Alexithymia (/əˌlɛksɪˈθaɪmiə/ ə-LEK-sih-THY-mee-ə), also called emotional blindness,[1] is a neuropsychological phenomenon characterized by significant challenges in recognizing, expressing, sourcing,[2] and describing one's emotions.[3][4][5] It is associated with difficulties in attachment and interpersonal relations.[6] While there is no scientific consensus on its classification as a personality trait, medical symptom, or mental disorder,[7][8] alexithymia is highly prevalent among individuals with autism spectrum disorder (ASD), ranging from 50% to 85% of prevalence.[9]
Alexithymia occurs in approximately 10% of the general population and often co-occurs with various mental disorders, particularly with neurodevelopmental disorders.[10] Difficulty in recognizing and discussing emotions may manifest at subclinical levels in men who conform to specific cultural norms of masculinity, such as the belief that sadness is a feminine emotion. This condition, known as normative male alexithymia, can be present in both sexes.[11][12][13][6]
The term alexithymia was introduced by psychotherapists John Case Nemiah and Peter Sifneos in 1973 to describe a particular psychological phenomenon.[14][15][16] Its etymology comes from Ancient Greek. The word is formed by combining the alpha privative prefix ἀ- (a-, meaning 'not') with λέξις (léxis, referring to 'words') and θῡμός (thȳmós, denoting 'disposition,' 'feeling,' or 'rage'). The term can be likened to "dyslexia" in its structure.[17]
In its literal sense, alexithymia signifies "no words for emotions".[16] This label reflects the difficulty experienced by individuals with this condition in recognizing, expressing, and articulating their emotional experiences. Nonmedical terminology, such as "emotionless" and "impassive", has also been employed to describe similar states.[18] Those who exhibit alexithymic traits or characteristics are commonly referred to as alexithymics or alexithymiacs.[19]
Alexithymia is considered to be a personality trait that places affected individuals at risk for other medical and mental disorders, as well as reducing the likelihood that these individuals will respond to conventional treatments to these disorders.[20] The DSM-V and the ICD-11 neither classify alexithymia as a symptom nor as mental disorder.[21] It is a dimensional personality trait that varies in intensity from person-to-person. A person's alexithymia score can be measured with questionnaires such as the Toronto Alexithymia Scale (TAS-20),[4] the Perth Alexithymia Questionnaire (PAQ),[22] the Bermond-Vorst Alexithymia Questionnaire (BVAQ),[23] the Levels of Emotional Awareness Scale (LEAS),[24] the Online Alexithymia Questionnaire (OAQ-G2),[25] the Toronto Structured Interview for Alexithymia (TSIA),[26] or the Observer Alexithymia Scale (OAS).[20] It is distinct from the psychiatric personality disorders, such as antisocial personality disorder.[27]
However, there is no consensus on the definition of alexithymia, with debate between cognitive behavioral and psychoanalytic theorists.[28][29][30]
The cognitive behavioral model (i.e., the attention-appraisal model of alexithymia) defines alexithymia as having three components:[31][32]
The psychoanalytic model defines alexithymia as having four components:[33]
In empirical research, it is often observed that constricted imaginal processes, defined as a lack of spontaneous imagining (daydreaming; compare aphantasia), when measured, do not statistically correlate with the other components of alexithymia.[29][34][35][36][37] Such findings have led to ongoing debate in the field about whether IMP is indeed a component of alexithymia.[28][29][23] For example, in 2017, Preece and colleagues introduced the attention-appraisal model of alexithymia, where they suggested that IMP be removed from the definition and that alexithymia be conceptually composed only of DIF, DDF, and EOT, as each of these three are specific to deficits in emotion processing.[5][29] These core differences in the definition of alexithymia, regarding the inclusion or exclusion of IMP, correspond to differences between psychoanalytic and cognitive-behavioral conceptualizations of alexithymia; whereby psychoanalytic formulations tend to continue to place importance on IMP,[38] whereas the attention-appraisal model (presently the most widely used cognitive-behavioral model of alexithymia)[39] excludes IMP from the construct.[37] In practice, since the constricted imaginal processes items were removed from earlier versions of the TAS-20 in the 1990s,[40] the most used alexithymia assessment tools (and consequently most alexithymia research studies) have only assessed the construct in terms of DIF, DDF, and EOT.[4][22] In terms of the relevance of alexithymic deficits for the processing of negative (e.g., sadness) or positive (e.g., happiness) emotions, the PAQ is presently the only alexithymia measure that enables valence-specific assessments of alexithymia across both negative and positive emotions;[41] recent work with the PAQ has highlighted that alexithymic deficits in emotion processing do often extend across both negative and positive emotions, although people typically report more difficulties for negative emotions.[41][42] Such findings of valence-specific effects in alexithymia are also supported by brain imaging studies.[43]
Studies (using measures of alexithymia assessing DIF, DDF, and EOT) have reported that the prevalence rate of high alexithymia is less than 10% of the population.[44] A less common finding suggests that there may be a higher prevalence of alexithymia amongst males than females, which may be accounted for by difficulties some males have with "describing feelings", but not by difficulties in "identifying feelings", in which males and females show similar abilities.[45] Work with the PAQ has suggested that the alexithymia construct manifests similarly across different cultural groups, and those of different ages (i.e., has the same structure and components).[46][41]