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can live without emotions?

Alexithymia is often referred to as emotional illiteracy, i.e. the opposite of emotional intelligence.

The etymology of the word alexithymia is Greek and derives from a- absence, lexis- language, thymos- emotions and literally means 'absence of words to express emotions'.

So, what is meant by alexithymia? The term indicates the difficulty in accessing one's emotional world and identifying emotions in others and oneself. For psychology, alexithymia is not a pathology per se (alexithymia is not present in the DSM-5) but represents a way of being that can be connected to various psychophysical discomfort.

Alexithymia and emotions

People with alexithymia are not people 'without feelings and emotions'. Rather than the absence of emotions, in fact, we speak of not being able to recognise emotions and not being able to express their feelings.

Alexithymics perceive emotion, but have not learnt how to give words to their emotional world, sometimes considering it useless or seeing it as a weakness.

Therein lies the difference between anaffectivity and alexithymia: while the anaffective person has an inability to feel emotions, the characteristics of the alexithymic person are that of not recognising emotions and not knowing how to express their feelings. How does alexithymia manifest itself?

Features of the alexithymic personality

What does an alexithymic experience? A person with high levels of alexithymia experiences great psychological distress as a result of not understanding their emotions and having difficulty expressing them. Alexithymia brings with it symptoms such as:

  • difficulty identifying and describing emotions

  • sudden outbursts of intense emotions such as anger or fear

  • inability to connect internal events with specific situations from which they originate.

Examples of alexithymia include a very frequent behaviour: an alexithymic person will tend to recount in great detail an argument with a loved one, but will not be able to express their emotions.

  • difficulty distinguishing subjective emotional states from the somatic components triggered by the emotion: emotions are mainly expressed through the physiological component

  • poverty of imaginative and dream processes

  • reality-oriented cognitive style: alexithymic people are focused on everything external to psychic life, show rational thinking and poor introspection skills.

Correlation with other psychological disorders

The alexithymic person manifests psychosomatic changes more frequently and is more likely to suffer from addictions or an anxiety disorder. In addition, frequent correlations are those between:

  • alexithymia and eating disorders

  • alexithymia and depression

  • alexithymia and post-traumatic stress disorder.

It was initially believed that alexithymia was a specific characteristic of psychosomatic illness. Today, it is considered to be a non-specific risk factor to various disorders, both physical and psychic, characterised by emotional anaesthesia.

Alexithymia is also found in personality disorders (e.g. there is a connection between alexithymia and narcissism, also documented by a study in which a limited ability to understand the causes of one's own emotional states was observed in people with narcissistic disorder) and, among the forms of autism, it can be found in individuals with Asperger's Syndrome.

Possible causes of alexithymia

Why does one become alexithymic? The causes of alexithymia can be found in the relationship with attachment figures during childhood.

Often, alexithymia arises in response to a family context lacking of a 'good enough' affective relationship , which usually aenables the child to develop the mentalisation skills needed for recognising and modulating his or her own emotional states. Problems such as:

  • belonging to a family unit in which there is little room for emotional expression

  • separation from parents

  • traumatic events

  • affective deficiencies

can have deleterious effects on the ability to understand and communicate one's emotional states.

Is someone suffering from alexithymia an emotional illiterate?

We can call alexithymia 'emotional illiteracy', an expression that connotes the inability to show, recognise and express emotions. The subject of emotional illiteracy was addressed by psychologist and journalist D. Goleman, who defined it as 'the inability to recognise and manage one's own and others' emotions'.

The main characteristic of emotional illiteracy is the lack of empathy and the display of emotional detachment.

Emotional illiteracy is also spoken of by the psychoanalyst and essayist U. Galimberti who defines it, quoting Nietzsche, as 'the disturbing guest'.

The consequences of alexithymia in relationships

The inability to identify, recognise and verbalise one's emotions can have consequences in the relational life of an alexithymic person.

The inability to self-regulate one's emotions can in fact lead to problems in relationships, due precisely to the struggle to express one's feelings and distinguish emotions from physical sensations.

There is a strong correlation between alexithymia and sexuality, as shown by research that investigated interoceptive awareness, i.e. awareness of one's own bodily manifestations.

The research results show that people with a high degree of alexithymia are more likely to have sexual disorders such as erection difficulties or arousal problems.

Research has also been conducted on alexithymia and relatedness, such as one conducted by a team of researchers at the University of Missouri-Columbia, in which they found that "higher alexithymia was associated with greater loneliness, which predicted less intimate communication, which correlated with lower marital quality."

Test for alexithymia

Various tests are used for the assessment and treatment of alexithymia. The most widely used is the Toronto Alexithymia Scale (TAS-20), a psychometric self-assessment scale comprising 20 questions that investigate the presence of the three characteristics believed to underlie the disorder. They are:

  • difficulty in identifying feelings

  • difficulty in describing the feelings of others

  • Thinking oriented almost never towards one's own endopsychic processes but mostly towards the outside world.

However, this scale lacks an important element that characterises the alexithymic subject, i.e. the ability to imagine, which is added in a second type of test, developed by the same team of researchers, and called the TSIA test for alexithymia (Toronto Structured Interview for Alexitymia) consisting of 24 questions, 6 for each aspect of alexithymia:

  • difficulty identifying feeling (DIF)

  • difficulty describing feeling (DDF)

  • externally-oriented thinking (EOT)

  • imaginal processes (IMP).

How is alexithymia treated?

It is rare for a person with alexithymia to be aware of their difficulties and thus seek help. Often, these people turn to a specialist when other, more disabling discomforts appear to which alexithymia is related.

Alexithymia is not an 'all or nothing' phenomenon: alexithymia is not the absence of feelings, but denotes the difficulty in recognising and managing emotions. Psychological therapy for alexithymia can start with emotional education, the exercise of empathy and the nurturing of relationships.

Also important is the work that links alexithymia and mentalisation, which acts on the person's cognitive capacity. Among the types of psychotherapy that have proven effective for treating alexithymia are mentalisation-based therapy (MBT) and cognitive behavioural therapy.

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