What is Alexithymia?
Some people struggle when asked to explain or share and their emotions. This is a personality trait known as alexithymia. People with alexithymia can describe their physiological reactions to events, (such as a rapid heartbeat or a queasy stomach), but they are unable to identify any specific emotions. Whether they are happy, sad or angry, their emotional world is almost impossible for them to put into words. Alexithymics are also unable to identify the source of their emotions, or describe moment by moment shifts in their emotional states. It is no surprise that alexithymics struggle in their close relationships, and are uneasy in intimate conversation.
People with alexithymia often tend to avoid intimate relationships, and may be fairly described as intimacy avoidant. However, just because they have difficulty identifying and processing emotions isn’t the same thing as saying that they don’t have them at all.
Alexithymics are consummate stoics. They prefer to avoid emotional topics. Their conversational style tends to be objective and dispassionate. But they still form “attachments,” possessing as all humans do, the fundamental need for community.
However, People with alexithymia are stressed by their intimate bonds on a daily basis. They have a felt sense of just how much trouble marriage can be. Alexithymics perpetually weigh the costs and benefits of intimacy on a private inner balance sheet. They doubt that other people can meet their needs, and because of their emotional processing deficit, they also often fail to meet the needs of others. Alexithymics seem to easily exit “intimate” relationships with little angst or fanfare. Couples therapy is often a last-shot effort, and true to their preference for the concrete, the alexithymic often prefers a science-based couples therapy approach.
Alexithymia is diagnosed by the following traits:
- A difficulty in identifying feelings and distinguishing between feelings. Alexithymics also have difficulty recognizing bodily sensations as emotional arousal.
- Alexithymics typically have great difficulty describing feelings to other people.
- Their capacity for visual imagination is constricted. There is a scarcity of fantasies or vivid imaginings.
- Alexithymics have a stimulus-bound, externally oriented concrete cognitive style.
What Causes Alexithymia?
Alexithymia is a trait that is found in varying degrees across a panorama of psychiatric disorders. A recent study of Vietnam veterans with PTSD revealed that over 40% were alexithymic. Other studies identified Alexithymia in 63% of anorexics, 56% of bulimics, and as many as 50% of those struggling with a major depressive disorder.
Alexithymia also impacts 34% of clients with a panic disorder, as many as half of all alcoholics and drug addicts, and almost 30% of people with social phobia. Alexithymia is also often found in clients with traumatic brain injury.
Alexithymia is quite often a significant indication of a neuro-atypical brain. One study found that over 80% of people who present as high functioning (Asperger’s) on the autism spectrum are to some degree alexithymic. This is such a high correlation that therapists often seek a differential diagnosis with Asperger’s first.
As if that weren’t bad enough, certain illnesses such as fibromyalgia, migraine headache, inflammatory bowel disease, high blood pressure, asthma, and severe allergies have been correlated with bouts of alexithymia. There is a great deal of discussion in couples therapy of the difference between treating state-dependent alexithymia (such as illness) and the trait-based kind found in Asperger’s Syndrome, personality disorders, and Developmental Trauma.
Common Factors in Alexithymia
What is the underlying cause of alexithymia? We don’t know. But from a Couples Therapy perspective, whenever we see Alexithymia, we also see problems with attachment. And what causes problems with attachment? Often it is Adverse Childhood Experiences and, you guessed it, our old friend Developmental Trauma. Attachment styles are a window into the family of origin. The most common attachment style in which you will find in alexithymia is Avoidant. And it is also possible in some cases, that a personality disorder may be evident as well.
In other words, when I read in a Big Big Book a complaint about a partner’s emotional unavailability, I have a number of rocks that I need to turn over to learn exactly what flavor of alexithymia I am dealing with.
How does Developmental Trauma relate to Alexithymia? Psychotherapist Joyce McDougall reminds that all infants are born alexithymic. They are fundamentally unable to describe their emotional experiences. We know from attachment science that caregivers teach emotional expression by interaction with infants. Failure to do so impairs a child’s emotional self-awareness, and their capacity to be intimate with their future partners. As a result, they will fail to develop the capacity to detect, understand or express emotion for themselves or reliably respond to others.
Alexithymics Acting Out
What do alexithymics do with their emotions if they can’t talk about them? They often engage in compulsive maladaptive behaviors such as substance abuse, sex addiction, or have food issues such as anorexia or binge eating. Alexithymics often rage (we prefer to use the word tantrum in couples therapy). This is because of the amygdala, a small walnut-sized organ deep in the brain which handles all the fight, flight, freeze responses.
Their impaired ability to emotionally regulate has health consequences as well. The autonomic nervous system (ANS) and the neuroendocrine system can become constantly stressed leading to chronic inflammation and illness. This acting out is often a presenting problem in couples therapy. But it is usually a symptom, not a cause. As science-based couples therapists, we have to dig deeper.
Alexithymia in Couples Therapy
When your life-partner has alexithymia, you can experience a profound loneliness. Empathy is the bedrock of a happy marriage This lack of intimacy and empathy may lead to low marital satisfaction. Researcher Maxine Aston has described a bookend disorder to alexithymia, which is the consequence of living with an emotionally stunted partner. She coined a name for this affliction; Affective Deprivation Disorder (AfDD).
Aston first applied her idea of Affective Deprivation to spouses with a partner diagnosed with Asperger Syndrome. These neurotypical, otherwise emotionally “normal” spouses displayed profound psychological impacts resulting from their lack of emotional connection.
Aston eventually broadened her population to include the spouses of those with other conditions such as eating disorders, PTSD, various personality disorders, and substance abuse. These afflictions often result in a similarly low level of emotional engagement. From a couples therapy perspective, in many cases, alexithymia is described as the essential presenting problem. Emotional distance is hard on the body as well as the soul. It wears down the immune system, increasing vulnerability to a wide range of illnesses… from colds to cancer.