When you first enter therapy, it might be surprisingly difficult to answer the question, "How are you feeling?" Answering that question can be even more of a challenge if you deal with what is known as alexithymia, a dysfunction that makes it tough to recognize and name your emotions.
Many people who have depression, post-traumatic stress disorder (PTSD), or other mental health conditions also deal with alexithymia—and it's also a more common issue than many people realize. For instance, Alyson Stoner, who is known for her roles in Cheaper By the Dozen and Camp Rock, recently told People that she had severe anxiety when she was six and eventually developed eating disorders, as well as alexithymia.
If you’ve never heard of alexithymia before, you’re not the only one.
Although alexithymia is well known among psychologists, it’s not something most people outside the field are aware of. And even though mental health professionals have known of the existence of this condition for years, it’s still a little bit of a mystery, John Richey, Ph.D., an associate professor of psychology at Virginia Tech who has researched alexithymia, tells SELF.
Alexithymia is essentially a dysfunction in the normal emotional awareness processes that makes it tough for people to put a label on their feelings, Richey explains. In research, it has been described as a “personality construct characterized by altered emotional awareness” and something that “negatively impacts empathic processing.” In practice, alexithymia makes it difficult to recognize when you're feeling something and even more difficult to assign a name to it.
“We’re constantly applying labels to complicated internal states like happiness and sadness, and that takes practice over time,” Richey says. “For some people, for reasons that are not clear, they have difficulty decoding what’s going on inside their own internal world and giving it a name.”
That said, alexithymia isn't actually a condition, and it's not in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic handbook used by health care professionals to diagnose mental disorders, Kathryn Moore, Ph.D., psychologist at Providence Saint John's Child and Family Development Center in Santa Monica, California, tells SELF. "It’s usually an aspect of a person’s functioning and how they deal with emotions, but it's not a separate diagnosis," she says.
Alexithymia has been linked to a range of mental health disorders like depression, PTSD, schizophrenia, and autism spectrum disorder. It’s also associated with suicide, elevated mortality rates, and psychosomatic issues (e.g. a physical illness caused by mental conflict or stress).
It also seems to be more common in men than women, and people can experience alexithymia to varying degrees, Sophie Lazarus, Ph.D., a psychologist at the Ohio State University Wexner Medical Center, tells SELF. "People vary widely in the degree to which they are in touch with and able to describe their own emotions," she says. "This likely depends on a number of factors, including how much this was modeled, reinforced, or punished in their early environment."
A person might not be aware they have alexithymia.
Considering that alexithymia is characterized by a lack of awareness or recognition of an internal state, it's probably not surprising that “people usually aren’t fully aware that they have this difficulty,” Richey says. That's also why many people don't seek treatment for it, which makes it difficult to know exactly how common it is on its own rather than when it occurs with a disorder, such as depression.
Even if someone is diagnosed with alexithymia, it can be difficult to treat. “There’s so little research on whether you can even get rid of it,” Richey says. But how you developed alexithymia likely matters in whether it's treatable, he says. If you’re experiencing it as a result of depression or PTSD, for example, it’s likely that therapy (as well as treating the other mental health issues you’re struggling with) can help. But for others, alexithymia could just be “more an enduring trait over time,” Richey says.
For people who experience alexithymia, it may be helpful to:
- Learn to connect your emotions with the physical feelings that can come with them, like an accelerated heartbeat, sweating, or sluggishness, Richey says.
- Try cognitive behavioral therapy (CBT) to focus on identifying and understanding the connection between thoughts and emotions, Lazarus says.
- Practice mindfulness and other exercises to increase your emotional awareness, Lazarus says.
- Enter group therapy programs, Moore suggests, which will give you the opportunity to see how others talk about their emotions.
- Reflect on your personal beliefs about emotion and what you think will happen if you display your emotions, Moore says.
Still, although therapy is generally recommended (and may be a given if you're already treating another mental health issue), it's not guaranteed to work for everyone. “Some people do well with starting to apply names and labels to emotions in the context of therapy, while others struggle with it profoundly,” Richey says. “It’s very specific to the person and the context.”
Overall, more research is needed to better understand alexithymia and how to treat it effectively. “As a field, we still don’t have a good understanding of why or how this happens in some people,” Richey says. “But we’re learning a little more each year.”