Alexithymia is the inability for someone to recognize, identify, and describe feelings or emotions. It is sometimes referred to as emotional blindness.
The word alexithymia was coined in 1972 and can be translated to mean “lack of words for emotion.” Alexithymia is not a condition with which you can be diagnosed—you will not find it in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) that mental health providers use as a guide when making a diagnosis. Instead, alexithymia is considered a personality trait.12
About 10% of the general population has a significant level of alexithymia, meaning the personality trait interferes with their day-to-day life in a way that makes work and social relationships more challenging.3 Alexithymia is even more common among people with neurodivergent conditions such as autism spectrum disorder (ASD), sometimes referred to simply as autism. In fact, about 50% of people with autism have alexithymia.4
Better understanding alexithymia—including its symptoms, causes, and treatment—can be helpful if you or someone you know has the trait.
Symptoms of Alexithymia
Because this trait is marked by a lack of emotion or an inability to identify emotions, it can be hard for people with alexithymia to recognize the signs and symptoms in themselves. Instead, friends and family members may be able to first recognize that someone has indicators of alexithymia.
Someone with alexithymia might exhibit the following signs:56
- Finding it difficult to identify how they are feeling
- Finding it difficult to describe their feelings
- Thinking in concrete ways
- Focusing their attention and the attention of others away from feelings
- Using physical sensations to describe emotions
- Feeling physically uncomfortable when they are emotional
- Being unable to identify what their physical sensations mean
- Experiencing difficulties identifying facial expressions
- Struggling to understand others’ emotions
- Having a limited ability to feel or show empathy
- Avoiding close social relationships
- Tending not to care about others’ well-being or happiness
Why Do People Develop Alexithymia?
Researchers are unsure what exactly causes someone to develop alexithymia. There haven’t been many studies on the trait’s origin.
Some experts think the trait has a genetic component because of how prevalent alexithymia is in several neurodevelopmental disorders that are hereditary. Cultural or environmental factors may impact your risk of developing the trait, too. Likely, it’s combination of all these factors.2
Why you develop alexithymia might also depend on which type you have. It’s believed there are two types: primary and secondary alexithymia.
Usually, any research or discussion about alexithymia refers to primary alexithymia. Primary alexithymia is related to your development, with the trait first showing in childhood or early adulthood. This means alexithymia is a stable part of your disposition—it doesn’t change as you experience different events.
Researchers also believe that some people can develop secondary alexithymia, or acquired alexithymia. This type of alexithymia can develop when you experience trauma or a distressing life event. It can develop at any time in your life, not necessarily during a time of development. Secondary alexithymia is believed to develop as a defense mechanism to the extreme stress, so you don’t have to experience the emotion.7
You might also develop secondary alexithymia if experience some type of brain damage or have a neurological condition that affects your brain.2
The Link Between Alexithymia and Autism
There appears to be a strong link between alexithymia and autism. It’s a link that was first considered in the mid 1990s and that has continued to be researched in the decades since. Still, there is no solid answer as to what the exact relationship is between the two. It remains unclear whether one causes the other and, if so, which one causes which.8
Some researchers speculate that the challenges people with ASD experience when identifying emotions may not actually be caused by autism but are instead caused by alexithymia. Rather than autism causing people to be more prone to alexithymia, researchers believe the personality trait and ASD co-occur.9
For instance, imaging research suggests that the lack of empathy people with autism have in response to another person’s pain is predicted by alexithymia and not by autism. Likewise, studies controlling for both alexithymia and autism have found that it is actually alexithymia and not autism that predicts difficulties in recognizing facial expressions and emotions.4
What is known is that people with ASD have the trait at a rate 10 times that of the general population. In fact, some research indicates that approximately half of people with ASD also have alexithymia.2
Other Associated Conditions
Alexithymia has been linked to a number of other health conditions, too. Here are some of the other conditions where alexithymia may co-occur:
- Depression: People with depression are more likely to experience alexithymia than the general population. Research has found that the prevalence of the trait in people with depression ranges from 27%-50%.10
- Schizophrenia: People with schizophrenia often have trouble understanding and regulating emotions. One 2023 study found that as many as 35% of people with schizophrenia had alexithymia.11
- Traumatic brain injury (TBI): A TBI is usually caused by a forceful, sudden blow to the head. The injury damages the brain and affects how it works. It’s not uncommon for people with a TBI to have trouble processing emotions. It’s estimated between 30%-60% of people with a TBI have alexithymia.12
- Neurological disorders: People with neurological diseases may develop alexithymia. Some examples include Alzheimer’s disease, Parkinson’s disease, dystonia, epilepsy, multiple sclerosis, and Huntington’s disease.13
- Post-traumatic stress disorder (PTSD): Trauma is one of the main risk factors for developing alexithymia.14 Research suggests that people diagnosed with PTSD tend to experience the trait more significantly than the general population.15
- Disordered eating: People who have eating disorders often report having difficulties identifying and describing their feelings. It’s believed that alexithymia may play a part in the development, continuation, and treatment difficulty of eating disorders.16
- Substance abuse disorders: Research suggests that people with substance abuse disorders may be prone to alexithymia. For instance, 45%-67% of people with alcohol use disorder reported high alexithymia scores while 45%-50% of people who use illicit drugs exhibiting alexithymia.17
How Is Alexithymia Diagnosed?
Because alexithymia is not an official mental health disorder listed in the DSM-5, there are no set guidelines or criteria that must be met to diagnose the trait.
That said, some researchers and clinicians use the 20-item Toronto Alexithymia Scale (TAS-20), which was developed in 1994. The TAS-20 is a self-report questionnaire that assesses the different aspects of alexithymia, including difficulty identifying and describing feelings.
Another tool, known as the Bermond–Vorst Alexithymia Questionnaire, attempts to assess the lack of imaginative abilities in people suspected of having alexithymia.
There is still a great deal of disagreement on how to accurately diagnose alexithymia. For this reason, researchers are still exploring a number of other options to help with assessing people that may have the trait.18
How Is Alexithymia Treated?
While there is no prescribed treatment for overcoming the challenges associated with alexithymia, people with this trait can work on improving their emotional awareness through a variety of treatment options, such as therapy and other interventions.19 Here are some potential ways alexithymia may be treated by a mental heath provider:
- Dialectical behavioral therapy (DBT): Research indicates that DBT, which helps people learn emotional regulation and social skills, may be useful for improving alexithymia. Although more research is needed, one study found that using DBT helped decrease alexithymia while increasing the participants’ ability to identify other people’s emotions.20
- Interoceptive training: Because alexithymia and interoception (being able to recognize internal bodily signals like hunger) are closely related, some researchers have found that focusing on developing interoception skills may help improve a person’s ability to also recognize internal emotions.21
- Mindfulness training: There is some evidence that using mindfulness techniques can help address alexithymia, possibly because mindfulness and emotion regulation are linked. However, more research is needed to confirm whether the treatment method is effective.2223
- Cognitive behavioral therapy (CBT): In therapy settings, CBT is a commonly used approach to addressing a wide variety of challenging conditions, which may include alexithymia. However, some research suggests that CBT may not always be as effective as DBT in addressing alexithymia, particularly in people with autism with emotion dysregulation.2425
Coping With Alexithymia
Having alexithymia can be both challenging and frustrating, especially if it causes issues at work or in personal relationships with friends and family members. For this reason, it is important to have some coping tools, particularly if you are working on getting more in touch with your emotions.
One possible way of coping with alexithymia is to try journaling. There is some evidence that expressive writing can help people—particularly those who have alexithymia as a result of abuse or trauma—detect emotions. At first, this might be a challenging endeavor, but the goal is to broaden your awareness of yourself and others. For those with alexithymia that is more fixed or static, journaling may not be effective.26
Meanwhile, if you have a loved one with alexithymia, it is important to be supportive as well as communicative. Knowing that your friend or family member has trouble expressing emotions as well as recognizing yours, it is important for you to be direct and to the point. Tell them how you feel and what you would like for them to do. You also can encourage them to see a therapist if they are not already seeing one.27
When To Contact a Healthcare Provider
Because alexithymia is not a mental health condition but instead a personality trait, most people who receive treatment will do so alongside treatment for another condition like depression or PTSD. People with alexithymia can learn skills for coping with the trait, particularly if it occurs alongside depression or is the result of a trauma or abuse.
That said, when alexithymia occurs alongside a TBI, dementia, a psychotic disorder, or a neurodevelopmental disorder, it may appear more static and less likely to be changed. But if alexithymia is interfering with a person’s day-to-day life, it is important to let a healthcare provider know so that appropriate treatment can be recommended.19
A Quick Review
Alexithymia is a personality trait that causes a person to struggle in recognizing and describing their feelings and emotions. Someone with the trait might focus their attention or the attention of others away from emotions. They might also try to describe their feelings in terms of physical sensations and become physically uncomfortable when they are emotional.
Researchers are unsure why alexithymia develops, but it can co-occur with a number of conditions, including traumatic brain injuries, dementia, post-traumatic stress disorder, and autism spectrum disorder.
There are a number of ways you can cope with alexithymia, including therapy, mindfulness techniques, and interoception skill development. But there are some cases where the trait is more static and unable to be changed. In these situations, it is important to show compassion and support as well as utilize direct communication techniques to minimize the number of challenges encountered.