Alexithymia Might Be the Reason It's Hard to Label Your Emotions

Alexithymia, also known as, "emotional blindness" refers to a difficulty or an inability to identify, experience, and describe your emotions.

Alexithymia is not listed as a mental health condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, it’s a symptom frequently seen by mental health professionals and is linked to psychiatric conditions like depression and anxiety, adverse childhood experiences, and physical conditions like traumatic brain injuries and Parkinson’s disease.

Being unable to perceive one's emotions can have a profound impact on mental health, behavior, and relationships. The condition, by some estimates, affects about 10% of the population.

Here, we’ll take a closer look at alexithymia, including causes, impacts, treatments, coping, and how to support someone who has alexithymia.

So, What Exactly Causes Alexithymia?

Experts aren’t sure what causes alexithymia. There may be genetic, neurological, and developmental contributions. It affects both genders equally, and is often thought of as a personality trait more than anything else. Still, it’s more likely to affect people with mental health conditions, including:

• Anxiety disorders
• Depressive disorders
• Eating disorders
• Substance use disorders
• Obsessive-compulsive disorder

Alexithymia is also linked to certain behavioral, neurological, and medical conditions such as autism spectrum disorder, traumatic brain injuries, stroke, epilepsy, Parkinson’s disease, and multiple sclerosis.

Finally, alexithymia is often associated with trauma and adverse childhood experiences. This is something that Cynthia King, Psy.D., clinical psychologist and co-founder of FemFwd, sees frequently among her patients, particularly those who are adult survivors of prolonged child abuse and who have developed complex PTSD.

“When abuse begins in childhood and is prolonged, it does not serve the child to be able to identify, label, and express feelings,” she explains. As such, shutting down and detaching from feelings becomes a survival mechanism. “Over time, these children become adults who have no idea what they are feeling,” Dr. King explains.

These Are the Ways in Which Alexithymia Affects People

Living with alexithymia can have significant impacts on your day to day life and relationships. Here’s what that may look like.

Psychological Impacts

Experiencing alexithymia can lead to high levels of psychological distress. It can also make it difficult for you to interact with your environment, explains Brett Marroquin, PhD, clinical psychologist in private practice at Solid Ground CBT and associate professor of psychological science at Loyola Marymount University.

“Emotions tell us whether events or situations are safe or dangerous, urgent or non-urgent, relevant or irrelevant to ourselves, and so on,” Dr. Marroquin describes. “People who struggle in discerning their own emotions are less equipped to make interpretations and decisions about themselves and the world because those signals are murkier.”

Additionally, they may have difficulty with emotional regulation, because they have less knowledge about what to regulate, he says.

Relationship Impacts

Interpersonal relationships are one of the areas where alexithymia can have the greatest impact. There are a few reasons why this happens, according to Dr. King:

• People with alexithymia also often have trouble recognizing emotions in others, which makes it difficult to respond to their needs
• They may have persistent difficulty expressing their own needs in a relationship, which means their needs will not be met

Real Life Examples

In people without alexithymia, emotions may be experienced and expressed with clarity or precision, Dr. Marroquin describes. These people may be able to feel disappointed in how they behaved on a previous occasion or may feel embarrassed about how they may have been perceived by others.

On the other hand, someone struggling with alexithymia might have more vague conceptions of emotions, such as “something feels weird,” or “I feel bad,” or may simply feel confused about how they feel, Dr. Marroquin says.

• Example 1: Let's say a couple is in the middle of an argument over finances for the month. Someone with alexithymia might appear to be uninterested in the conversation or seem distant. They may be feeling "off" but may have a hard time pinpointing their real feelings. The person without alexithymia may feel very frustrated and are attempting to convey that frustration to their partner. In this situation, the conflict is unlikely to be resolved in a timely manner. Over time, unresolved conflict can lead to relationship dissatisfaction or a breakup.
• Example 2: Couples often have to make important life decisions, some of which can be emotionally fraught. For example, deciding where to live, whether or not to have children, and what job to take may feel like high-stakes decisions. A person without alexithymia might feel stressed about these decisions and want feedback from their spouse. If the spouse is someone with alexithymia, little feedback will likely be given, and the spouse without alexithymia may feel alone and unheard. When this is a consistent pattern, the relationship may become strained.
• Example 3: People with alexithymia usually have trouble with intimacy. This can be both emotional intimacy and sexual intimacy. For example, a person with alexithymia may not initiate sex, or share personal details about their emotions. This can leave the person without alexithymia feeling undesirable and unloved. They may assume that their spouse doesn’t care about them or is somehow repressing their feelings or hiding something. This can lead to frustration and distrust in the relationship.

Case Study

Dr. King shared a case study of someone she worked with who had complex PTSD and experienced alexithymia as a symptom.

This patient was in her 40s and had experienced severe physical abuse by a parent for all of her childhood. “She spent most of her time at home trying to avoid making her parents agitated in an attempt to avoid abuse,” Dr King says. This patient went to therapy because she was having trouble in romantic relationships; her alexithymia resulted in a lack of intimacy and frequent breakups.

“She was unable to share her feelings with her significant others, though she desperately wanted to,” Dr. King described. “She was highly successful in her career and could not understand why she couldn’t even begin to do something as simple as identify her own feelings.”

How to Cope With Alexithymia

If you are living with alexithymia, it’s important to understand that there are ways to cope and it’s possible that you can get better at identifying and expressing your feelings.

You Can Get Better at Expressing Your Feelings

There’s a common conception that people with alexithymia will always be that way, but that’s not always the case, especially if it has psychological causes, says Dr. Marroquin. “Alexithymia doesn't have to be fixed or static, although it can be in cases like certain psychotic disorders, dementia, neurodevelopmental disorder, or brain injury,” he explains.

• Consider going to therapy: Therapy is usually the best way to address alexithymia. If you have difficulty labeling, describing, or being aware of your emotions, this is something that can be worked on in therapy, after you’ve been assessed, says Dr. Marroquin. “Most approaches to therapy share a focus on emotional awareness and insight, and those skills can definitely be built,” he says.
• Using an emotional wheel can help: One tool that a therapist might use is something called the “emotional wheel,” Dr. Marroquin says. “You can find different versions out there, but essentially it's a visual tool that helps the person move from the most basic label for their emotion (like good) to the next level (like happy) to more nuanced, specific descriptions (like joyful, exuberant, or content),” he explains. “In doing that, you're practicing increasing levels of emotional clarity and labeling.”
  

How to Support Someone With Alexithymia

Seeing a loved one struggle with alexithymia can be challenging and you may not know what to do or how to help. If you are noticing a loved one is struggling with being aware of their emotions or expressing them, Dr. King offered some tips for support:

• Show compassion: Have compassion for how and why alexithymia developed in your loved one, whether it’s from a medical condition or as a result of a psychological condition
• Learn more about their life experiences: Try to understand what caused this condition; this may include discussing your loved one’s background and experiences, doing some reading or research, or having conversations with medical and mental health professionals
• Give your loved one some breathing room: Give your loved one space in times when they are trying to figure out what they are feeling

If you want to support them in better understanding their emotions, do this only after you and they have come up with an agreed-upon system that feels supportive for everyone involved.