts in seemingly exaggerated reactions of anger, fear, or crying.
• Somatizations: pains, discomforts and physical symptoms that ultimately have a significant emotional component.

At work, alexithymia can have two sides: on the one hand, rational and pragmatic style It can be highly valued in certain positions; on the other hand, when the role requires leadership, team management, or close interpersonal skillsEmotional difficulties can generate conflicts or limit professional development.

Alexithymia assessment and test

The diagnosis of alexithymia is made by a mental health professional (clinical psychologist, health psychologist or psychiatrist) based on a detailed clinical evaluation, which includes interviews, personal history and, in many cases, psychometric tests.

The most used tools are:

• Toronto Alexithymia Scale (TAS-20): a 20-item self-report questionnaire that measures three major dimensions: difficulty identifying feelings, problems describing them, and a thinking style oriented outward rather than inward.
• Toronto Structured Interview for Alexithymia (TSIA): semi-structured clinical interview with 24 questions that delves deeper into the same dimensions as before and incorporates the imaginative componentThat is, the ability to fantasize and visualize.
• Online Alexithymia Questionnaire (OAQ-G2): a 37-item test that can be administered over the Internet, used primarily in research and initial screening.

In some cases, especially when a neurological origin is suspected, it may be necessary to resort to neuroimaging tests (such as magnetic resonance imaging) to study the structure and function of brain areas involved in emotion, such as the insula.

It is important to remember that, since it is not an independently recognized disorder in the DSM-5, alexithymia is conceptualized as a feature or dimensionThat is why self-report questionnaires are valued as much as clinical observation of communication style, relationships, introspection ability, and the management of one's own discomfort.

How is alexithymia treated?

People with alexithymia do not usually come to therapy saying “I have problems with my emotions”The most common reason they ask is... relationship crisis, unexplained physical symptoms, anxiety, depression, work problems, or a feeling of emptinessIt is during the evaluation that the professional detects the alexithymic pattern.

Therapeutic work is aimed at gradually developing a greater emotional awareness, affective vocabulary, and regulation capacitySome common lines of intervention are:

• Emotional psychoeducation: explain what emotions are, what they are for, how they are felt in the body, how they differ from each other and why there are no "good" and "bad" emotions, but rather more or less pleasant ones.
• Expansion of emotional vocabulary: work with lists of words, examples, movie scenes or everyday situations to refine the label (anger is not the same as frustration or rage).
• Mindset training (Mentalization-based therapy, MBT): helping the person think about their own internal states and those of others, connecting behaviors with thoughts and emotions.
• Cognitive behavioral therapy: Identify rigid beliefs about emotions (“feeling is weakness”, “if I cry I lose control”) and replace them with more flexible and functional ways of thinking.
• Experiential and expressive therapies: use of play, drawing, music, writing or therapeutic theater to give vent to emotional content that is initially difficult to verbalize.
• Bodywork and physiological awareness: learn to register signals such as changes in heart rate, breathing or muscle tension and link them to possible emotions (differentiate fear, enthusiasm, anger...).

In many cases it is also key confront concomitant disorders (depression, anxiety, addictions, personality disorders…) and work on the life history, especially if there has been trauma or early insecure attachments.

Alexithymia in children and emotional development

In early childhood, all children show, in some way, a certain degree of “natural alexithymia”They feel a lot, but they don't yet have the words or resources to explain what's happening to them. It's through their relationship with their caregivers that they learn to name and give meaning to their emotions.

Therefore, parenting style is fundamental. A marked emotional difficulty is more likely to persist when:

• The child's feelings are not validated ("don't cry over silly things", "that's not scary").
• There is no room to express anger, sadness, or fear without being punished or ridiculed.
• Adults systematically hide their own emotions and do not model how to manage them.

Resources used in interventions with children with alexithymic traits include:

• Therapeutic play and symbolic activities (dolls, stories, tales) that allow emotions to be represented indirectly.
• Narrative therapy to help them construct a narrative of their internal experience.
• Emotional intelligence exercises adapted to their age, using face cards, colors, emotional thermometers, etc.
• I work with the family so that they learn to be models of secure attachment, validation, and emotional regulation.

The sooner we intervene, The emotional system is more plastic. And the greater the chances that the child will develop a rich affective language and a good ability to regulate what he feels.

Overall, understanding alexithymia allows us to stop labeling these people as "cold, strange, or unfeeling" and begin to see that there is a real difficulty in reading and expressing their inner worldWith respectful support, emotionally safe spaces, and systematic work on recognizing and expressing emotions, it is possible to build closer relationships, reduce psychosomatic symptoms, and live with a greater sense of inner coherence and well-being.