Alexithymia: The Role Of Emotions In Health

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What Is Alexithymia (Alexi’)?

The term “alexithymia” was introduced by Peter Sifneos in 1973, to designate a cluster of cognitive and affective characteristics that were observed among patients with classical psychosomatic diseases (1).

Messina et al. have postulated that at least three forms, primary, secondary, and organic, might characterize alexithymia.

What Is Primary Alexithymia?

It is considered to be primary when emerging “as a life-long dispositional factor that can lead to psychosomatic illness”.

Primary alexithymia may derive from a psychic trauma occurring during childhood or from negative primary caregivers interactions. It has been recently suggested that genetic polymorphism of the 5-HT transporter-linked promoter region may influence the conditions occurrence.

Hence, primary alexithymia is currently thought of as a more or less stable personality trait that becomes molded during childhood and early adult years. Therefore, primary alexithymia is developmental in nature.

What Is Secondary Alexithymia?

This is posited to arise not during development, but as a consequence of events occurring later in life. These may be events with psychological significance and/or medical-surgical events (illnesses or disease) that have a direct or indirect effect on brain functioning.

Therefore, secondary alexithymia may have both psychological and/or somatic (organic) mechanisms

What Are The Symptoms Of Alexithymia?

The condition is multifaceted and includes several distinct characteristics (1):

  1. Difficulty in identifying and describing feelings/emotions.
  2. Difficulty in distinguishing feelings from the bodily sensations.
  3. Diminution of fantasy.
  4. Concrete and poorly introspective thinking.
  5. The persons with alexithymia may show affective dysregulation, the inability to self soothe, and manage emotions because of a lack of awareness of emotions.
  6. Therefore, the adaptive informational meaning of emotions that is essential for emotion regulation often lacks in these individuals

“Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.” (Sigmund Freud)

As a result of this, alexithymia has been associated with numerous conditions (we could in some cases call these symptoms too).

Let’s summarise some of these quickly…

Alexithymia And Addiction (Alexi’)

Elkholi et al. evaluated the rates of alexi’ and its relationship with smartphone addiction in a cross-sectional study on a sample of 200 university students and found a strong association between both. These results were consistent with most of the previous literature that pointed out that persons with Alexi’ tend to regulate their emotions through several forms of addictive behaviors.

Alexithymia And Stress

Kajanoja et al. examined the relationships of Alexi’ and hair cortisol concentrations (HCC), a measure of long-term cortisol levels, and a biomarker for chronic stress in pregnant women. They found that among pregnant women, moderate to high Alexi’ was associated with elevated HCC levels, and this association was driven by the subjective difficulty in identifying feelings (DIF) dimension of Alexi’, the only associated with HCC in the whole sample, after controlling for potential confounders.

These results are in line with the so-called “stress-alexithymia hypothesis”.

Alexithymia And Chronic Pain

Overall, the examined studies showed a high prevalence of Alexi’, especially difficulties in identifying feelings, in all the different chronic pain conditions considered.

ADHD

It has long been recognised that emotion dysregulation is common in individuals with neuro-developmental disorders, including Attention-Deficit/Hyperactivity Disorder (ADHD) (2).

Alexithymia And Multiple Unexplained Symptoms

Ten studies met the criteria for inclusion in the review. Seven of the eight studies which focused on a comparison between children with MUS and healthy controls, found higher levels of self-reported alexithymia in the children with MUS. However, in the two studies where children were asked to complete tasks that objectively measure Alexi’, significant differences were not found. Results of studies comparing alexithymia in children with MUS and children with medical/psychiatric controls were inconsistent; there was some evidence of increased anxiety and depression in young people with alexithymia and MUS but inconsistency of measures across studies makes drawing conclusions difficult.

Alexithymia And Health-related Quality Of Life (HRQoL)

Alexi’ was significantly associated with lower HRQoL independently of other variables. The TAS-20 subfactor Difficulties Identifying Feelings was the strongest common denominator between alexithymia and HRQoL.

Alexithymia And Parkinson’s Disease

In recent years, Alexi’ has gained attention of medical researchers as a prognostic factor for serious health problems. The present study (6) aimed to assess alexithymia as a determinant of cognitive decline in patients with Parkinson’s disease.

Alexithymia is a significant marker of cognitive decline in patients with Parkinson’s disease

Alexithymia And Rheumatoid Arthritis and Psoriatic Arthritis

This study suggests that alexithymia assessment should be a part of the comprehensive management of RA and PsA patients

Alexithymia And Personality Type And Mental Health

The relationship between the Big Five personality dimensions and mental health is mediated by alexi’

Alexithymia And Inflammation

Altered immune responses are seen in depression, and recent data suggest that similar changes could also be observable in Alexi’. In one study (9) authors  examined whether the inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6 are independently related to alexithymia or its factors in a population-based sample.

The authors concluded:

Our findings suggest that the association between hs-CRP [inflammation] and Alexi’ resembles that observed in depressed patients. It is, however, independent of depressive symptoms. These findings widen our view on the stress-alexithymia concept

How Do You Treat Alexithymia?

Treatment of psychiatric disorders relies heavily on a trial and error approach, often prolonging the time required to obtain symptomatic improvements (9).

Research has invariably focused on evaluation of the predictive impact of alexithymia on the outcome of different forms of group or individual psychotherapy:

  • Cognitive behavioral therapy
  • Psychodynamic therapy
  • Interpersonal therapy
  • Psychodynamic-interpersonal therapy
  • Psychoeducational therapy
  • Mentalization-based treatment
  • Rhythmic movement therapy
  • Dialectical behavior therapy

These were all conducted in a series of treatment settings (doctor’s surgery, day-hospital, hospital).

The authors of this review concluded unfortunately that “we are still far from being able to draw conclusions in favor of specific treatment protocols demonstrating a greater efficacy in this type of patients”.

They did discuss however how treatment options encouraging the identification, sharing, and understanding of feelings would appear to be more effective in reducing alexithymia. Additionally, these patients appear to prefer, and obtain greater benefit from, a group therapeutic setting.

A group context provides these patients with an opportunity to observe and copy other members of the group who are able to express their feelings more effectively, to gather feedback on their method of communication, to be encouraged to share their feelings with the others in the group, to witness the watering down of their “emotional arousal” with a lower risk of somatic expression, or to be, as needed, mere observers.

Several authors have highlighted how patients with alexithymia may be poorer responders to classic medical treatments and to psychotherapy, particularly psychodynamic psychotherapy

The opinion according to which patients with alexithymia are poorly suited to psychodynamic approaches has to date found little support, although it is assumed that individuals with high levels of alexithymia may gain greater benefit from psychodynamic approaches involving a more active and empathetic role of the therapist, elements of supportive therapy, and a good therapeutic alliance. (9)

Self-compassion has been discussed as a potential tool to mitigate Alexithymia (11).

Psychedelics And Alexithymia

“For people who are alexithymic—that is, they cannot express feelings verbally—MDMA is thought to be a very, very valuable adjunct to psychotherapy.” Charles Grob

It has been discussed how microdosing may be beneficial for those with alexithymia but more research is needed here (12).

Check out the section of my blog on psychedelics here.

Conclusion: Alexithymia: The Role Of Emotions In Health

Our ability to feel, acknowledge and express our emotions is fundamental to health. This is why I am such a fan of transformational breathwork, psychedelics and other therapies which help us drop down from our heads to our hearts. In my experience they can help us learn to feel, or put more correctly perhaps, remind us how to feel.

Society has taught us emotional expression is to be avoided. That, in certain situations, it can be a sign of weakness. This is particularly true for men I feel.

References

  1. Editorial: “No Words for Feelings, Yet!” Exploring Alexi’, Disorder of Affect Regulation, and the “Mind-Body” Connection: click here.
  2. Emotion dysregulation in attention deficit hyperactivity disorder: click here.
  3. The relationship between college students’ Alexi’ and mobile phone addiction: Testing mediation and moderation effects: click here.
  4. Alexi’ in children with medically unexplained symptoms: a systematic review: click here.
  5. Alexi’ and health-related quality of life in a general population: click here.
  6. Alexi’ Predicts Cognitive Deficits In Patients With Idiopathic Parkinson’s Disease: click here.
  7. Evaluation of Alexi’ in patients affected by rheumatoid arthritis and psoriatic arthritis: A cross-sectional study: click here.
  8. The Big Five personality dimensions and mental health: The mediating role of Alexi’: click here.
  9. The Impact of Alexi; on Treatment Response in Psychiatric Disorders: A Systematic Review: click here.
  10. Towards a classification of alexi’: primary, secondary and organic: click here.
  11. Self-compassion in Relation to Alexithymia, Empathy, and Negative Mood in Young Adults: click here.
  12. Exploring the relationship between microdosing, personality and emotional insight: A prospective study: click here.
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