Alexithymia or emotional illiteracy

Published: 20-10-2020

The term “alexithymia” was introduced in the 1970s by Sifneos and Nemiah, who noticed that patients with psychosomatic diseases often have problems with talking about their emotions, focus on details, have poor imagination and a rigid body posture. The term comes from the Greek words a – lack, lexis – the word, thymos – emotions, so in the literal sense it means the inability to talk about emotions. This trait is also sometimes referred to as “emotional illiteracy.”

Currently, alexithymia is most often described as difficulties in identifying one’s feelings and distinguishing between emotions and physiological arousal (e.g. increased heartbeat under stress, an alexithymic may consider a symptom of heart disease), difficulties in describing one’s feelings and an operational style of thinking (describing an event, people with alexithymia do not tell what they felt, but focus on the specifics and details of the situation).

Bermond distinguishes two types of alexithymia:

Type I alexithymia (affective) – people with this type of alexithymia do not experience emotions or their emotional reactions are weakened. A study by Bermond et al. in which the sympathetic nervous system was measured (by measuring the electrical response of the skin) while subjects viewed neutral and stimulating pictures showed that pictures that trigger an anxiety response in others, in people with type I alexithymia, hardly cause any reaction.
Type II alexithymia (cognitive) – people with this type of alexithymia feel emotions, but have cognitive deficits that prevent them from analyzing and understanding these emotions. Psychosomatic illnesses may be frequent in such people.

Alexithymia is not included in the classifications of mental disorders, it is a trait that has a normal distribution. It means that every human being is worse or better able to understand and describe his emotions, and everyone is characterized by a certain intensity of operational style of thinking. Most people find these features of moderate severity. Only an extremely low ability to understand and describe one’s emotions and an extremely intensified operational style of thinking are called alexithymia. It is more common in men than in women.

Alexithymia and emotional intelligence

The term “emotional intelligence” is more commonly known among the society, although it was created later than the term “alexithymia” (at the turn of the 1980s and 1990s). People with high emotional intelligence have great ability to understand their emotions and the emotions of others. In addition, they are good at dealing with stress, can control their impulses, are assertive, independent and have high social skills. The definition of alexithymia only talks about understanding one’s emotions, but research indicates that people with alexithymia are also less able to recognize other people’s emotions based on their facial expressions and are less empathetic. Thus, it can be seen that alexithymia shares many features with low emotional intelligence, and research does indeed indicate that these features negatively correlate with each other (although alexithymia is a narrower concept than emotional intelligence).

Alexithymia and a brain

Type II alexithymia may result from a dysfunction of the corpus callosum. It is the structure that connects both hemispheres of the brain. The right hemisphere is more involved than the left one in the interpretation of emotional reactions and unconscious information processing, while the left hemisphere is more responsible for speech and conscious information processing. The cognitive component of emotions, i.e. information enabling the understanding of emotions, travels from the right to the left hemisphere through the corpus callosum, while the affective component first reaches the limbic system and from there, through the anterior commissure, information is sent to the left hemisphere. The blockage of the functions of the corpus callosum can therefore lead to a situation in which a person experiences emotions (the limbic system and the right hemisphere are functioning properly), but is not able to consciously process these feelings and understand and describe why they feel what they feel.

Type I alexithymia, in which not only the understanding of emotions is disturbed, but also the emotional reactions themselves are weakened, may result from the dysfunction of the right hemisphere of the brain, which disturbs the perception of emotions. Other hypotheses concern disturbances in the functioning of the frontal cortex, namely the orbitofrontal cortex (OFC) and the anterior cingulate gyrus (ACC). These structures play an important role in emotional functioning, and their removal leads, inter alia, to diminish emotional responses.

Alexithymia in somatic diseases and mental disorders

People with type II alexithymia are unable to cope with stress and other negative emotions, which may result in the development of psychosomatic diseases (e.g. irritable bowel syndrome, cardiovascular diseases), but also in other diseases and disorders, alexithymia is common.

People with alexithymia often have hypersensitivity and lower tolerance to unpleasant stimuli coming from the body. Alexithymics also tend to explain their symptoms for somatic rather than mental causes, which may result in the development of hypochondria (health anxiety) if the patient cannot be convinced that their symptoms are, for example, the result of stress and not a serious illness. Misinterpretation of body sensations can also lead to the development and treatment difficulties of panic disorder. A person with alexithymia can, for example, interpret the acceleration of the heartbeat caused by stress as a symptom of a heart attack, which will cause him even more stress and even faster heartbeat, and as a result, a panic reaction (I wrote more about panic disorder in the article on agoraphobia).

Alexithymia also occurs in about 37% of patients with depression (55% of men and 29% of women) and its presence is associated with a greater severity of depressive symptoms, a greater risk of suicide and a lower effectiveness of pharmacological treatment. Psychotherapy is also more difficult in such patients due to their task-oriented thinking, inability to identify and talk about their emotions and difficulties in searching for the causes of experienced symptoms of depression. However, it is uncertain what the cause and effect relationship is between depression and alexithymia. Alexithymia may increase the risk of developing depression, but it may also be secondary to depression.

Other disorders associated with alexithymia include eating disorders. Alexithymic features are observed in 23-77% of patients with anorexia and 51-83% of patients with bulimia. Patients with anorexia have difficulties in describing their feelings, while people with bulimia have more difficulties in identifying their emotions. People with obesity also have frequent problems with insight into their own emotions and talking about their feelings.

Another disorder that often coexists with alexithymia is post-traumatic stress disorder (PTSD). Features of alexithymia are observed in 60-85% of patients with PTSD, however, it is not known whether the alexithymia is a cause or a consequence. Type II alexithymia, which makes it difficult to deal with emotions, may be a factor influencing the development of PTSD after a traumatic event, but on the other hand, emotional anesthesia is common in PTSD patients, which can be considered as type I alexithymia in response to trauma.

Many alexithymics (50-78%) can also be found among alcohol addicts, but as in the case of other disorders, the direction of this relationship is not known here either. People with type II alexithymia, who are unable to determine why they feel tension, may use alcohol, which will allow them to reduce this tension. Research shows that people with alexithymia and childhood alcohol abusers lacked warm relationships and their parents were overly controlling. Moreover, the avoiding attachment style and the lack of warm relations with the father in childhood correlate with a greater intensity of alexithymic features in people addicted to alcohol. This indicates that alexithymia may be one of the causes of the development of alcoholism, but it cannot be ruled out that it is a consequence. Alexithymia decreases in people addicted to alcohol after 3-4 weeks of therapy. It can therefore be an adaptive reaction that allows you to protect yourself from unpleasant emotions related to the loss of good relationships with loved ones, work, or other effects of alcoholism. It can also be seen that the areas of the brain that are damaged by alcohol (the right hemisphere and the prefrontal cortex) overlap with the areas of the brain likely responsible for type I alexithymia.

Despite 40 years of research, alexithymia is still not well understood. In my opinion, Bermond did a lot to understand alexithymia by dividing it into two types, but in many publications, alexithymics are still treated as a uniform group, which may make it difficult to understand their features.

References:

Bermond B., Bierman D.J., Cladder M.A., Moormann P.P., Vorst H.C. (2010). The cognitive and affective alexithymia dimensions in the regulation of sympathetic responses. International Journal of Psychophysiology, 75, 227-233. (pdf at researchgate.net)
Januszko P., Kopera M., Żuk-Januszko D., Radziwoń-Zaleska M., Wojnar M. (2009). Aleksytymia a problemy związane z używaniem alkoholu. Alkoholizm i Narkomania, 22(4), 399-413. (pdf at ipin.edu.pl)
Larsen J.K., Brand N., Bermomd B., Hijman R. (2003). Cognitive and emotional characteristics of alexithymia. A review of neurobiological studies. Journal of Psychosomatic Research, 54, 533-541. (pdf at researchgate.net)
Parker J.D., Taylor G.J., Bagby R.M. (2001). The relationship between emotional intelligence and alexithymia. Personality and Individual Differences, 30, 107-115. (pdf at researchgate.net)
Płońska D., Czernikiewicz A. (2006). Aleksytymia — ciągle wiele pytań. Część I. Definiowanie aleksytymii. Psychiatria 3(1), 1-7. (download from viamedica.pl)
Płońska D., Hnat L., Grzesiewska J., Czernikiewicz A. (2006). Aleksytymia — ciągle wiele pytań. Część II. Aleksytymia w wybranych zaburzeniach psychicznych i somatycznych. Psychiatria 3(1), 8-14. (download from viamedica.pl)