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Alexithymia

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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.

Classification

Alexithymia describes "people who have difficulties recognizing, processing, and regulating emotions". It is a personality trait that places individuals at risk for other medical and psychiatric disorders while reducing the likelihood that these individuals will respond to conventional treatments for the other conditions. 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), the Bermond-Vorst Alexithymia Questionnaire (BVAQ) or the Observer Alexithymia Scale (OAS).

In studies of the general population the degree of alexithymia was found to be influenced by age, but not by gender; the rates of alexithymia in healthy controls have been found at 8.3% (2 of 24 persons) 4.7% (2 of 43), 8.9% (16 of 179), and 7% (4 of 56). Thus, several studies have reported that the prevalence rate of alexithymia is less than 10% in healthy controls.

In another study, alexithymia was found to be approximately 13% of the population, with men (17%) almost twice as likely to be affected as women (10%). Specifically, men scored higher in difficulty describing feelings and for externally oriented thinking, but there was no gender difference whatsoever in difficulty in identifying feelings. The alexithymia construct is strongly inversely related to the concept of emotional intelligence . Other opinions differ and can show evidence that it may be state-dependent.


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. 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.

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 such as "happy" or "unhappy" when describing these feelings. The core issue is that alexithymics have poorly differentiated emotions limiting their ability to distinguish and describe them to others.

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." Inadequate differentiation between self and other by alexithymic individuals has been observed by Blaustein & Tuber (1998) and Taylor et al (1997).

In a 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 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.

In medical and psychiatric illness

Alexithymia frequently co-occurs 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.

Research indicates that alexithymia overlaps with Asperger 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." Fitzgerald & Bellgrove pointed out that, "Like Alexithymia, Asperger’s syndrome is also characterised by core disturbances in speech and language and social relationships". Hill & Berthoz 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.

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.

Etiology

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.


Although physiological effects are important to determine, 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 parent's 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.

See also

References

  • Bar-On, Reuven (2000). The Handbook of Emotional Intelligence: Theory, Development, Assessment, and Application at Home, School, and in the Workplace. San Francisco, California: Jossey-Bass. ISBN 0787949841. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  • Krystal, H (1988). Integration and Self Healing: Affect, Trauma, Alexithymia. Hillsdale, NJ: The Analytic Press. ISBN 0881630705.
  • Linden W, Wen F, Paulhaus DL (1994). Measuring alexithymia: reliability, validity, and prevalence. In: J. Butcher, C. Spielberger (Eds.). Advances in Personality Assessment. Hillsdale, NJ: Lawrence Erlbaum Associates.
  • McDougall, J (1989). Theaters of the Body: A Psychoanalytic Approach to Psychosomatic Illness, Norton.
  • McDougall, J (1985). Theatres of the Mind: Truth and Illusion on the Psychoanalytic Stage. New York: Basic Books.
  • Nemiah CJ, Freyberger H, Sifneos PE, "Alexithymia: A View of the Psychosomatic Process" in O.W. Hill (1970) (ed), Modern Trends in Psychosomatic Medicine, Vol 2.
  • Taylor, Graeme J (1997). Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge: Cambridge University Pres. ISBN 052145610X. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  • ^ Taylor GJ & Taylor HS (1997). Alexithymia. In M. McCallum & W.E. Piper (Eds.) Psychological mindedness: A contemporary understanding. Munich: Lawrence Erlbaum Associates

Notes

  1. ^ Bar-On & Parker (2000), pp. 40–59
  2. Taylor (1997), pp. 28–31
  3. ^ Haviland MG, Warren WL, Riggs ML (2000). "An observer scale to measure alexithymia". Psychosomatics. 41 (5): 385–92. PMID 11015624. Retrieved 2007-08-10.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. Vorst HCM, Bermond B (February 2001). "Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire". Personality and Individual Differences, Volume 30, Number 3, pp. 413–434(22) DOI: 10.1016/S0191-8869(00)00033-7
  5. Fukunishi I, Berger D, Wogan J, Kuboki T (1999). "Alexithymic traits as predictors of difficulties with adjustment in an outpatient cohort of expatriates in Tokyo". Psychological reports. 85 (1): 67–77. PMID 10575975. Retrieved 2007-08-10.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. Salminen JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J (1999). "Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland". Journal of psychosomatic research. 46 (1): 75–82. PMID 10088984.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. Parker JDA, Taylor GJ, Bagby RM (2001). "The Relationship Between Emotional Intelligence and Alexithymia". Personality and Individual Differences 30, 107–115
  8. ^ Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamäki H (2001). "Alexithymia and depression: a prospective study of patients with major depressive disorder". Psychosomatics. 42 (3): 229–34. PMID 11351111.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. Krystal H (1979). "Alexithymia and psychotherapy". American journal of psychotherapy. 33 (1): 17–31. PMID 464164.
  10. Nemiah CJ (1978). Alexithymia and Psychosomatic Illness, Journal of Continuing Education, 39, 25-37
  11. Sifneos, PE (1967). Clinical Observations on some patients suffering from a variety of psychosomatic diseases. Acta Medicina Psychosomatica, 7, 1-10.
  12. ^ Vanheule S, Desmet M, Meganck R, Bogaerts S (2007). "Alexithymia and interpersonal problems". Journal of clinical psychology. 63 (1): 109–17. doi:10.1002/jclp.20324. PMID 17016830.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. Blaustein JP, Tuber S B (1998). Knowing the Unspeakeable. Bulletin of the Menninger Clinic, 62, 351–365
  14. Taylor (1997), pp.26-46
  15. Sifneos PE (1996). "Alexithymia: past and present". The American journal of psychiatry. 153 (7 Suppl): 137–42. PMID 8659637.
  16. Yelsma P, Marrow S (2003). "An Examination of Couples' Difficulties With Emotional Expressiveness and Their Marital Satisfaction". Journal of Family Communication. 3 (1): 41–62. doi:10.1207/S15327698JFC0301_03.
  17. Hill E, Berthoz S, Frith U (2004). "Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives". Journal of Autism and Developmental Disorders. 34 (2): 229–235. doi:10.1023/B:JADD.0000022613.41399.14.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. Shipko S, Alvarez WA, Noviello N (1983). "Towards a teleological model of alexithymia: alexithymia and post-traumatic stress disorder". Psychotherapy and psychosomatics. 39 (2): 122–6. PMID 6878595.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. Cochrane CE, Brewerton TD, Wilson DB, Hodges EL (1993). "Alexithymia in the eating disorders". The International journal of eating disorders. 14 (2): 219–22. PMID 8401555.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. Cox BJ, Swinson RP, Shulman ID, Bourdeau D (1995). "Alexithymia in panic disorder and social phobia". Comprehensive psychiatry. 36 (3): 195–8. PMID 7648842.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. Taylor GJ, Parker JD, Bagby RM (1990). "A preliminary investigation of alexithymia in men with psychoactive substance dependence". The American journal of psychiatry. 147 (9): 1228–30. PMID 2386256.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  22. Frith U (2004). "Emanuel Miller lecture: confusions and controversies about Asperger syndrome". Journal of child psychology and psychiatry, and allied disciplines. 45 (4): 672–86. doi:10.1111/j.1469-7610.2004.00262.x. PMID 15056300. The study to which Frith refers is Hill E, Berthoz S, Frith U (2004). "Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives". Journal of Autism and Developmental Disorders. 34 (2): 229–235. doi:10.1023/B:JADD.0000022613.41399.14.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. Fitzgerald M, Bellgrove MA (2006). "The overlap between alexithymia and Asperger's syndrome". Journal of autism and developmental disorders. 36 (4): 573–6. doi:10.1007/s10803-006-0096-z. PMID 16755385. Retrieved 2007-04-11.
  24. Hill E, Berthoz S (2006). "Response to "Letter to the Editor: The Overlap Between Alexithymia and Asperger's syndrome", Fitzgerald and Bellgrove, Journal of Autism and Developmental Disorders, 36(4)". Journal of Autism and Developmental Disorders. 36 (8): 1143–1145. doi:10.1007/s10803-006-0287-7. {{cite journal}}: Unknown parameter |month= ignored (help)
  25. Schizotypal, dependent and avoidant disorders are particularly indicated: See Taylor (1997), pp. 162–165
  26. Jula A, Salminen JK, Saarijärvi S (1999). "Alexithymia: a facet of essential hypertension". Hypertension. 33 (4): 1057–61. PMID 10205248. Retrieved 2006-12-17.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. Verissimo R, Mota-Cardoso R, Taylor G (1998). "Relationships between alexithymia, emotional control, and quality of life in patients with inflammatory bowel disease". Psychotherapy and psychosomatics. 67 (2): 75–80. PMID 9556198.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  28. Jones MP, Schettler A, Olden K, Crowell MD (2004). "Alexithymia and somatosensory amplification in functional dyspepsia". Psychosomatics. 45 (6): 508–16. doi:10.1176/appi.psy.45.6.508. PMID 15546828. Retrieved 2006-12-17.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. Michetti PM, Rossi R, Bonanno D, Tiesi A, Simonelli C (2006). "Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)". Int. J. Impot. Res. 18 (2): 170–4. doi:10.1038/sj.ijir.3901386. PMID 16151475. Retrieved 2007-02-02.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. Li CS, Sinha R (2006). "Alexithymia and stress-induced brain activation in cocaine-dependent men and women". Journal of psychiatry & neuroscience : JPN. 31 (2): 115–21. PMID 16575427. Retrieved 2006-12-17.
  31. Lumley MA, Downey K, Stettner L, Wehmer F, Pomerleau OF (1994). "Alexithymia and negative affect: relationship to cigarette smoking, nicotine dependence, and smoking cessation". Psychotherapy and psychosomatics. 61 (3–4): 156–62. PMID 8066152.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  32. Jones BA (1984). "Panic attacks with panic masked by alexithymia" (PDF). Psychosomatics. 25 (11): 858–9. PMID 6505131. Retrieved 2006-12-17.
  33. Jessimer M, Markham R (1997). "Alexithymia: a right hemisphere dysfunction specific to recognition of certain facial expressions?". Brain and cognition. 34 (2): 246–58. doi:10.1006/brcg.1997.0900. PMID 9220088.
  34. Hoppe KD, Bogen JE (1977). "Alexithymia in twelve commissurotomized patients". Psychotherapy and psychosomatics. 28 (1–4): 148–55. PMID 609675.
  35. Lane RD, Ahern GL, Schwartz GE, Kaszniak AW (1997). "Is alexithymia the emotional equivalent of blindsight?". Biol. Psychiatry. 42 (9): 834–44. PMID 9347133.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  36. Tabibnia G, Zaidel E (2005). "Alexithymia, interhemispheric transfer, and right hemispheric specialization: a critical review". Psychotherapy and psychosomatics. 74 (2): 81–92. doi:10.1159/000083166. PMID 15741757.
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