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We probably all know people who seem out of touch with their emotions. We may suspect that they are distressed, but typically they say that they feel fine emotionally.

I’m not talking about people with social anxiety issues or stoicism who hold back their feelings and simply need to learn to express them. I’m referring to those who truly don’t know what they’re feeling. Or, if they do, they have great difficulty putting those feelings into words. The lightning bolt of major depression could strike them, but they would be clueless to articulate how they felt. In fact, they may be more likely to seek medical care for somatic symptoms if clinically depressed.

It’s called alexithymia. It’s not really a diagnosis; it’s considered a personality trait and affects approximately 10% of the population. Many with it have comorbid psychiatric issues such as autism, eating disorders, substance abuse, depression, panic disorder, or posttraumatic stress disorder.

To paraphrase Graeme Taylor, M.D., those with alexithymia have trouble determining what they are feeling emotionally and putting into words any emotions they may be able to feel. They also struggle to understand other people’s emotions. They often confuse their own physical sensations with their own emotions. They have little fantasy life and tend to see the world in a very logical, matter-of-fact manner devoid of emotion. They may approach the world as though it is comprised of objects instead of people who have emotions.

Because patients with alexithymia may seek medical attention for unexplained physical symptoms due to emotional or psychiatric issues, nurses, physicians, and other providers could benefit from being aware of this phenomenon. If primary care providers suspect alexithymia, then after non-psychiatric causes of a patient’s symptoms have reasonably been ruled out, consideration should be given to psychiatric or psychological referral for further evaluation.

From Alexithymia Depot:

More often the individual will misread the physical expression of emotion as a physical expression of diseases, i.e. where the tears on the cheek become not sadness but a defective tear duct; the racing heart of passion, a faulty valve; or an anxious tightening in the stomach, appendicitis. Alternatively, emotional states may be blamed on adverse environmental influences such as a change in the barometer, poisons in the air, or an uncomfortable mattress. It is as if there were a missing link allowing imagination to form a picture of the emotional situation for the mind to work with. This then leads to the next point regarding the importance of imagination (and it’s lack) in articulating clear thought, for as Aristotle said- “The mind never thinks without a picture”.

Since alexithymia is a personality trait, there is no cure for it, but psychotherapy can be helpful in improving the condition in some patients. If patients have alexithymia, it’s important to remember that the physical symptoms are real to them. They are not feigning them. They just are not psychologically sophisticated enough to realize that their somatic symptoms are manifestations of underlying psychological symptoms.

Another interesting article about alexithymia:
“When a patient has no story to tell: Alexithymia” (Psychiatric Times)

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