At first blush, it sounds like a scene from a New Yorker cartoon: A psychiatrist asks a patient, “So how are you feeling?” and the patient replies, “I don’t know, doc — that’s why I’m here.” It seems like a joke, but it’s not a far-fetched scenario. There’s a personality trait, sometimes viewed as a subclinical condition, called alexithymia, which is characterized by an inability to recognize, identify and describe your own emotions.
“Alexithymia isn’t a clinical diagnosis, but it’s a difficulty that millions of people struggle with every day — and it carries very real costs,” says Susan David, a psychologist at Harvard Medical School and author of the book “Emotional Agility: Get Unstuck, Embrace Change, and Thrive in Work and Life.”
Though it was first described in the psychological literature in 1976, alexithymia has recently been linked with a host of health problems, including hypertension, migraines, tinnitus severity, poorer pain control, sleep problems, eating disorders and substance abuse, as well as depression and other mental health conditions. What’s more, people with alexithymia have a higher tendency to overreport unusual physical symptoms — including fatigue and other bodily sensations like aches and pains — perhaps because they have difficulty articulating internal emotional experiences, according to a study in the April 2018 issue of the Scandinavian Journal of Psychology.
And yet, most people have never heard of alexithymia — but it’s something they’ve undoubtedly observed. Among the main features are a lack of emotional awareness, an inability to identify or describe emotions and trouble distinguishing between emotions and bodily sensations. In other words, someone with alexithymia may recognize that he or she is feeling upset or unsettled but be unable to identify the exact emotion — whether it’s anger, anxiety, disappointment or something else. Since he or she doesn’t know how to recognize or regulate those emotions, the person might turn to alcohol or food to manage the distress.
[Read: Emotional States That Are Often Confused for Each Other.]
Or, if someone with alexithymia is feeling anxious and experiencing muscle tension or heart palpitations, he or she might simply chalk up the symptoms to feeling tired or having a heart problem, says Kristen Morie, an associate research scientist at the Yale School of Medicine. “They will not recognize their feelings as being caused by anxiety and may not be able to put words to how they’re feeling. This can make certain emotions, especially anxiety, worse. Since the person doesn’t know what’s causing it, it becomes more distressing.” In a way, alexithymia is the opposite of emotional intelligence.
But it can be difficult for people to recognize it in themselves, “especially since alexithymia involves lack of insight,” Morie adds. “It’s more likely that someone else will recognize it in their friends or loved ones.”
In the meantime, “alexithymia can cause difficulties in interpersonal relationships, in understanding and responding to emotional distress in other people,” notes Rebecca Ready, a professor of psychological and brain sciences at the University of Massachusetts–Amherst. Sure enough, a study published in a 2017 issue of the American Journal of Psychology found that people with alexithymia have trouble recognizing emotions in other people’s faces and they have reduced emotional empathy for others. And a study in the January 2018 issue of the Journal of Counseling Psychology found that alexithymia was associated with attachment avoidance (shying away from getting close to other people), especially among men.
The Roots of Emotional Disconnection
Alexithymia can develop for a variety of reasons: If kids were raised to believe that they shouldn’t cry or express emotions because they need to be strong, that can lead to alexithymia, David says. Alexithymia also can develop as a coping mechanism for psychological trauma such as physical, emotional or sexual abuse.
Physiologically, traumatic brain injury, or TBI, can cause alexithymia, due to neurological damage to the brain, says Dawn Neumann, an associate professor and research director of physical medicine and rehabilitation at the Indiana University School of Medicine and Rehabilitation Hospital of Indiana. “Alexithymia occurs when the injury causes disruption to brain regions and neural networks that are responsible for processing emotions, which may lead to disconnections between an internal emotional response and the way that emotion is identified, experienced or not experienced, expressed or not expressed.” Similarly, alexithymia can occur with other neurologic conditions such as Parkinson’s disease.
Treating the condition can be challenging. People usually get treated for the depression, anxiety, post-traumatic stress disorder, substance abuse or other mental health condition that accompanies alexithymia, rather than for alexithymia itself. “Because they may lack the emotional vocabulary needed to communicate or describe these emotions, people with alexithymia are not likely to seek emotional support from a counselor or even a family member or friend,” Neumann says. Even if they are in therapy, those who have alexithymia may not be able to accurately describe their emotions or they may not have insight into their emotions — “issues that make it harder to actively engage in and benefit from therapy,” Neumann adds.
[Read: Are You Too Emotional?]
Learning the Language of Emotions
One way to expand your emotional awareness and vocabulary on your own is to question your emotions: If you think you’re feeling angry, ask yourself what two other emotions you might be feeling (perhaps frustration and disappointment), then consider why you’re feeling that way, David suggests. “Emotions are signposts for things we care about, so ask, ‘What is this emotion trying to tell me?'” It also can help to write about your feelings in a journal and try to glean meanings from them, she adds, by using phrases such as “I have learned that…” or “The reason that…” or “I now realize…”
Participating in a formal treatment program also can help. In a study involving adults who had moderate to severe TBI and alexithymia, Neumann and her colleagues had the subjects participate in eight sessions of an emotional self-awareness treatment program, designed to help them develop an emotional vocabulary to describe their feelings and learn exercises to help them tune into physiological signals of emotions. After two months, the participants experienced considerable improvements in their emotional self-awareness and their ability to regulate their emotions. “The very act of labeling emotions is believed to help minimize an unpleasant feeling by engaging the prefrontal cortex, which helps to down-regulate the implicit emotional response that occurs in the limbic system,” Neumann explains.
Meanwhile, a study published in a 2015 issue of the journal Drug and Alcohol Dependence found that people with alexithymia who had a cocaine habit benefited from computer-based cognitive behavioral therapy and were better able to abstain from use than those who had traditional treatment. This may be partly because CBT teaches cognitive strategies to deal with cravings but also because computers were used, says study co-author Morie. People “with alexithymia may find it difficult to be asked to relate their emotions or interact with a clinician, and being told to focus on and regulate feelings they can’t identify may be stressful,” she explains. “With a computerized setting, this high-pressure environment is absent. They can progress through the treatment modules at their own pace and comfort level and not have to focus on feelings they don’t understand.”
[Read: The Hazards of Rumination for Your Mental and Physical Health.]
Along these lines, some new apps are designed to help people broaden their emotional vocabularies and develop greater emotional awareness. My Emotional Compass, developed by Neumann and her colleagues, helps people navigate their emotions by breaking them down into pleasant versus unpleasant valences and levels of emotional arousal; it will be released in April (in the Apple App Store and Google Play Store). Or, you can use the Mood Meter app (available in the Apple App Store and Google Play Store), developed by researchers at the Yale Center for Emotional Intelligence, which uses colors to help you label your shifting moods.
However you choose to do it, developing a greater understanding of your emotions, the positive and negative ones, can help you lead a richer life. “Being able to label one’s emotions in a robust, granular way is associated with high levels of well-being, low levels of depression and anxiety, a better capacity to move forward with one’s goals and effectively navigate a complex world,” David says. What more could you ask for?
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When You Can’t Put Your Feelings Into Words: The Emotional Ignorance of Alexithymia originally appeared on usnews.com
