Sometimes I work with children and adults who can’t put words to their feelings and thoughts. It’s not that they don’t want to – it’s more that they don’t know how.

The clinical term for this experience is alexithymia and is defined as the inability to recognize emotions and their subtleties and textures [1]. Alexithymia throws a monkey wrench into a person’s ability to know their own self-experience or understand the intricacies of what others feel and think. Here are a few examples those with alexithymia experience:

  • Difficulty identifying different types of feelings
  • Limited understanding of what causes feelings
  • Difficulty expressing feelings
  • Difficulty recognizing facial cues in others
  • Limited or rigid imagination
  • Constricted style of thinking
  • Hypersensitive to physical sensations
  • Detached or tentative connection to others

History of Alexithymia
Alexithymia was first mentioned as a psychological construct in 1976 and was viewed as a deficit in emotional awareness [2]. Research suggests that approximately 8% of males and 2% of females experience alexithymia, and that it can come in mild, moderate and severe intensities [3]. Studies also show that alexithymia has two dimensions – a cognitive dimension, where a child or adult struggles to identify, interpret and verbalize feelings (the “thinking” part of our emotional experience). And an affective dimension, where difficulties arise in reacting, expressing, feeling and imagining (the “experiencing” part of our emotional experience) [4].

Alexithymia has long been associated to a range of psychological disorders, from autism, depression, schizophrenia, and somatoform disorders, just to name a few [5]. It’s very challenging for those who struggle with alexithymia to cope with co-existing psychological disorders because their innate vulnerability to understanding themselves and others complicates recovery.

Courtesy of Deborah Serani

Treatments for Alexithymia
If you love a child or adult with alexithymia, realize that the missed cues, flat reactions or lack of emotional recognition have real neurobiological and psychological origins. Don’t punish, shame or mock their emotional unresponsiveness. Instead, practice patience. Consider explaining your needs in briefer terms, “I’m feeling tired, I don’t want to cook. Let’s get take-out for dinner.” Or helping them label emotions, “You look angry. Is something bothering you?” Help raise their awareness of triggers or stressors that are bubbling to the surface, “You have your SAT’s soon, are you feeling anxious?” Realizing that your loved one may not speak, hear or sense the same emotional language as you can help when conflicts or misunderstandings take place.

If you live with alexithymia, the goal is to strengthen your ability to identify and understand feelings. Teaching yourself about the subjective experiences of others will be important too. Keep in mind that stretching and learning emotional awareness can be a very challenging journey. Here are some ways to broaden your skills:

Journaling: Studies show that expressive writing can be helpful in stretching one’s ability to detect emotions [6]. Generally, it’s recommended to write everyday in a journal, going beyond listing the events of the day. In the beginning this will be hard for those who have thymia. But the goal is to broaden the range of your observations within and outside of yourself.

Reading Novels: The language of describing thoughts, feelings, moments and experiences is literally found in novels. Studies suggest this is a great way to learn expressive language, develop the muscle of receptive language and gain mastery in how to describe a story or personal narrative [7].

The Expressive Arts: Taking a more formal approach with an acting, dance, art, music or movement therapy class has been shown to help those with alexithymia recognize and externalize feelings [8]. Try signing up for courses offered in adult and child education in your town, community programs or college workshops. Consider private sessions with a licensed creative arts or dance movement therapist.

Skill-Based Psychotherapy Treatments: This is a short form of psychotherapy that aims to teach through skill building. Treatments like Dialectical Behavior Therapy, Cognitive Mindfulness Training and Short Term Interpersonal Therapy will teach you how to be more attentive to personal feeling states and how to identify emotions in others [9].

Group Psychotherapy: The interactive aspect of group therapy can offer children and adults ways to explore their own thoughts and feelings as well as experience meaningful exchanges with others. This mode of psychotherapy also deepens a sense of connectedness with others [10].

Hypnosis and Relaxation Training: While most psychotherapies utilize talking as a way to reduce alexithymic symptoms, hypnosis and relaxation training look towards guided imagery and mentalizations to help enhance emotional understanding [11]. Seek out relaxation training workshops in your community, and always work with a licensed hypnotist when using hypnosis treatment for alexithymia.

Alexithymia is a trait that makes it hard to find words for thoughts and feelings. It is experienced by both children and adults and can come in mild, moderate and severe forms. When identified, alexithymia can be treated – with the goal of making feelings and their textures easier to navigate.

[1] Bermond, B. et. al. (2007). A cognitive and an affective dimension of alexithymia in six languages and seven populations. Cognition and Emotion, 21: 1125-1136.

[2] Nemiah, J.C. ; Freyberger, H. & Sifneos, P.E. (1976). Alexithymia: A view of the psychosomatic process. In: Hill OW, editor. Modern trends in psychosomatic research, Vol. 3. Buttersworth; London: 1976. pp. 430-439.

[3] Blanchard, E.B ; Arena, J.G. & Pallmeyer, T.P. (1981). Psychosomatic properties of a scale to measure alexithymia. Psychotherapy and Psychosomatics, 35, 64-71.

[4] Bermond, B. et. al. (2007). A cognitive and an affective dimension of alexithymia in six languages and seven populations. Cognition and Emotion, 21: 1125-1136.

[5] Samur, D. et. al. (2013). Four decades on research on alexithymia. Moving towards clinical implications. Frontiers in Psychology, 19.

[6] Paez, D.; Velasco, C. & Gonzalez J.L. (1999). Expressive writing and the role of alexithymia as a dispositional deficit in self-disclosure and psychological health. Journal of Personality & Social Psychology, 77:630-641.

[7] Kidd, D. C. & Castano, E. (2013). Reading literary fiction improves theory of mind. Science, 342, 377-380.

[8] Levy, F. (1995). Dance and other expressive therapies. When words are not enough. New York: Routledge.

[9] Kennedy, M. & Franklin, J. (2002). Skill based treatment for alexithymia: An exploratory case series. Behavior Change, 19(3):158-171.

[10] Beresnevaite, M.(2000). Exploring the benefits of group psychotherapy in reducing alexithymia in coronary heart disease patients: A preliminary study. Psychotherapy & Psychosomatics, 69:117-122.

[11] Gay, M.C.; Hanin, D. & Luminet, O.(2008). Hypnotic imagery intervention in reducing alexithymia. Contemporary Hypnosis, 25: 1-13.