Alexithymia

Alexithymia (pronEng|əˌlɛksəˈθaɪmiə) from the Greek words λεξις and θυμος (literally "without words for emotions") is a term coined by Peter Sifneos in 1973Bar-On & Parker (2000), pp. 40–59] Taylor (1997), pp. 28–31] to describe a state of deficiency in understanding, processing, or describing emotions.

Classification

Alexithymia is considered to be 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.cite journal |author=Haviland MG, Warren WL, Riggs ML |title=An observer scale to measure alexithymia |journal=Psychosomatics |volume=41 |issue=5 |pages=385–92 |year=2000 |pmid=11015624 |url=http://psy.psychiatryonline.org/cgi/content/full/41/5/385#R26732 | accessdate=2007-08-10 |doi=10.1176/appi.psy.41.5.385] 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) [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) [http://www.ingentaconnect.com/content/els/01918869/2001/00000030/00000003/art00033 DOI: 10.1016/S0191-8869(00)00033-7] ] or the Observer Alexithymia Scale (OAS).

Alexithymia is defined by:Taylor (1997), p. 29]
# difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal
# difficulty describing feelings to other people
# constricted imaginal processes, as evidenced by a of fantasies
# a stimulus-bound, externally oriented cognitive style.

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. [cite journal |author=Fukunishi I, Berger D, Wogan J, Kuboki T |title=Alexithymic traits as predictors of difficulties with adjustment in an outpatient cohort of expatriates in Tokyo |journal=Psychological reports |volume=85 |issue=1 |pages=67–77 |year=1999 |pmid=10575975 |url = http://www.japanpsychiatrist.com/Abstracts/Expats1.html | accessdate = 2007-08-10 |doi=10.2466/PR0.85.5.67-77] 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 they have with 'describing feelings', but not by a difficulty in 'identifying feelings' in which males and females show similar abilities. [cite journal |author=Salminen JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J |title=Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland |journal=Journal of psychosomatic research |volume=46 |issue=1 |pages=75–82 |year=1999 |pmid=10088984 |doi=10.1016/S0022-3999(98)00053-1] The alexithymia construct is strongly inversely related to the concepts of psychological mindedness [Taylor & Taylor (1997), pp. 77–104] and emotional intelligence [Taylor (1997), p. 38] [Parker JDA, Taylor GJ, Bagby RM (2001). "The Relationship Between Emotional Intelligence and Alexithymia". "Personality and Individual Differences" 30, 107–115] and M. Bagby and G. Taylor state that there is "strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress". [Taylor (1997), p. 37] Other opinions differ and can show evidence that it may be state-dependent.cite journal |author=Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamäki H |title=Alexithymia and depression: a prospective study of patients with major depressive disorder |journal=Psychosomatics |volume=42 |issue=3 |pages=229–34 |year=2001 |pmid=11351111 | url=http://psy.psychiatryonline.org/cgi/content/full/42/3/229 |doi=10.1176/appi.psy.42.3.229]

Bagby and Taylor also suggest that there may be two kinds of alexithymia, 'primary alexithymia' which is an enduring psychological trait which does not alter over time, and 'secondary alexithymia' which is state dependent and disappears after the evoking stressful situation has changed. These two manifestations of alexithymia are otherwise called 'trait' or 'state' alexithymia. [Taylor (1997), p. 37]

Description

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. [cite journal |author=Krystal H |title=Alexithymia and psychotherapy |journal=American journal of psychotherapy |volume=33 |issue=1 |pages=17–31 |year=1979 |pmid=464164] Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterizes alexithymia.

Some alexithymic individuals may appear to contradict the above mentioned characteristics because they can experience chronic dysphoria or manifest outbursts of crying or rage. [ Nemiah "et al" (1970), pp. 432–33] [Krystal (1988), p. 246; McDougall (1985), pp. 169–70] [Taylor (1997), pp. 29, 246–47] However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings.

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. [Krystal (1988) pp. 246-247] [Nemiah CJ (1978). Alexithymia and Psychosomatic Illness, "Journal of Continuing Education", 39, 25-37] 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.Taylor (1997), pp. 248-253]

A common misconception about alexithymia is that affected individuals 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. [Sifneos, PE (1967). Clinical Observations on some patients suffering from a variety of psychosomatic diseases. "Acta Medicina Psychosomatica", 7, 1-10.] 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, making alexithymia negatively associated with life satisfaction even when depression and other confounding factors are controlled for. [Aino K. Mattila, M.D., Outi Poutanen, M.D., Ph.D., Anna-Maija Koivisto, M.Sc., Raimo K.R. Salokangas, M.D., Ph.D., M.A., and Matti Joukamaa, M.D., Ph.D. "Alexithymia and Life Satisfaction in Primary Healthcare Patients". Psychosomatics 48:523-529, December 2007]

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." cite journal |author=Vanheule S, Desmet M, Meganck R, Bogaerts S |title=Alexithymia and interpersonal problems |journal=Journal of clinical psychology |volume=63 |issue=1 |pages=109–17 |year=2007 |pmid=17016830 |doi=10.1002/jclp.20324] Inadequate "differentiation" between self and other by alexithymic individuals has been observed by Blaustein & Tuber (1998) and Taylor "et al" (1997). [Blaustein JP, Tuber S B (1998). Knowing the Unspeakeable. Bulletin of the Menninger Clinic, 62, 351–365; and Taylor (1997) pp.26-46]

In a study, a large group of alexithymic individuals completed the 64-item Inventory of Interpersonal problems (IIP-64) which found that "two interpersonal problems are significantly and stably related to alexithymia: cold/distant and non-assertive social functioning. All other IIP-64 subscales were not significantly related to alexithymia,"

In medical and psychiatric illness

Research indicates that alexithymia overlaps with Asperger syndrome. In a 2004 study, Uta Frith reported an overlap and that at least half of the Asperger syndrome group obtained scores on the Toronto Alexithymia Scale (TAS-20) that would classify them as severely impaired.cite journal |author=Frith U |title=Emanuel Miller lecture: confusions and controversies about Asperger syndrome |journal=Journal of child psychology and psychiatry, and allied disciplines |volume=45 |issue=4 |pages=672–86 |year=2004 |pmid=15056300 |doi=10.1111/j.1469-7610.2004.00262.x The study to which Frith refers is cite journal | author = Hill E, Berthoz S, Frith U |year = 2004 | title = Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives | journal =Journal of Autism and Developmental Disorders | volume = 34 | issue = 2 | pages = 229–235 | doi=10.1023/B:JADD.0000022613.41399.14] Fitzgerald & Bellgrove pointed out that, "Like Alexithymia, Asperger’s syndrome is also characterised by core disturbances in speech and language and social relationships".cite journal |author=Fitzgerald M, Bellgrove MA |title=The overlap between alexithymia and Asperger's syndrome |journal=Journal of autism and developmental disorders |volume=36 |issue=4 |pages=573–6 |year=2006 |pmid=16755385 |doi=10.1007/s10803-006-0096-z| url = http://www.springerlink.com/content/238u61255x78m843/ | accessdate = 2007-04-11] 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.cite journal | author = Hill E, Berthoz S| month = May | year = 2006 | title = 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 = Journal of Autism and Developmental Disorders | volume = 36 | issue = 8 | pages = 1143–1145 | doi=10.1007/s10803-006-0287-7] The exact nature of the overlap is uncertain. Alexithymic traits in AS may be linked to depression or anxiety; the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety.cite journal |author=Tani P, Lindberg N, Joukamaa M, "et al" |title=Asperger syndrome, alexithymia and perception of sleep |journal=Neuropsychobiology |volume=49 |issue=2 |pages=64–70 |year=2004 |pmid=14981336 |doi=10.1159/000076412]

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,Taylor (1997), pp. 190–216] substance abuse, [Taylor (1997), pp. 166–190] 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 French psychoanalyst 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".McDougall (1985), p. 161] 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. [cite journal |author=Jessimer M, Markham R |title=Alexithymia: a right hemisphere dysfunction specific to recognition of certain facial expressions? |journal=Brain and cognition |volume=34 |issue=2 |pages=246–58 |year=1997 |pmid=9220088 |doi=10.1006/brcg.1997.0900] 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. [cite journal |author=Hoppe KD, Bogen JE |title=Alexithymia in twelve commissurotomized patients |journal=Psychotherapy and psychosomatics |volume=28 |issue=1–4 |pages=148–55 |year=1977 |pmid=609675] In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex. [cite journal |author=Lane RD, Ahern GL, Schwartz GE, Kaszniak AW |title=Is alexithymia the emotional equivalent of blindsight? |journal=Biol. Psychiatry |volume=42 |issue=9 |pages=834–44 |year=1997 |pmid=9347133 |doi=10.1016/S0006-3223(97)00050-4] These studies have some shortcomings, however, and the empirical evidence about the causes of alexithymia remain inconclusive. [cite journal |author=Tabibnia G, Zaidel E |title=Alexithymia, interhemispheric transfer, and right hemispheric specialization: a critical review |journal=Psychotherapy and psychosomatics |volume=74 |issue=2 |pages=81–92 |year=2005 |pmid=15741757 |doi=10.1159/000083166] A biochemical etiology is suggested by the cross-relationships with post marijuana use,post ecstasy chronic use, major depression and bipolar depression. [ AJ Giannini. Alexithymia,affective disorders and substance abuse:possible cross relationships. Psychological Reports. 78:1389-1391,1996.] Joyce McDougall objected to the strong focus by clinicians on neurophysiological at the expense of psychological explanations for the genesis and operation of alexithymia, and introduced the alternative term 'disaffectation' to stand for psychogenic alexithymia. [ McDougall (1989), pp. 93, 103] For McDougall, the disaffected individual had at some point "experienced overwhelming emotion that threatened to attack their sense of integrity and identity," to which they applied psychological defenses to pulverize and eject all emotional representations from consciousness. [McDougall (1989), pp. 93–94]

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.

Although environmental, neurological, and genetic factors are each involved, the role of genetic and environmental factors for developing alexithymia is still unclear. [Michael Martini, Jørgensena, Robert Zachariaea, Axel Skyttheb, Kirsten KyvikbGenetic, 'Environmental Factors in Alexithymia: A Population-Based Study of 8,785 Danish Twin Pairs'. Psychotherapy and Psychosomatics 2007;76:369-375 (DOI: 10.1159/000107565)] The results from a large population-based sample of Danish twins suggest that genetic factors have a noticeable and similar impact on all facets of alexithymia. While the results suggested a moderate influence of shared environmental factors, results are in concordance with the general finding that environmental influences on most psychological traits are primarily of the nonshared rather than the shared type. [Michael Martini, Jørgensena, Robert Zachariaea, Axel Skyttheb, Kirsten KyvikbGenetic, 'Environmental Factors in Alexithymia: A Population-Based Study of 8,785 Danish Twin Pairs'. Psychotherapy and Psychosomatics 2007;76:369-375 (DOI: 10.1159/000107565)]

ee also

* Amplification (psychology)
* Disaffectation
* Emotional intelligence
* Psychological mindedness
* Somatosensory Amplification

External links

* [http://search.dmoz.org/cgi-bin/search?search=Alexithymia+questionnaire Online alexithymia questionnaire] at the Open Directory Project

* [http://search.dmoz.org/cgi-bin/search?search=Alexithymia+Depot Alexithymia depot] at the Open Directory Project

References

*
*
* 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.
*
* 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.
*cite book | last = Taylor | first = Graeme J | coauthors =Bagby, R. Michael and Parker, James DA | year = 1997 | title = Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness | location = Cambridge | publisher = Cambridge University Pres | isbn = 052145610X
*^ Taylor GJ & Taylor HS (1997). Alexithymia. In M. McCallum & W.E. Piper (Eds.) "Psychological mindedness: A contemporary understanding". Munich: Lawrence Erlbaum Associates

Notes

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Alexithymia — Alexithymie (Gefühlsblindheit) bedeutet nach John C. Nemiah und Peter E. Sifneos, die den Begriff 1973 maßgeblich prägten die Unfähigkeit, Gefühle hinreichend wahrnehmen und beschreiben zu können. Alexithymie ist ein griechisches Kunstwort,… … Deutsch Wikipedia
alexithymia — /ay lek seuh thuy mee euh/, n. Psychiatry. difficulty in experiencing, expressing, and describing emotional responses. [A 6 + Gk léxi(s) speech (see ALEXIA) + THYMIA] * * * … Universalium
alexithymia — noun A personality trait, characterised by cognitive emotional deficits … Wiktionary
alexithymia — Difficulty in recognizing and describing one s emotions, defining them in terms of somatic sensations or behavioral reactions. [G. a priv. + lexis, word, + thymia, feelings, passion] * * * alex·i·thy·mia ə .leks i thī mē ə n inability to express… … Medical dictionary
alexithymia — n. a lack of ability to communicate one s own emotions and moods. It is common in depression and can cause significant relationship difficulties during the person s illness … The new mediacal dictionary
alexithymia — /ay lek seuh thuy mee euh/, n. Psychiatry. difficulty in experiencing, expressing, and describing emotional responses. [A 6 + Gk léxi(s) speech (see ALEXIA) + THYMIA] … Useful english dictionary
Toronto Alexithymia Scale — Die Toronto Alexithymie Skala (Toronto Alexithymia Scale, TAS) ist ein psychologischer Persönlichkeitstest zur Erfassung der Alexithymie (Unfähigkeit, emotionale Bedürfnisse wahrzunehmen und auszudrücken). Inhaltsverzeichnis 1 Geschichte 2… … Deutsch Wikipedia
Алекситимия (Alexithymia) — трудность психологического понимания собственных эмоций и настроений. Некоторые психиатры убеждены в том, что это один из путей развития у людей психосоматических симптомов. Источник: Медицинский словарь … Медицинские термины
АЛЕКСИТИМИЯ — (alexithymia) трудность психологического понимания собственных эмоций и настроений. Некоторые психиатры убеждены в том, что это один из путей развития у людей психосоматических симптомов … Толковый словарь по медицине
Emotional intelligence — (EI) is a skill or ability in the case of the trait EI model, a self perceived ability to identify, assess, and control the emotions of oneself, of others, and of groups. Various models and definitions have been proposed of which the ability and… … Wikipedia

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