Alexithymia

Last updated
Alexithymia
Other namesEmotional blindness
Pronunciation
Specialty Clinical Psychology, Psychiatry
Frequency10% (lifetime risk)

Alexithymia, also called emotional blindness, [1] is a neuropsychological phenomenon characterized by significant challenges in recognizing, expressing, feeling, sourcing, [2] and describing one's emotions. [3] [4] [5] It is associated with difficulties in attachment and interpersonal relations. [6] There is no scientific consensus on its classification as a personality trait, medical symptom, or mental disorder. [7] [8]

Contents

Alexithymia occurs in approximately 10% of the population and often co-occurs with various mental or neurodevelopmental disorders. [9] It is present in 50% to 85% of individuals with autism spectrum disorder (ASD). [10]

Difficulty in recognizing and discussing emotions may manifest at low levels in men who conform to specific cultural norms of masculinity, such as the belief that sadness is a feminine emotion. This condition, known as normative male alexithymia, can be present in both sexes. [11] [12] [13] [6]

Etymology

The term alexithymia was introduced by psychotherapists John Case Nemiah and Peter Sifneos in 1970 to describe a particular psychological phenomenon. [14] [15] [16] [17] Its etymology comes from Ancient Greek. The word is formed by combining the alpha privative prefix ἀ- (a-, meaning 'not') with λέξις (léxis, referring to 'words') and θῡμός (thȳmós, denoting 'disposition,' 'feeling,' or 'rage'). The term can be likened to "dyslexia" in its structure. [18]

In its literal sense, alexithymia signifies "impermeable to emotions". [17] This label reflects the difficulty experienced by individuals with this condition in recognizing, expressing, and articulating their emotional experiences. Nonmedical terminology, such as "emotionless" and "impassive", has also been employed to describe similar states. [19] Those who exhibit alexithymic traits or characteristics are commonly referred to as alexithymics or alexithymiacs. [20]

Classification

As of 2025, scholars have not reached a consensus about the classification of alexithymia. The DSM-5 and the ICD-11 classify alexithymia as neither a symptom nor a mental disorder. [21] Cognitive behavioral and psychoanalytic theorists have proposed conceptualizations, including lists of characteristic signs and symptoms. [22] [23] [24]

Cognitive behavioral model

The cognitive behavioral model, also known as the attention-appraisal model, proposes three descriptive components: [25] [26]

  1. difficulty identifying feelings (DIF)
  2. difficulty describing feelings (DDF)
  3. externally oriented thinking (EOT), characterized by a tendency to not focus attention on emotions.

Psychoanalytic model

The psychoanalytic model suggests four components: [27]

  1. difficulty identifying feelings (DIF)
  2. difficulty describing feelings to other people (DDF)
  3. a stimulus-bound, externally oriented thinking style (EOT)
  4. constricted imaginal processes (IMP) characterized by infrequent daydreaming

Constricted imaginal processes, defined as a lack of spontaneous imagining, does not correlate with the other components. [23] [28] [29] [30] [31] Such findings have led to ongoing debate in the field about whether IMP is indeed a component of alexithymia. [22] [23] [32] For example, in 2017, Preece and colleagues introduced the attention-appraisal model of alexithymia, where they suggested that IMP be removed from the definition and that alexithymia be conceptually composed only of DIF, DDF, and EOT, as each of these three are specific to deficits in emotion processing. [5] [23] These core differences in the definition of alexithymia, regarding the inclusion or exclusion of IMP, correspond to differences between psychoanalytic and cognitive-behavioral conceptualizations of alexithymia; whereby psychoanalytic formulations tend to continue to place importance on IMP, [33] whereas the attention-appraisal model (presently the most widely used cognitive-behavioral model of alexithymia) [34] excludes IMP from the construct. [31] In practice, since the constricted imaginal processes items were removed from earlier versions of the TAS-20 in the 1990s, [35] the most used alexithymia assessment tools (and consequently most alexithymia research studies) have only assessed the construct in terms of DIF, DDF, and EOT. [4] [36] In terms of the relevance of alexithymic deficits for the processing of negative (e.g., sadness) or positive (e.g., happiness) emotions, the PAQ is presently the only alexithymia measure that enables valence-specific assessments of alexithymia across both negative and positive emotions; [37] recent work with the PAQ has highlighted that alexithymic deficits in emotion processing do often extend across both negative and positive emotions, although people typically report more difficulties for negative emotions. [37] [38] Such findings of valence-specific effects in alexithymia are also supported by brain imaging studies. [39]

Studies (using measures of alexithymia assessing DIF, DDF, and EOT) have reported that the prevalence rate of high alexithymia is less than 10% of the population. [40] A less common finding suggests that there may be a higher prevalence of alexithymia amongst males than females, which may be accounted for by difficulties some males have with "describing feelings", but not by difficulties in "identifying feelings", in which males and females show similar abilities. [41] Work with the PAQ has suggested that the alexithymia construct manifests similarly across different cultural groups, and those of different ages (i.e., has the same structure and components). [42] [37]

Psychologist R. Michael Bagby and psychiatrist Graeme J. Taylor have argued that the alexithymia construct is inversely related to the concepts of psychological mindedness [43] and emotional intelligence [44] [45] and there is "strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress". [46]

Signs and symptoms

Typical deficiencies may include problems identifying, processing, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others; difficulty distinguishing between feelings and the bodily sensations of emotional arousal; [15] confusion of physical sensations often associated with emotions; few dreams or fantasies due to restricted imagination; and concrete, realistic, logical thinking, often to the exclusion of emotional responses to problems. Those who have alexithymia also report very logical and realistic dreams, such as going to the store or eating a meal. [47] Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterizes alexithymia. [15]

Some alexithymic individuals may appear to contradict the above-mentioned characteristics because they can experience chronic dysphoria or manifest outbursts of crying or rage. [48] [49] [50] [51] However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings. [27]

According to Henry Krystal, individuals exhibiting alexithymia think in an operative way and may appear to be superadjusted to reality. In psychotherapy, however, a cognitive disturbance becomes apparent as patients tend to recount trivial, chronologically ordered actions, reactions, and events of daily life with monotonous detail. [52] [53] In general, these individuals can, but not always, seem oriented toward things and even treat themselves as robots. These problems seriously limit their responsiveness to psychoanalytic psychotherapy; psychosomatic illness or substance abuse is frequently exacerbated should these individuals enter psychotherapy. [27]

A common misconception about alexithymia is that affected individuals are totally unable to express emotions verbally and that they may even fail to acknowledge that they experience emotions. Even before coining the term, Sifneos (1967) noted patients often mentioned things like anxiety or depression. The distinguishing factor was their inability to elaborate beyond a few limited adjectives such as "happy" or "unhappy" when describing these feelings. [54] The core issue is that people with alexithymia have poorly differentiated emotions, limiting their ability to distinguish and describe them to others. [15] This contributes to the sense of emotional detachment from themselves and difficulty connecting with others, making alexithymia negatively associated with life satisfaction even when depression and other confounding factors are controlled for. [55]

Associated conditions

Alexithymia frequently co-occurs with other disorders. Research indicates that alexithymia overlaps with autism spectrum disorders (ASD). [56] [57] [58] In a 2004 study using the TAS-20, 85% of the adults with ASD fell into the "impaired" category and almost half fell into the "severely impaired" category; in contrast, among the adult control population only 17% were "impaired", none "severely impaired". [58] [59] Fitzgerald & Bellgrove pointed out that, "Like alexithymia, Asperger's syndrome is also characterised by core disturbances in speech and language and social relationships". [60] Hill & Berthoz agreed with Fitzgerald & Bellgrove (2006) and in response stated that "there is some form of overlap between alexithymia and ASDs". They also pointed to studies that revealed impaired theory of mind skill in alexithymia, neuroanatomical evidence pointing to a shared etiology, and similar social skills deficits. [61] The exact nature of the overlap is uncertain. Alexithymic traits in AS may be linked to clinical depression or anxiety; [59] the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety. [62] On the other hand, while the total alexithymia score as well as the difficulty in identifying feelings and externally oriented thinking factors are found to be significantly associated with ADHD, and while the total alexithymia score, the difficulty in identifying feelings, and the difficulty in describing feelings factors are also significantly associated with symptoms of hyperactivity and impulsivity, there is no significant relationship between alexithymia and inattentiveness. [63]

There are many more psychiatric disorders that overlap with alexithymia. One study found that 41% of US veterans of the Vietnam War with post-traumatic stress disorder (PTSD) were alexithymic. [64] Another study found higher levels of alexithymia among Holocaust survivors with PTSD compared to those without. [65] Higher levels of alexithymia among mothers with interpersonal violence-related PTSD were found in one study to have proportionally less caregiving sensitivity. [66] This latter study suggested that when treating adult PTSD patients who are parents, alexithymia should be assessed and addressed also with attention to the parent-child relationship and the child's social-emotional development. [66]

Single study prevalence findings for other disorders include 63% in anorexia nervosa, [67] 56% in bulimia, [67] 45% [68] to 50% [69] in major depressive disorder, 34% in panic disorder, [70] 28% in social phobia, [70] and 50% in substance abusers. [71] Alexithymia is also exhibited by a large proportion of individuals with acquired brain injuries such as stroke or traumatic brain injury. [72] [73] [74]

Alexithymia is correlated with certain personality disorders, particularly schizoid, avoidant, dependent and schizotypal, [75] [76] substance use disorders, [77] [78] some anxiety disorders [79] and sexual disorders [80] as well as certain physical illnesses, such as hypertension, [81] inflammatory bowel disease, [82] diabetes [83] and functional dyspepsia. [84] Alexithymia is further linked with disorders such as migraine headaches, lower back pain, irritable bowel syndrome, asthma, nausea, allergies and fibromyalgia. [85]

An inability to modulate emotions is a possibility in explaining why some people with alexithymia are prone to discharge tension arising from unpleasant emotional states through impulsive acts or compulsive behaviors such as binge eating, substance abuse, perverse sexual behavior or anorexia nervosa. [86] The failure to regulate emotions cognitively might result in prolonged elevations of the autonomic nervous system (ANS) and neuroendocrine systems, which can lead to somatic diseases. [85] People with alexithymia also show a limited ability to experience positive emotions leading Krystal [87] and Sifneos (1987) to describe many of these individuals as anhedonic. [16]

Alexisomia is a clinical concept that refers to the difficulty in the awareness and expression of somatic, or bodily, sensations. [88] The concept was first proposed in 1979 by Yujiro Ikemi when he observed characteristics of both alexithymia and alexisomia in patients with psychosomatic diseases. [88]

Causes

It is unclear what causes alexithymia, though several theories have been proposed.

Early studies showed evidence that there may be an interhemispheric transfer deficit among people with alexithymia; that is, the emotional information from the right hemisphere of the brain is not being properly transferred to the language regions in the left hemisphere, as can be caused by a decreased corpus callosum, often present in psychiatric patients who have suffered severe childhood abuse. [89] A neuropsychological study in 1997 indicated that alexithymia may be due to a disturbance to the right hemisphere of the brain, which is largely responsible for processing emotions. [90] In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex. [91] These studies have some shortcomings, however, and the empirical evidence about the neural mechanisms behind alexithymia remains inconclusive. [92]

French psychoanalyst Joyce McDougall objected to the strong focus by clinicians on neurophysiological explanations at the expense of psychological ones for the genesis and operation of alexithymia, and introduced the alternative term "disaffectation" to stand for psychogenic alexithymia. [93] For McDougall, the disaffected individual had at some point "experienced overwhelming emotion that threatened to attack their sense of integrity and identity", to which they applied psychological defenses to pulverize and eject all emotional representations from consciousness. [94] A similar line of interpretation has been taken up using the methods of phenomenology. [95] McDougall has also noted that all infants are born unable to identify, organize, and speak about their emotional experiences (the word infans is from the Latin "not speaking"), and are "by reason of their immaturity inevitably alexithymic". [96] Based on this fact McDougall proposed in 1985 that the alexithymic part of an adult personality could be "an extremely arrested and infantile psychic structure". [96] The first language of an infant is nonverbal facial expressions. The parent's emotional state is important for determining how any child might develop. Neglect or indifference to varying changes in a child's facial expressions without proper feedback can promote an invalidation of the facial expressions manifested by the child. The parent's ability to reflect self-awareness to the child is another important factor. If the adult is incapable of recognizing and distinguishing emotional expressions in the child, it can influence the child's capacity to understand emotional expressions.[ citation needed ]

The attention-appraisal model of alexithymia by Preece and colleagues describes the mechanisms behind alexithymia within a cognitive-behavioral framework. [25] Within this model, it is specified that alexithymia levels are due to the developmental level of people's emotion schemas (those cognitive structures used to process emotions) and/or the extent to which people are avoiding their emotions as an emotion regulation strategy. There is a large body of evidence currently supporting the specifications of this model. [34] [97]

Molecular genetic research into alexithymia remains minimal, but promising candidates have been identified from studies examining connections between certain genes and alexithymia among those with psychiatric conditions as well as the general population. A study recruiting a test population of Japanese males found higher scores on the Toronto Alexithymia Scale among those with the 5-HTTLPR homozygous long (L) allele. The 5-HTTLPR region on the serotonin transporter gene influences the transcription of the serotonin transporter that removes serotonin from the synaptic cleft, and is well studied for its association with numerous psychiatric disorders. [98] Another study examining the 5-HT1A receptor, a receptor that binds serotonin, found higher levels of alexithymia among those with the G allele of the Rs6295 polymorphism within the HTR1A gene. [99] Also, a study examining alexithymia in subjects with obsessive–compulsive disorder found higher alexithymia levels associated with the Val/Val allele of the Rs4680 polymorphism in the gene that encodes Catechol-O-methyltransferase (COMT), an enzyme which degrades catecholamine neurotransmitters such as dopamine. [100] These links are tentative, and further research will be needed to clarify how these genes relate to the neurological anomalies found in the brains of people with alexithymia.

Although there is evidence for the role of environmental and neurological factors, the role and influence of genetic factors for developing alexithymia is still unclear. [101] A single large scale Danish study suggested that genetic factors contributed noticeably to the development of alexithymia. However, some scholars find twin studies and the entire field of behavior genetics to be controversial. Those scholars raise concerns about the "equal environments assumption". [102] [ needs update ] Traumatic brain injury is also implicated in the development of alexithymia, and those with traumatic brain injury are six times more likely to exhibit alexithymia. [72] [103] Alexithymia is also associated with newborn circumcision trauma. [104]

Relationships

Alexithymia can create interpersonal problems because these individuals tend to avoid emotionally close relationships, or if they do form relationships with others they usually position themselves as either dependent, dominant, or impersonal, "such that the relationship remains superficial". [105] Inadequate "differentiation" between self and others by alexithymic individuals has also been observed. [106] [107] Their difficulty in processing interpersonal connections often develops where the person lacks a romantic partner. [108]

In a study, a large group of alexithymic individuals completed the 64-item Inventory of Interpersonal Problems (IIP-64) which found that "two interpersonal problems are significantly and stably related to alexithymia: cold/distant and non-assertive social functioning. All other IIP-64 subscales were not significantly related to alexithymia." [105]

Chaotic interpersonal relations have also been observed by Sifneos. [109] Due to the inherent difficulties identifying and describing emotional states in self and others, alexithymia also negatively affects relationship satisfaction between couples. [110]

In a 2008 study [111] alexithymia was found to be correlated with impaired understanding and demonstration of relational affection, and that this impairment contributes to poorer mental health, poorer relational well-being, and lowered relationship quality. [111] Individuals high on the alexithymia spectrum also report less distress at seeing others in pain and behave less altruistically toward others. [6]

Some individuals working for organizations in which control of emotions is the norm might show alexithymic-like behavior but not be alexithymic. However, over time the lack of self-expressions can become routine and they may find it harder to identify with others. [112]

Treatment

Generally speaking, approaches to treating alexithymia are still in their infancy, with not many proven treatment options available. [113] [114]

In 2002, Kennedy and Franklin found that a skills-based intervention is an effective method for treating alexithymia. Kennedy and Franklin's treatment plan involved giving the participants a series of questionnaires, psychodynamic therapies, cognitive-behavioral and skills-based therapies, and experiential therapies. [115] After treatment, they found that participants were generally less ambivalent about expressing their emotion feelings and more attentive to their emotional states.

In 2017, based on their attention-appraisal model of alexithymia, Preece and colleagues recommended that alexithymia treatment should try to improve the developmental level of people's emotion schemas and reduce people's use of experiential avoidance of emotions as an emotion regulation strategy (i.e., the mechanisms hypothesized to underlie alexithymia difficulties in the attention-appraisal model of alexithymia). [5] [23]

In 2018, Löf, Clinton, Kaldo, and Rydén found that mentalisation-based treatment is also an effective method for treating alexithymia. Mentalisation is the ability to understand the mental state of oneself or others that underlies overt behavior, and mentalisation-based treatment helps patients separate their own thoughts and feelings from those around them. [116] This treatment is relational, and it focuses on gaining a better understanding and use of mentalising skills. The researchers found that all of the patients' symptoms including alexithymia significantly improved, and the treatment promoted affect tolerance and the ability to think flexibly while expressing intense affect rather than impulsive behavior.

A significant issue impacting alexithymia treatment is that alexithymia has comorbidity with other disorders. Mendelson's 1982 study showed that alexithymia frequently presented in people with undiagnosed chronic pain. Participants in Kennedy and Franklin's study all had anxiety disorders in conjunction with alexithymia, while those in Löf et al. were diagnosed with both alexithymia and borderline personality disorder. [117] All these comorbidity issues complicate treatment because it is difficult to find people who exclusively have alexithymia.

See also

Related Research Articles

<span class="mw-page-title-main">Borderline personality disorder</span> Medical condition

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

<span class="mw-page-title-main">Narcissistic personality disorder</span> Personality disorder

Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a diminished ability to empathize with other people's feelings. Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders. It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.

<span class="mw-page-title-main">Schizoid personality disorder</span> Personality disorder involving extreme asociality

Schizoid personality disorder is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy. Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world. Other associated features include stilted speech, a lack of deriving enjoyment from most activities, feeling as though one is an "observer" rather than a participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, all forms of asexuality, and idiosyncratic moral or political beliefs.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

<span class="mw-page-title-main">Psychological pain</span> Unpleasant feeling of a psychological nature

Psychological pain, mental pain, or emotional pain is an unpleasant feeling of a psychological, non-physical origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment." There are numerous ways psychological pain is referred to, using a different word usually reflects an emphasis on a particular aspect of mind life. Technical terms include algopsychalia and psychalgia, but it may also be called mental pain, emotional pain, psychic pain, social pain, spiritual or soul pain, or suffering. While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling. Psychological pain is widely believed to be an inescapable aspect of human existence.

An emotional expression is a behavior that communicates an emotional state or attitude. It can be verbal or nonverbal, and can occur with or without self-awareness. Emotional expressions include facial movements like smiling or scowling, simple behaviors like crying, laughing, or saying "thank you," and more complex behaviors like writing a letter or giving a gift. Individuals have some conscious control of their emotional expressions; however, they need not have conscious awareness of their emotional or affective state in order to express emotion.

Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings either verbally or nonverbally, especially when talking about issues that would normally be expected to engage emotions. In this condition, expressive gestures are rare and there is little animation in facial expression or vocal inflection. Additionally, reduced affect can be symptomatic of autism, schizophrenia, depression, post-traumatic stress disorder, depersonalization-derealization disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications.

Intensive short-term dynamic psychotherapy (ISTDP) is a form of short-term psychotherapy developed through empirical, video-recorded research by Habib Davanloo.

<span class="mw-page-title-main">Emotional detachment</span> Inability and/or disinterest in emotionally connecting to others

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion-focused coping, is used when avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

Emotional dysregulation is characterized by an inability to flexibly respond to and manage emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.

Somatosensory amplification (SSA) is a tendency to perceive normal somatic and visceral sensations as being relatively intense, disturbing and noxious. It is a common feature of hypochondriasis and is commonly found with fibromyalgia, major depressive disorder, anxiety disorders, autism spectrum disorder, and alexithymia. One common clinical measure of SSA is the Somatosensory Amplification Scale (SSAS).

Robert Michael Bagby is a Canadian psychologist, senior clinician scientist and director of clinical research at the Centre for Addiction and Mental Health (CAMH). He is a full professor in the Department of Psychiatry, University of Toronto. He became a full professor of psychology at the University of Toronto Scarborough campus in July 2011.

Post-traumatic embitterment disorder (PTED) is defined as a pathological reaction to a negative life event, which those affected experienced as a grave insult, humiliation, betrayal, or injustice. Prevalent emotions of PTED are embitterment, anger, fury, and hatred, especially against the triggering stressor, often accompanied by fantasies of revenge. The disorder commences immediately and without time delay at the moment of the triggering event. If left untreated, the prognosis of PTED presents as rather unfavorable, with those who have the disorder trapped in a vicious circle of strong negative emotions constantly intensifying one another and eventually leading into a self-destructive downward spiral. People affected by PTED are more likely to put fantasies of revenge into action, making them a serious threat to the stressor.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

Meta-mood is a term used by psychologists to refer to an individual's awareness of their emotions. The term was first utilized by John D. Mayer and Peter Salovey who believed the experience of mood involved "direct" and "indirect" components. While the direct level refers to the simple appearance of mood - happiness, fear, anger, sadness, and surprise, the indirect level, or the meta-mood experience, does not solely consist of the emotions experienced by an individual in the moment. Rather, it is a reflective state which involves additional thoughts and feelings about the mood itself. "I shouldn’t feel this way" or "I am thinking of ways to improve my mood" are examples of reflective thoughts during a meta-mood experience.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Somatic symptom disorder, also known as somatoform disorder or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

The Toronto Alexithymia Scale is a measure of deficiency in understanding, processing, or describing emotions. It was developed in 1986 and later revised, removing some of the items. The current version has twenty statements rated on a five-point Likert scale.

Dr. Allan Abbass is professor, psychiatrist, and founding Director of the Centre for Emotions and Health at Dalhousie University in Halifax, Nova Scotia, Canada.

Anxious-preoccupied attachment has been linked to various psychological and interpersonal difficulties. For example, research has suggested that anxious-preoccupied attachment may mediate the relationship between childhood emotional abuse and borderline personality disorder.

References

  1. Serani D. "The Emotional Blindness of Alexithymia". Scientific American Blog Network. Archived from the original on 2023-05-21. Retrieved 2023-05-22.
  2. Hoerricks J (2023). "Chapter 2: What is autism?". No Place for Autism?. Lived Places Publishing. p. 62. ISBN   978-1915271815.
  3. Sifneos PE (1973). "The prevalence of 'alexithymic' characteristics in psychosomatic patients". Psychotherapy and Psychosomatics. 22 (2): 255–262. doi:10.1159/000286529. PMID   4770536.
  4. 1 2 Bagby RM, Parker JD, Taylor GJ (January 1994). "The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure". Journal of Psychosomatic Research. 38 (1): 23–32. doi:10.1016/0022-3999(94)90005-1. PMID   8126686.
  5. 1 2 3 Preece D, Becerra R, Allan A, Robinson K, Dandy J (2017). "Establishing the theoretical components of alexithymia via factor analysis: Introduction and validation of the attention-appraisal model of alexithymia" (PDF). Personality and Individual Differences . 119: 341–352. doi:10.1016/j.paid.2017.08.003. S2CID   148867428.
  6. 1 2 3 Feldmanhall O, Dalgleish T, Mobbs D (March 2013). "Alexithymia decreases altruism in real social decisions". Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 49 (3): 899–904. doi:10.1016/j.cortex.2012.10.015. PMID   23245426. S2CID   32358430.
  7. von Rad M (1984). "Alexithymia and symptom formation". Psychotherapy and Psychosomatics. 42 (1–4): 80–89. doi:10.1159/000287827. PMID   6514973.
  8. Assogna F, Palmer K, Pontieri FE, Pierantozzi M, Stefani A, Gianni W, et al. (February 2012). "Alexithymia is a non-motor symptom of Parkinson disease". The American Journal of Geriatric Psychiatry. 20 (2): 133–141. doi:10.1097/JGP.0b013e318209de07. PMID   22273734.
  9. Taylor, Bagby & Parker 1997.
  10. Hogeveen J, Grafman J (2021). "Alexithymia". Disorders of Emotion in Neurologic Disease. Handbook of Clinical Neurology. Vol. 183. Elsevier. pp. 47–62. doi:10.1016/b978-0-12-822290-4.00004-9. ISBN   978-0-12-822290-4. PMC   8456171 . PMID   34389125.
  11. Karren K (2014). Mind/body health: The effects of attitudes, emotions, and relationships. Boston, MA: Pearson. p. 68. ISBN   978-0-321-88345-2.
  12. Karakis EN, Levant RF (2012). "Is Normative Male Alexithymia Associated with Relationship Satisfaction, Fear of Intimacy and Communication Quality Among Men in Relationships?". The Journal of Men's Studies. 20 (3): 179–186. doi:10.3149/jms.2003.179. S2CID   147645682.
  13. Nadal KL, ed. (2017). "Alexithymia". The SAGE Encyclopedia of Psychology and Gender. SAGE Publications. p. 58. ISBN   978-1-4833-8427-6.
  14. John (1970). "Affect and fantasy in patients with psychosomatic disorders". In Hill, Oscar W. (ed.). 'Modern Trends in Psychosomatic Medicine. Vol. 2. London: Butterworths. pp. 26–34. ISBN   978-0407313019. ISSN   0091-343X.
  15. 1 2 3 4 Bar-On R, Parker JD (2000). The Handbook of Emotional Intelligence: Theory, Development, Assessment, and Application at Home, School, and in the Workplace . San Francisco, California: Jossey-Bass. ISBN   978-0-7879-4984-6. pp. 40–59
  16. 1 2 Taylor GJ & Taylor HS (1997). Alexithymia. In M. McCallum & W.E. Piper (Eds.) Psychological mindedness: A contemporary understanding. Munich: Lawrence Erlbaum Associates pp. 28–31. ISBN 9780805817225
  17. 1 2 "Stichwort Alexi | thymie". Duden. Das Wörterbuch medizinischer Fachausdrücke. Software für PC-Bibliothek. Mannheim: Bibliographisches Institut.
  18. "alexithymic - definition of alexithymic in English". Oxford Dictionaries. Archived from the original on 11 October 2016. Retrieved 11 October 2016.
  19. Nicholls ME, Clode D, Wood SJ, Wood AG (August 1999). "Laterality of expression in portraiture: putting your best cheek forward". Proceedings. Biological Sciences. 266 (1428): 1517–1522. doi:10.1098/rspb.1999.0809. PMC   1690171 . PMID   10467743.
  20. Mark A (2005). "Organizing emotions in health care". Journal of Health Organization and Management. 19 (4–5): 277–289. doi:10.1108/14777260510615332. PMID   16206913.
  21. World Health Organization (2022). International Classification of Diseases, eleventh revision – ICD-11. Genova – icd.who.int Archived 2018-11-02 at the Wayback Machine .
  22. 1 2 Taylor GJ, Bagby RM (2021). "Examining Proposed Changes to the Conceptualization of the Alexithymia Construct: The Way Forward Tilts to the Past". Psychotherapy and Psychosomatics. 90 (3): 145–155. doi: 10.1159/000511988 . PMID   33285546.
  23. 1 2 3 4 5 Preece DA, Becerra R, Robinson K, Allan A, Boyes M, Chen W, et al. (December 2020). "What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity". Journal of Personality. 88 (6): 1162–1176. doi:10.1111/jopy.12563. PMID   32463926. S2CID   218984376.
  24. Bermond B, Oosterveld P, Vorst HC (2015-01-01). "Measures of Alexithymia". Measures of Personality and Social Psychological Constructs: 227–256. doi:10.1016/B978-0-12-386915-9.00009-7. ISBN   9780123869159. Archived from the original on 2021-05-01. Retrieved 2021-05-01.
  25. 1 2 Preece, David; Becerra, Rodrigo; Allan, Alfred; Robinson, Ken; Dandy, Justine (2017-12-01). "Establishing the theoretical components of alexithymia via factor analysis: Introduction and validation of the attention-appraisal model of alexithymia". Personality and Individual Differences. 119: 341–352. doi:10.1016/j.paid.2017.08.003. ISSN   0191-8869. S2CID   148867428.
  26. Preece, David A.; Gross, James J. (2023-12-01). "Conceptualizing alexithymia". Personality and Individual Differences. 215: 112375. doi: 10.1016/j.paid.2023.112375 . ISSN   0191-8869.
  27. 1 2 3 Taylor, Bagby & Parker 1997, p. 29.
  28. Watters CA, Taylor GJ, Bagby RM (June 2016). "Illuminating the theoretical components of alexithymia using bifactor modeling and network analysis". Psychological Assessment. 28 (6): 627–638. doi:10.1037/pas0000169. PMID   26168310.
  29. Watters CA, Taylor GJ, Quilty LC, Bagby RM (2016-11-01). "An Examination of the Topology and Measurement of the Alexithymia Construct Using Network Analysis". Journal of Personality Assessment. 98 (6): 649–659. doi:10.1080/00223891.2016.1172077. PMID   27217088. S2CID   2734992.
  30. Bermond B, Clayton K, Liberova A, Luminet O, Maruszewski T, Bitti PE, et al. (2007-08-01). "A cognitive and an affective dimension of alexithymia in six languages and seven populations". Cognition and Emotion. 21 (5): 1125–1136. doi:10.1080/02699930601056989. ISSN   0269-9931. S2CID   143728880.
  31. 1 2 Preece, David A.; Becerra, Rodrigo; Robinson, Ken; Allan, Alfred; Boyes, Mark; Chen, Wai; Hasking, Penelope; Gross, James J. (December 2020). "What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity". Journal of Personality. 88 (6): 1162–1176. doi:10.1111/jopy.12563. ISSN   0022-3506. PMID   32463926. S2CID   218984376.
  32. Vorst HC, Bermond B (2001). "Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire". Personality and Individual Differences. 30 (3): 413–434. doi:10.1016/S0191-8869(00)00033-7.
  33. Taylor, Graeme J.; Bagby, R. Michael (2020-12-07). "Examining Proposed Changes to the Conceptualization of the Alexithymia Construct: The Way Forward Tilts to the Past". Psychotherapy and Psychosomatics. 90 (3): 145–155. doi: 10.1159/000511988 . ISSN   0033-3190. PMID   33285546. S2CID   227946625.
  34. 1 2 Luminet, Olivier; Nielson, Kristy A.; Ridout, Nathan (2021-04-03). "Cognitive-emotional processing in alexithymia: an integrative review". Cognition and Emotion. 35 (3): 449–487. doi:10.1080/02699931.2021.1908231. ISSN   0269-9931. PMID   33787442. S2CID   232430204. Archived from the original on 2023-06-19. Retrieved 2023-06-19.
  35. Taylor GJ, Bagby RM, Parker JD (1992). "The Revised Toronto Alexithymia Scale: some reliability, validity, and normative data". Psychotherapy and Psychosomatics. 57 (1–2): 34–41. doi:10.1159/000288571. PMID   1584897.
  36. Preece D (2018-10-01). "The psychometric assessment of alexithymia: Development and validation of the Perth Alexithymia Questionnaire". Personality and Individual Differences. 132: 32–44. doi:10.1016/j.paid.2018.05.011. ISSN   0191-8869. S2CID   149815915. Archived from the original on 2021-05-01. Retrieved 2021-05-01.
  37. 1 2 3 Chan, Joan; Becerra, Rodrigo; Weinborn, Michael; Preece, David (2023-05-04). "Assessing Alexithymia across Asian and Western Cultures: Psychometric Properties of the Perth Alexithymia Questionnaire and Toronto Alexithymia Scale-20 in Singaporean and Australian Samples". Journal of Personality Assessment. 105 (3): 396–412. doi:10.1080/00223891.2022.2095641. ISSN   0022-3891. PMID   35900047. S2CID   251132219. Archived from the original on 2022-08-01. Retrieved 2023-06-19.
  38. Preece, David A.; Becerra, Rodrigo; Allan, Alfred; Robinson, Ken; Chen, Wai; Hasking, Penelope; Gross, James J. (2020-11-01). "Assessing alexithymia: Psychometric properties of the Perth Alexithymia Questionnaire and 20-item Toronto Alexithymia Scale in United States adults". Personality and Individual Differences. 166: 110138. doi:10.1016/j.paid.2020.110138. ISSN   0191-8869. S2CID   224870754.
  39. van der Velde, Jorien; Servaas, Michelle N.; Goerlich, Katharina S.; Bruggeman, Richard; Horton, Paul; Costafreda, Sergi G.; Aleman, André (2013-09-01). "Neural correlates of alexithymia: A meta-analysis of emotion processing studies". Neuroscience & Biobehavioral Reviews. 37 (8): 1774–1785. doi:10.1016/j.neubiorev.2013.07.008. ISSN   0149-7634. PMID   23886515. S2CID   33945541.
  40. Fukunishi I, Berger D, Wogan J, Kuboki T (August 1999). "Alexithymic traits as predictors of difficulties with adjustment in an outpatient cohort of expatriates in Tokyo". Psychological Reports. 85 (1): 67–77. doi:10.2466/pr0.1999.85.1.67. PMID   10575975. S2CID   39620868. Archived from the original on 2007-08-12. Retrieved 2007-08-10.
  41. Salminen JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J (January 1999). "Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland". Journal of Psychosomatic Research. 46 (1): 75–82. doi:10.1016/S0022-3999(98)00053-1. PMID   10088984.
  42. Mazidi, Mahdi; Azizi, Alireza; Becerra, Rodrigo; Gross, James J.; Zarei, Majid; Mirshafiei, Maryam; Preece, David A. (2023-06-07). "Cross-cultural validation and measurement invariance of the Perth Alexithymia Questionnaire (PAQ): a study in Iran and the USA". Australian Psychologist. 58 (6): 432–447. doi: 10.1080/00050067.2023.2217325 . ISSN   0005-0067.
  43. Taylor & Taylor (1997), pp. 77–104
  44. Taylor, Bagby & Parker 1997, p. 38.
  45. Parker JD, Taylor GJ, Bagby RM (2001). "The Relationship Between Emotional Intelligence and Alexithymia". Personality and Individual Differences. 30: 107–115. doi:10.1016/S0191-8869(00)00014-3.
  46. Taylor, Bagby & Parker 1997, p. 37.
  47. Krystal H (January 1979). "Alexithymia and psychotherapy". American Journal of Psychotherapy. 33 (1): 17–31. doi:10.1176/appi.psychotherapy.1979.33.1.17. PMID   464164.
  48. Nemiah, Freyberger & Sifneos 1970, p. 432–3.
  49. Krystal 1988, p. 246.
  50. McDougall 1985, p. 169-70.
  51. Taylor, Bagby & Parker 1997, pp. 29, 246–47.
  52. Krystal 1988, pp. 246–47.
  53. Nemiah CJ (1978). "Alexithymia and Psychosomatic Illness". Journal of Continuing Education. 39: 25–37.
  54. Sifneos PE (1967). "Clinical Observations on some patients suffering from a variety of psychosomatic diseases". Acta Medicina Psychosomatica. 7: 1–10.
  55. Mattila AK, Poutanen O, Koivisto AM, Salokangas RK, Joukamaa M (2007). "Alexithymia and life satisfaction in primary healthcare patients". Psychosomatics. 48 (6): 523–529. doi: 10.1176/appi.psy.48.6.523 . PMID   18071100.
  56. Paula-Perez I (Mar 2010). "Alexitimia y sindrome de Asperger". Rev Neurol. 50 (Suppl 3): S85–90. Archived from the original on 2011-07-27.
  57. Shah P, Hall R, Catmur C, Bird G (August 2016). "Alexithymia, not autism, is associated with impaired interoception". Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 81: 215–220. doi:10.1016/j.cortex.2016.03.021. PMC   4962768 . PMID   27253723.
  58. 1 2 Hill E, Berthoz S, Frith U (April 2004). "Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives". Journal of Autism and Developmental Disorders. 34 (2): 229–235. doi:10.1023/B:JADD.0000022613.41399.14. PMID   15162941. S2CID   776386.
  59. 1 2 Frith U (May 2004). "Emanuel Miller lecture: confusions and controversies about Asperger syndrome". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 45 (4): 672–686. doi: 10.1111/j.1469-7610.2004.00262.x . PMID   15056300.
  60. Fitzgerald M, Bellgrove MA (May 2006). "The overlap between alexithymia and Asperger's syndrome". Journal of Autism and Developmental Disorders. 36 (4): 573–576. doi:10.1007/s10803-006-0096-z. PMC   2092499 . PMID   16755385.
  61. Hill EL, Berthoz S (November 2006). "Response to "Letter to the Editor: The overlap between alexithymia and Asperger's syndrome", Fitzgerald and Bellgrove, Journal of Autism and Developmental Disorders, 36(4)". Journal of Autism and Developmental Disorders. 36 (8): 1143–1145. doi:10.1007/s10803-006-0287-7. PMID   17080269. S2CID   28686022.
  62. Tani P, Lindberg N, Joukamaa M, Nieminen-von Wendt T, von Wendt L, Appelberg B, et al. (2004). "Asperger syndrome, alexithymia and perception of sleep". Neuropsychobiology. 49 (2): 64–70. doi:10.1159/000076412. PMID   14981336. S2CID   45311366.
  63. Donfrancesco R, Di Trani M, Gregori P, Auguanno G, Melegari MG, Zaninotto S, Luby J (December 2013). "Attention-deficit/hyperactivity disorder and alexithymia: a pilot study". Attention Deficit and Hyperactivity Disorders. 5 (4): 361–367. doi:10.1007/s12402-013-0115-9. PMID   23864438. S2CID   20228527.
  64. Shipko S, Alvarez WA, Noviello N (1983). "Towards a teleological model of alexithymia: alexithymia and post-traumatic stress disorder". Psychotherapy and Psychosomatics. 39 (2): 122–126. doi:10.1159/000287730. PMID   6878595.
  65. Yehuda R, Steiner A, Kahana B, Binder-Brynes K, Southwick SM, Zemelman S, Giller EL (1997). "Alexithymia in Holocaust survivors with and without PTSD". J Trauma Stress. 10 (1): 83–100. doi:10.1002/jts.2490100108.
  66. 1 2 Schechter DS, Suardi F, Manini A, Cordero MI, Rossignol AS, Merminod G, et al. (June 2015). "How do maternal PTSD and alexithymia interact to impact maternal behavior?" (PDF). Child Psychiatry and Human Development. 46 (3): 406–417. doi:10.1007/s10578-014-0480-4. PMID   25008189. S2CID   254378167. Archived (PDF) from the original on 2023-08-10. Retrieved 2023-06-05.
  67. 1 2 Cochrane CE, Brewerton TD, Wilson DB, Hodges EL (September 1993). "Alexithymia in the eating disorders". The International Journal of Eating Disorders. 14 (2): 219–222. doi:10.1002/1098-108x(199309)14:2<219::aid-eat2260140212>3.0.co;2-g. PMID   8401555.
  68. Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamäki H (2001). "Alexithymia and depression: a prospective study of patients with major depressive disorder". Psychosomatics. 42 (3): 229–234. doi: 10.1176/appi.psy.42.3.229 . PMID   11351111.
  69. Kim JH, Lee SJ, Rim HD, Kim HW, Bae GY, Chang SM (September 2008). "The Relationship between Alexithymia and General Symptoms of Patients with Depressive Disorders". Psychiatry Investigation. 5 (3): 179–185. doi:10.4306/pi.2008.5.3.179. PMC   2796028 . PMID   20046363.
  70. 1 2 Cox BJ, Swinson RP, Shulman ID, Bourdeau D (1995). "Alexithymia in panic disorder and social phobia". Comprehensive Psychiatry. 36 (3): 195–198. doi:10.1016/0010-440X(95)90081-6. PMID   7648842.
  71. Taylor GJ, Parker JD, Bagby RM (September 1990). "A preliminary investigation of alexithymia in men with psychoactive substance dependence". The American Journal of Psychiatry. 147 (9): 1228–1230. doi:10.1176/ajp.147.9.1228. PMID   2386256.
  72. 1 2 Williams C, Wood RL (March 2010). "Alexithymia and emotional empathy following traumatic brain injury". Journal of Clinical and Experimental Neuropsychology. 32 (3): 259–267. doi:10.1080/13803390902976940. PMID   19548166. S2CID   34126700.
  73. Koponen S, Taiminen T, Honkalampi K, Joukamaa M, Viinamäki H, Kurki T, et al. (2005). "Alexithymia after traumatic brain injury: its relation to magnetic resonance imaging findings and psychiatric disorders". Psychosomatic Medicine. 67 (5): 807–812. CiteSeerX   10.1.1.533.7505 . doi:10.1097/01.psy.0000181278.92249.e5. PMID   16204442. S2CID   22630865.
  74. Becerra R, Amos A, Jongenelis S (July 2002). "Organic alexithymia: a study of acquired emotional blindness". Brain Injury. 16 (7): 633–645. doi:10.1080/02699050110119817. PMID   12119081. S2CID   13877968.
  75. Coolidge FL, Estey AJ, Segal DL, Marle PD (February 2013). "Are alexithymia and schizoid personality disorder synonymous diagnoses?". Comprehensive Psychiatry. 54 (2): 141–148. doi:10.1016/j.comppsych.2012.07.005. PMID   23021894. S2CID   15019411.
  76. Taylor, Bagby & Parker 1997, pp. 162–5.
  77. Li CS, Sinha R (March 2006). "Alexithymia and stress-induced brain activation in cocaine-dependent men and women". Journal of Psychiatry & Neuroscience. 31 (2): 115–121. PMC   1413961 . PMID   16575427.
  78. Lumley MA, Downey K, Stettner L, Wehmer F, Pomerleau OF (1994). "Alexithymia and negative affect: relationship to cigarette smoking, nicotine dependence, and smoking cessation". Psychotherapy and Psychosomatics. 61 (3–4): 156–162. doi:10.1159/000288884. PMID   8066152.
  79. Jones BA (November 1984). "Panic attacks with panic masked by alexithymia". Psychosomatics. 25 (11): 858–859. doi:10.1016/S0033-3182(84)72947-1. PMID   6505131. Archived from the original (PDF) on 2012-07-14. Retrieved 2006-12-17.
  80. Michetti PM, Rossi R, Bonanno D, Tiesi A, Simonelli C (2006). "Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)". International Journal of Impotence Research. 18 (2): 170–174. doi:10.1038/sj.ijir.3901386. PMID   16151475. S2CID   22350032.
  81. Jula A, Salminen JK, Saarijärvi S (April 1999). "Alexithymia: a facet of essential hypertension". Hypertension. 33 (4): 1057–1061. doi: 10.1161/01.HYP.33.4.1057 . PMID   10205248.
  82. Verissimo R, Mota-Cardoso R, Taylor G (1998). "Relationships between alexithymia, emotional control, and quality of life in patients with inflammatory bowel disease". Psychotherapy and Psychosomatics. 67 (2): 75–80. doi:10.1159/000012263. PMID   9556198. S2CID   46763537.
  83. Abramson L, McClelland DC, Brown D, Kelner S (August 1991). "Alexithymic characteristics and metabolic control in diabetic and healthy adults". The Journal of Nervous and Mental Disease. 179 (8): 490–494. doi:10.1097/00005053-199108000-00007. PMID   1856712. S2CID   12385601.
  84. Jones MP, Schettler A, Olden K, Crowell MD (2004). "Alexithymia and somatosensory amplification in functional dyspepsia". Psychosomatics. 45 (6): 508–516. doi: 10.1176/appi.psy.45.6.508 . PMID   15546828.
  85. 1 2 Taylor, Bagby & Parker 1997, pp. 216–248.
  86. Taylor, Bagby & Parker 1997, pp. 190–216.
  87. Krystal 1988.
  88. 1 2 Oka T (2020). "Shitsu-taikan-sho (alexisomia): a historical review and its clinical importance". BioPsychoSocial Medicine. 14: 23. doi: 10.1186/s13030-020-00193-9 . PMC   7520027 . PMID   32999684.
  89. Hoppe KD, Bogen JE (1977). "Alexithymia in twelve commissurotomized patients". Psychotherapy and Psychosomatics. 28 (1–4): 148–155. doi:10.1159/000287057. PMID   609675.
  90. Jessimer M, Markham R (July 1997). "Alexithymia: a right hemisphere dysfunction specific to recognition of certain facial expressions?". Brain and Cognition. 34 (2): 246–258. doi:10.1006/brcg.1997.0900. PMID   9220088. S2CID   29419777.
  91. Lane RD, Ahern GL, Schwartz GE, Kaszniak AW (November 1997). "Is alexithymia the emotional equivalent of blindsight?". Biological Psychiatry. 42 (9): 834–844. doi:10.1016/S0006-3223(97)00050-4. PMID   9347133. S2CID   10963766.
  92. Tabibnia G, Zaidel E (2005). "Alexithymia, interhemispheric transfer, and right hemispheric specialization: a critical review". Psychotherapy and Psychosomatics. 74 (2): 81–92. doi:10.1159/000083166. PMID   15741757. S2CID   37677853.
  93. McDougall 1989, pp. 93, 103.
  94. McDougall 1989, p. 93-4.
  95. Maclaren K (2006). "Emotional Disorder and the Mind-Body Problem: A Case Study of Alexithymia". Chiasmi International. 8: 139–55. doi:10.5840/chiasmi2006819.
  96. 1 2 McDougall 1985, p. 161.
  97. Preece, David A.; Mehta, Ashish; Petrova, Kate; Sikka, Pilleriin; Bjureberg, Johan; Becerra, Rodrigo; Gross, James J. (2023-03-01). "Alexithymia and emotion regulation". Journal of Affective Disorders. 324: 232–238. doi:10.1016/j.jad.2022.12.065. ISSN   0165-0327. PMID   36566943. S2CID   255081636.
  98. Kano M, Mizuno T, Kawano Y, Aoki M, Kanazawa M, Fukudo S (1 January 2012). "Serotonin transporter gene promoter polymorphism and alexithymia". Neuropsychobiology. 65 (2): 76–82. doi:10.1159/000329554. PMID   22222552. S2CID   26543708.
  99. Gong P, Liu J, Li S, Zhou X (December 2014). "Serotonin receptor gene (5-HT1A) modulates alexithymic characteristics and attachment orientation". Psychoneuroendocrinology. 50: 274–279. doi:10.1016/j.psyneuen.2014.09.001. PMID   25247748. S2CID   7545489.
  100. Koh MJ, Kang JI, Namkoong K, Lee SY, Kim SJ (May 2016). "Association between the Catechol-O-Methyltransferase (COMT) Val¹⁵⁸Met Polymorphism and Alexithymia in Patients with Obsessive-Compulsive Disorder". Yonsei Medical Journal. 57 (3): 721–727. doi:10.3349/ymj.2016.57.3.721. PMC   4800363 . PMID   26996573.
  101. Jørgensen MM, Zachariae R, Skytthe A, Kyvik K (2007). "Genetic and environmental factors in alexithymia: a population-based study of 8,785 Danish twin pairs". Psychotherapy and Psychosomatics. 76 (6): 369–375. doi:10.1159/000107565. PMID   17917473. S2CID   5879112.
  102. Pam A, Kemker SS, Ross CA, Golden R (1996). "The "equal environments assumption" in MZ-DZ twin comparisons: an untenable premise of psychiatric genetics?". Acta Geneticae Medicae et Gemellologiae. 45 (3): 349–360. doi:10.1017/S0001566000000945. PMID   9014000.
  103. Hogeveen J, Bird G, Chau A, Krueger F, Grafman J (February 2016). "Acquired alexithymia following damage to the anterior insula". Neuropsychologia. 82: 142–148. doi:10.1016/j.neuropsychologia.2016.01.021. PMC   4752907 . PMID   26801227.
  104. Bollinger, Dan; Howe, Robert S. Van (2011-05-01). "Alexithymia and Circumcision Trauma: A Preliminary Investigation". International Journal of Men's Health. 10 (2): 184–195. doi:10.3149/jmh.1002.184. ISSN   1532-6306.
  105. 1 2 Vanheule S, Desmet M, Meganck R, Bogaerts S (January 2007). "Alexithymia and interpersonal problems". Journal of Clinical Psychology. 63 (1): 109–117. CiteSeerX   10.1.1.499.8287 . doi:10.1002/jclp.20324. PMID   17016830.
  106. Blaustein JP, Tuber SB (1998). "Knowing the Unspeakable". Bulletin of the Menninger Clinic. 62: 351–365.
  107. Taylor, Bagby & Parker 1997, pp. 26–46.
  108. Holmgreen L, Oswald DL (October 2017). "Men's Sexual Coerciveness, Perceptions of Women's Attachment, and Dating Preferences" (PDF). Violence and Victims. 32 (5): 935–952. doi:10.1891/0886-6708.VV-D-12-00133. PMID   28810935. S2CID   5016730. Archived (PDF) from the original on 2024-09-09. Retrieved 2023-06-05.
  109. Sifneos PE (July 1996). "Alexithymia: past and present". The American Journal of Psychiatry. 153 (7 Suppl): 137–142. doi:10.1176/ajp.153.7.137. PMID   8659637.
  110. Yelsma P, Marrow S (2003). "An Examination of Couples' Difficulties With Emotional Expressiveness and Their Marital Satisfaction". Journal of Family Communication. 3 (1): 41–62. doi:10.1207/S15327698JFC0301_03. S2CID   144200365.
  111. 1 2 Colin H, Kory F (2008). "Affectionate experience mediates the effects of alexithymia on mental health and interpersonal relationships". Journal of Social and Personal Relationships. 25 (5): 793–810. doi:10.1177/0265407508096696. S2CID   144438014.
  112. de Vries MF, de Vries MF (January 2001). Struggling with the Demon: Perspectives on Individual and Organizational Irrationality. Psychosocial Press.
  113. Samur D, Tops M, Schlinkert C, Quirin M, Cuijpers P, Koole SL (2013). "Four decades of research on alexithymia: moving toward clinical applications". Frontiers in Psychology. 4: 861. doi: 10.3389/fpsyg.2013.00861 . PMC   3832802 . PMID   24312069.
  114. Smith R, Kaszniak AW, Katsanis J, Lane RD, Nielsen L (February 2019). "The importance of identifying underlying process abnormalities in alexithymia: Implications of the three-process model and a single case study illustration". Consciousness and Cognition. 68: 33–46. doi:10.1016/j.concog.2018.12.004. PMID   30605861. S2CID   58594332.
  115. Kennedy M, Franklin J (2002). "Skills-based Treatment for Alexithymia: An Exploratory Case Series". Behaviour Change. 19 (3): 158–171. doi:10.1375/bech.19.3.158. S2CID   42495760.
  116. Löf J, Clinton D, Kaldo V, Rydén G (June 2018). "Symptom, alexithymia and self-image outcomes of Mentalisation-based treatment for borderline personality disorder: a naturalistic study". BMC Psychiatry. 18 (1): 185. doi: 10.1186/s12888-018-1699-6 . PMC   5996479 . PMID   29890960.
  117. Mendelson G (1982). "Alexithymia and chronic pain: prevalence, correlates and treatment results". Psychotherapy and Psychosomatics. 37 (3): 154–164. doi:10.1159/000287568. PMID   7178397.

Further reading