Alexithymia (pronounced ey-lek-suh-thahy-mee-uh)
In psychiatry, a range of behaviors associated with
certain conditions which manifests as a difficulty in experiencing, processing,
expressing and describing emotional responses.
1973: The construct was the Ancient Greek a- (not) + λέξις (léxis) (speaking) + θυμός (thumós)
(heart (in the sense of “soul”)) which deconstructs as a- + lexi + -thymia (in a medical context a
suffix meaning “one’s state of mind”), alexithymia thus understood as “without
words for emotions”. Alexithymia is a noun
and alexithymic & alexithymiac are nouns & adjectives; the noun plural of
alexithymia is also alexithymia but alexithymics, the plural of alexithymic is the
more common form.
The word alexithymia was in 1973 coined by US based
psychiatrists John Nemiah (1918–2009) and Peter Sifneos (1920-2008) to describe
a psychological state as well known to the general population as the profession,
the former preferring terms “emotionless”, “taciturn”, “feelingless” or “impassive”
although alexithymia has meanings which are more specific. Translated literally as “no words for
emotions”, in practice it’s a spectrum condition which references individual degrees
of difficulty in recognizing, processing or expressing emotional states or experiences. Although it appears in both the American
Psychiatric Association's (APA) Diagnostic
and Statistical Manual of Mental Disorders (DSM) and the World Health
Organization’s (WHO) International Classification of Diseases (ICD), neither
class it as either a diagnosable mental disorder or a symptom. Instead, it should be regarded as a
dimensional construct and one distributed normally in the general population. In other words it’s a personality trait and
like all spectrum conditions, it varies in frequency and intensity between
individuals.
Alexithymia was first described as a psychological construct characterized by difficulties in identifying, describing, and interpreting one's emotions but it was soon realized individuals less able to recognize and express their own feelings would often have a diminished ability to understand the emotional experiences of others. Clinically, alexithymia is classified in two sub-groups: (1) Primary (or Trait) Alexithymia is considered more stable and enduring and the evidence suggests there is often a genetic or developmental basis, those with primary alexithymia displaying indications from an early age. (2) Secondary (or State) Alexithymia is something usually temporary and often associated with specific psychological or medical conditions, noted especially in patients suffering post-traumatic stress disorder (PTSD) and depressive illnesses.
The characteristics common to alexithymia include (1) a limited imaginative capacity and “fantasy life”, (2) a difficulty in identifying and describing emotions, (3) thought processes which focus predominately on external events rather than internal emotional experience, (3) a difficulty in distinguishing between emotions and bodily sensations and (4) challenges in understanding (or even recognizing) the emotions of others. As a spectrum condition, alexithymia greatly can vary in severity, and not all with alexithymia will experience the same symptoms with there being a high instance reported among patients with psychiatric and psychosomatic disorders. Additionally, it does seem a common feature of neurological disease with most evidence available for patients with traumatic brain injury, stroke, and epilepsy although the numbers may be slanted because of the greater volume of study of those affected and it remains unclear how independent it is from affective disorders such as depression and anxiety, both common in neurological conditions.
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Clinicians have available a number of questionnaires which
can be use to assess a patient’s state of alexithymia and these can do more
than provide a metric; the limitation of drawing a conclusion from observation
alone is that with such an approach it can genuinely be impossible to distinguish
between the truly alexithymic and those who have no difficulties in experiencing,
processing, expressing and describing emotional responses but for some reason choose
not to. Such behavior can of course
induce problems in inter-personal relationships but it’s something distinct
from alexithymia and importantly too, it is clinically distinct from psychiatric
personality disorders, such as antisocial personality disorder. However, as a structural view of the DSM over
the seventy-odd years would indicate, within psychiatry, mission creep has been
a growing phenomenon and the definitional nets tend to be cast wide and wider
and it’s not impossible that alexithymia may in some future edition be
re-classified as a diagnostic criterion or at least recognized formally as a symptom. It has for some time been acknowledged the DSM
has over those decades documented the reassessment of some aspects of the human
condition as mental disorders but what is less discussed is the relationship
between cause and effect and there will be examples of both: it would be interesting
to try to work out if there’s a pattern in the nature of (1) the changes the DSM
has driven compare with (2) those which retrospectively have been codified.
Lindsay Lohan and her lawyer in court, Los Angeles, December 2011,
There may be movement because alexithymia has many of the qualities and attributes which appeal to both academia and the pharmaceutical industry. The orthodoxy is that it occurs in some 10% of the general population but is disproportionately seen in patients suffering certain mental conditions, notably neuro-developmental disorders; the prevalence among those with autism spectrum disorder (ASD) estimated at anything up to 90%. What will probably surprise few is that within any sub-group, it is males who are by far the most represented population and there is even the condition normative male alexithymia (NMA) although that describes the behavior and not the catchment, NMA identified also in females.
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