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While the majority of studies show alexithymia is a stable personality trait<ref>Taylor, G. J., Bagby, R. M., and Parker, D. A. (1997)''Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness'' p.29 Cambridge</ref> there are some studies of specific populations in which it is found to be state-dependent.<ref> Kirsi Honkalampi, Lic. Psych., Jukka Hintikka, M.D., Ph.D., Eila Laukkanen, M.D., Ph.D., Johannes Lehtonen, and Heimo Viinamäki, Alexithymia and Depression, A Prospective Study of Patients With Major Depressive Disorder</ref> Objections to its validity have been raised{{Views needing attribution|date=August 2007}}, in particular that it has been applied to clinical populations without correcting{{Views needing attribution|date=August 2007}} for the prevalence of depression in those populations.<ref> Kirsi Honkalampi, Lic. Psych., Jukka Hintikka, M.D., Ph.D., Eila Laukkanen, M.D., Ph.D., Johannes Lehtonen, and Heimo Viinamäki, Alexithymia and Depression, A Prospective Study of Patients With Major Depressive Disorder</ref> Opinions differ as to whether alexithymia is a stable, or state dependent personality trait. Some studies show it to be stable<ref>Taylor, G. J., Bagby, R. M., and Parker, D. A. (1997)''Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness'' p.29 Cambridge</ref> in others it is found to be state-dependent.<ref> Kirsi Honkalampi, Lic. Psych., Jukka Hintikka, M.D., Ph.D., Eila Laukkanen, M.D., Ph.D., Johannes Lehtonen, and Heimo Viinamäki, Alexithymia and Depression, A Prospective Study of Patients With Major Depressive Disorder</ref>. Objections have been raised in particular that studies have been applied to clinical populations without correcting{{Views needing attribution|date=August 2007}} for the prevalence of depression in those populations.


== Relational issues == == Relational issues ==

Revision as of 13:34, 10 August 2007

Alexithymia (pronounced: /ˌeɪlɛksəˈθaɪmiə/) from the Greek words λεξις and θυμος (literally "without words for emotions") is a term coined by Peter Sifneos in 1973 to describe people who appeared to have deficiencies in understanding, processing, or describing their emotions.


Description

Alexithymia is thought to affect 10% of the overall population and is defined by the following features:

  • (i) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal
  • (ii) difficulty describing feelings to other people
  • (iii) constricted imaginal processes, as evidenced by a paucity of fantasies
  • (iv) a stimulus-bound, externally oriented cognitive style.


The alexithymia construct is strongly, but inversely related to the concepts of psychological mindedness and emotional intelligence and according to M. Bagby and G. Taylor there is strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress.


Typical deficiencies may include problems identifying, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others; difficulty distinguishing between feelings and the bodily sensations of emotional arousal; confusion of physical sensations often associated with emotions; few dreams or fantasies due to restricted imagination; and concrete, realistic, logical thinking, often to the exclusion of emotional responses to problems. Those who have alexithymia also report very logical and realistic dreams, such as going to the store or eating a meal.


Some alexithymic individuals may appear to contradict the above mentioned characteristics because they can experience chronic dysphoria or manifest outbursts of crying or rage. However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings. Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterizes alexithymia.


According to Henry Krystal, individuals suffering from alexithymia think in an operative way and may appear to be superadjusted to reality. In psychotherapy, however, a cognitive disturbance becomes apparent as the patients tends to recount trivial, chronologically ordered actions, reactions, and events of daily life with monotonous detail. In general, these individuals lack imagination, intuition, empathy, and drive-fulfillment fantasy, especially in relation to objects. Instead, they seem oriented toward things and even treat themselves as robots. These problems seriously limit their responsiveness to psychoanalytic psychotherapy; psychosomatic illness or substance abuse is frequently exacerbated should these individuals enter psychotherapy.


A common misconception about alexithymia is that victims of this construct are totally unable to express emotions verbally and that they may even fail to acknowledge that they experience emotions. Even before coining the term, Sifneos (1967) noted patients often mentioned things like anxiety or depression. The distinguishing factor was their inability to elaborate beyond a few limited adjectives used to describe these feelings. The core issue is that alexithymics have poorly differentiated emotions limiting their ability to distinguish and describe them to others. This contributes to the sense of emotional detachment from themselves and difficulty connecting with others that is typical of the alexithymic's experience.


Alexithymia is not classified as a mental disorder in the DSM IV. It is a personality trait that varies in severity from person to person. A person's alexithymia score can be measured with questionnaires, such as the Toronto Alexithymia Scale (TAS-20) or the Bermond-Vorst Alexithymia Questionnaire (BVAQ).


Opinions differ as to whether alexithymia is a stable, or state dependent personality trait. Some studies show it to be stable in others it is found to be state-dependent.. Objections have been raised in particular that studies have been applied to clinical populations without correcting for the prevalence of depression in those populations.

Relational issues

According to Vanheule, Desmet and Meganck (2006) alexithymia creates interpersonal problems because these individuals avoid emotionally close relationships, or that if they do form relationships with others they tend to position themselves as either dependent or impersonal, "such that the relationship remains superficial." Furthermore, an inadequate differentiation between self and other by alexithymic individuals has been observed by Blaustein & Tuber (1998) and Taylor et al., (1997)

In a recent study a large group of alexithymic individuals completed the 64-item Inventory of Interpersonal problems (IIP-64) which screens for (a) Domineering/Controlling, indicating difficulties relinquishing control over others; (b) Vindictive/Self-Centered behaviour, which describes problems of hostile dominance and the tendency to fight with others; (c) Cold/Distant behaviour, which refers to low degrees of affection for and connection with others; (d) Socially Inhibited, which assesses the tendency to feel anxious and avoidant in the presence of others; (e) Non-Assertiveness, which measures problems in taking initiative in relation to others and coping with social challenges; (f) Overly Accommodating, which indicates an excess of friendly submissiveness; (g) Self-Sacrificing, which indicates a tendency to affiliate excessively; and (h) Intrusive/Needy, which describes problems with friendly dominance. The authors of this study found that alexithymic individuals "had significantly higher scores on all IIP-64 subscales than did the nonclinical sample." Chaotic interpersonal relations have also been observed by Sifneos

Due to the inherent difficulties identifying and describing emotional states in self and others, alexithymia also negatively effects relationship satisfaction between couples.

Alexithymia in medical and psychiatric illness

Alexithymia is frequently found in co-presence with other disorders, with a representative prevalence of 85% in autistic spectrum disorders, 40% in posttraumatic stress disorder, 63% in anorexia nervosa and 56% in bulimia, 45% in major depressive disorder, 34% in panic disorder, and 50% in substance abusers.

Recent research indicates that alexithymia overlaps with Asperger's syndrome. In a 2004 study Uta Frith reports that not only does this overlap exist, but that at least half of the Asperger syndrome group obtained such extreme scores on the Toronto Alexithymia Scale (TAS-20) that "they would have been classified as severely impaired." People with Asperger's syndrome may also exhibit disturbances in speech and language and social relationships. Fitzgerald & Bellgrove (2006) pointed out that, "Like Alexithymia, Asperger’s syndrome is also characterised by core disturbances in speech and language and social relationships". Hill & Berthoz (2006) agreed with Fitzgerald & Bellgrove (2006) and in response stated that "there is some form of overlap between alexithymia and ASDs". They also pointed to studies that revealed impaired Theory of Mind skill in alexithymia, neuroanatomical evidence pointing to a shared aetiology and similar social skills deficits etc.

In addition, alexithymia involves higher risk of developing certain personality disorders, and is correlated with particular illnesses, such as hypertension, inflammatory bowel disease, functional dyspepsia,, sexual disorders, substance use disorders, and some anxiety disorders. Alexithymia is further linked with psychosomatic disorders such as migraine headaches, lower back pain, irritable bowel syndrome, asthma, nausea, allergy, and fibromyalgia.

An inability to modulate emotions is a possibility in explaining why some alexithymics are prone to discharge tension arising from unpleasant emotional states through impulsive acts or compulsive behaviors such as binge eating, substance abuse, perverse sexual behavior, or the self-starvation of anorexia nervosa. The failure to regulate emotions cognitively might result in prolonged elevations of the autonomic nervous system (ANS) and neuroendocrine systems which can lead to somatic diseases. Alexithymics also show a limited ability to experience positive emotions leading Krystal (1988) and Sifneos (1987) to describe many of these individuals as anhedonic.

Etiology

According to Joyce McDougall all infants are born unable to identify, organize, and speak about their emotional experiences (the word infans is from the latin "not speaking"), and are "by reason of their immaturity inevitably alexithymic". Based on this fact McDougall writes, "Might it not be supposed that the alexithymic part of an adult personality is an extremely arrested and infantile psychic structure?"

It is unclear what causes alexithymia. Some neuropsychological studies indicate that alexithymia may be due to a disturbance to the right hemisphere of the brain, which is largely responsible for processing emotions. Other studies show evidence that there may be an interhemispheric transfer deficit among alexithymics; that is, the emotional information from the right hemisphere is not being properly transferred to the language regions in the left hemisphere, as can be caused by a decreased corpus callosum, often present in psychiatric patients who have suffered severe childhood abuse. In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex. These studies have some shortcomings, however, and the empirical evidence about the causes of alexithymia remain inconclusive (for a review, see ).

Although physiological effects are important to determine, one must remember the first language of an infant is nonverbal facial expressions. The mother's emotional state is important for determining how any child might develop. Neglect or indifference to varying changes in a child's facial expressions without proper feedback can promote an invalidation of the facial expressions manifested by the child. The parents ability to reflect self-awareness to the child is another important factor. If the adult is incapable of recognizing and distinguishing emotional expressions in the child, it can influence the child's capacity to understand emotional expressions. Moreover, if a parent responds with apathy, indifference, or anger to a child's natural range of emotions, the child will learn not to trust their feelings and over time may become conditioned to numb themselves to the experiences of their emotions.

References

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  2. ^ Taylor, Graeme J. (1997). Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. pp. 28–31. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  3. Linden, W., Wen, F., Paulhaus, D. L. (1994) Measuring alexithymia: reliability, validity, and prevalence. In: J. Butcher, C. Spielberger, (Eds.). Advances in Personality Assessment. Hillsdale, NJ: Lawrence Erlbaum Associates.
  4. Taylor, G. J., Bagby, R. M., and Parker, D. A. (1997)Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness p.29 Cambridge
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  15. Krystal, H. (1988) Integration and Self Healing: Affect, Trauma, Alexithymia. The Analytic Press
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  18. Vorst H.C.M.1; Bermond B. 'Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire' Personality and Individual Differences, Volume 30, Number 3, February 2001 , pp. 413-434(22)
  19. Taylor, G. J., Bagby, R. M., and Parker, D. A. (1997)Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness p.29 Cambridge
  20. Kirsi Honkalampi, Lic. Psych., Jukka Hintikka, M.D., Ph.D., Eila Laukkanen, M.D., Ph.D., Johannes Lehtonen, and Heimo Viinamäki, Alexithymia and Depression, A Prospective Study of Patients With Major Depressive Disorder
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  22. Vanheule, S., Desmet, M., and Meganck, R. (2006) 'Alexithymia and Interpersonal Problems' Journal of Clinical Psychology 63: p.110
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  42. Michetti, Paolo Maria (2006). "Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)". International Journal of Impotence Research. 18 (2): 170–174. PMID 16151475. Retrieved 2007-02-02. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
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See also

Further reading

  • Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness by Graeme J. Taylor, R. Michael Bagby, James D. A. Parker (ISBN 0521778506)
  • Integration and Self-Healing: Affect, Trauma, Alexithymia by Henry Krystal (ISBN 0881631809)
  • Theatres of the Mind: Illusion and Truth on the Psychoanalytic Stage by Joyce McDougall (ISBN 0946960658)
  • Alexithymia: A Psychological Analysis Based on Clinical and Healthy Individuals by Modjtaba S. Mortazavi Asl (ISBN 9155449220)
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