top of page

to have no words for emotions: Alexithymia

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

ALEXITIMIA derives from the Greek 'Alexis thymos', literally 'not having words for emotions.

Hence, alexithymia refers to the

difficulty in accessing one's own emotional world and identifying emotions in others and oneself: it is not a pathology in itself, but represents a way of being that can be connected to various psychophysical discomforts.

The test most commonly used in the diagnosis of alexithymia is the Toronto Alexithymia Scale (TAS-20), a psychometric self-assessment scale comprising 20 questions that investigate the presence of the three characteristics considered to be at the basis of the disorder, namely:

  • the difficulty in identifying feelings

  • difficulty in describing the feelings of others;

  • thinking oriented almost exclusively outwards and rarely towards one's own endopsychic processes.

It was John Nemian and Peter Sifneos who introduced this term in the early 1970s. Specifically, Sifneos coined it to indicate 'a specific disturbance in affective and symbolic functions that often renders the communicative style of psychosomatic patients sterile and colourless'.

Not all psychosomatic individuals, however, exhibit clear alexithymic elements.

Alexithymic individuals, in addition to having markedly reduced or absent symbolic thinking, generally manifest a number of difficulties with respect to

  • identifying, describing and interpreting their own and others' feelings;

  • distinguishing emotional states from physiological (bodily) perceptions;

  • identifying the causes of one's emotions;

  • use language as a tool to express feelings, resulting in a tendency to replace speech with physical action.

Although alexithymic subjects show normal physiological activation in the presence of emotions, they struggle to reorganise the elements that characterise their bodily experience into an intrapsychic mental representation. Only apparently are they well integrated into society.

Usually, they present coarse imaginative processes and tend to have outbursts of anger or uncontrolled crying and, when questioned about the reasons for these manifestations, are incapable of giving explanations and describing what they feel.

Furthermore, they tend towards highly dependent interpersonal relationships, or they prefer to be alone and avoid others, thus tending towards isolation.

In addition, it is not uncommon to see alexithymic traits in the context of compulsive behaviours such as:

  • binge eating;

  • substance abuse;

  • perversely experiencing sexuality to free themselves from the tensions caused by unprocessed emotional states.

Taylor, Bagby and Parker, in this regard, consider alexithymia to be an affect-processing disorder that interferes with the processes of self-regulation and reorganisation of emotions.

Recent studies and research show that alexithymia is one of the risk factors for various disorders, both physical (coronary heart disease, hypertension, gastrointestinal disorders) and psychological (anorexia and bulimia nervosa, depression, and anxiety disorders). Alexithymic characteristics have also been identified in patients with substance addiction, post-traumatic stress disorder, and depression. Finally, alexithymia has also been highlighted in patients who have undergone a transplant, are on dialysis or are in intensive care.

Living without emotions?

People with alexithymia have no difficulty in perceiving emotion, but they have not learnt to value their emotional world, considering it useless or seeing it as a weakness. These individuals manifest psychosomatic changes more frequently and are more likely to suffer from mental disorders such as eating disorders and addictions.

It was initially believed that alexithymia was a specific characteristic of psychosomatic disorders. Today, on the contrary, it has been observed to be a non-specific predisposition to various disorders, both physical and psychic, characterised by emotional anaesthesia.

Characteristics of the alexithymic personality

One only has to put oneself for a moment in the shoes of a person with high levels of alexithymia to realise how much psychological suffering is involved in constantly living in a fog in which feelings and desires are confused. The main characteristics of alexithymic people are:

  • difficulty identifying and describing emotions;

  • sudden outbursts of intense emotions such as anger, crying or fear;

  • inability to connect internal events with specific situations from which they originate: an alexithymic person will tend to recount in great detail an argument with a loved one without being able to say that he or she was angry;

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

  • poor imaginative and dream processes;

  • reality-oriented cognitive style: focused on everything external to psychic life, they display rational thinking that describes actions and experiences without investment, as if the individual were a spectator rather than an actor in their own life.

Alexithymia: what are the possible causes?

The causes of alexithymia can be sought in the relationship with parents during childhood, on which a large part of each person's psycho-affective development depends. Often alexithymia arises in response to a family context in which an adequate affective relationship is not present that allows the child to develop the mentalisation skills useful for recognising and modulating his or her own emotional states. Problems such as:

  • belonging to an authoritarian family nucleus 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.


There is probably no single explanation for the causes of such a complex phenomenon.

Communication styles are in fact influenced by socio-cultural factors, intelligence and family patterns of conversation, as well as genetic, neurophysiological and intrapsychic factors.

In general, a deficient functionality of the right hemisphere could explain not only alexithymic patients' difficulty in recognising and describing their emotions but also their lower empathic ability.

Of the various possible definitions, alexithymia can be considered a deficit in the reflexive function of the self due to the lack of emotional awareness that characterises it.


In contrast to alexithymia, empathy is

the ability that enables people to empathise with their own and others' states of mind.

The more open one is to one's own emotions, the more adept one is at reading the feelings of others, in fact, this skill is based on self-awareness and allows one to understand how another person is feeling. The empathic ability allows one to read and understand not only the emotions that people express in words but also those that, more or less consciously, is expressed in the tone of voice, gestures, facial expression and other similar non-verbal channels. This capacity comes into play in many situations, from those typical of professional life to those of private life.

According to Goleman, empathy and self-control are two social skills that help the individual build a rich and emotionally satisfying relational life, which also positively influences a person's psycho-physical well-being.

what can i do?

It is rare that a person with alexithymia is aware of his or her difficulties and therefore seeks 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: the person is not totally incapable of getting in touch with his or her emotions.

Starting from one's own resources, therefore, a course of psychotherapy may serve to train and improve one's ability to recognise, express and regulate one's emotions.

Recent Posts

See All


bottom of page