Keys to prevention in mental health - Alexithymia

I first encountered the concept of alexithymia when I worked with people suffering from eating disorders. Many people experiencing eating disorders have great difficulty identifying and naming their own emotions.

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For many people with eating disorders (and for a lot of the rest of us for that matter), it is so much easier to focus on and talk about, weight and shape than it is to talk about emotions.

People with alexithymia have trouble experiencing and naming their emotions as well as recognising and naming the emotions of others. A disability like that can lead to all sorts of difficulty in the interpersonal space and, unaddressed, is likely to evolve over time into something more serious.

Alexithymia, sometimes called “emotional blindness”, is associated with paying less attention to your internal world, a kind of sub-conscious head-in-the-sand approach to emotional management, if you like - but that implies that people with alexithymia could put their feelings into words if they wanted to.  The truth is, they just can’t.

So, is this another mental health disorder?

Traditionally (if something about a condition that was first described in 1972 can be considered “traditional”) alexithymia is not considered a disorder or a diagnosis but a personality trait. It is interesting that more recent research also finds associations between alexithymia and early childhood trauma. I’m quietly wondering if that situation might be more a kind of dissociation but, apologies, I seem to be wandering off track.

People with alexithymia often:

  • have difficulty identifying different types of feelings and limited understanding of what causes feelings
  • have difficulty expressing feelings
  • find recognising facial cues difficult and may often ignore or misinterpret them
  • have limited or rigid imagination and constricted style of thinking
  • are hypersensitive to physical sensations
  • are detached from or tentative in their connection to others

Where can alexithymia lead?

Some recent work done as part of the Longitudinal European Autism Project based at Kings College in London has looked at a group of people with alexithymia, both autistic and neurotypical, and confirmed that those with early alexithymia in both groups are much more likely to develop serious difficulty with anxiety as time goes by, along with interpersonal communication difficulties and sometimes depression.

(As an aside – it’s worth noting that only about half of the people diagnosed with autism have alexithymia and many people without autism are alexithymic. They are not the same thing!)

It goes without saying that it is especially challenging for people who start out with alexithymia to understand and manage these emotional disorders when they develop.

How can we identify the problem?

Hallmarks of alexithymia include “missed cues” in interpersonal relationships and flattened reactions. You can observe this in children as well as some adults.  It’s not that they are not paying attention or don’t care - they just don’t get it.

There’s an interesting article in Mosaic Science from 2018 here that describes one man’s journey through life with alexithymia. It also touches on autism and psychopathy, so it is an interesting all-round read.

What can we do to help?

There are ways to help people manage alexithymia. We can:

  • Encourage a language of feelings by explaining our own emotional reactions in clear concise terms to children to help them learn about emotions and encouraging them to talk about how they are feeling. They may also benefit from reading, watching or listening to stories that have emotional content as well as action. Other people’s stories are often helpful in developing mental health awareness and, in this case, they may contribute to improvement in emotional vocabulary and repertoire.
  • Regular journaling may be also useful to improve internal and external observational skills. They may well hate it at first, so perseverance and creative ways to encourage it may be necessary.
  • Art practice and art therapy can provide people with non-verbal ways of expressing emotional states that can be very helpful.
  • Relaxation training may also be useful – especially those methods that encourage awareness of internal states.

It’s interesting to note how universally beneficial each of these strategies is likely to be – you don’t have to have alexithymia to find them helpful!

Given the known trajectory of people with alexithymia towards mental health problems, I wonder if identifying and addressing it may be one of the ways that we can help prevent the development of mental health problems in our community.

 

 

 

 

 

 

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Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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