Alexithymia: The Term for Inability to Identify and Express Emotions
The term you're looking for is "alexithymia," which literally means "no words for feelings" in Greek and describes a personality trait characterized by difficulty identifying, describing, and expressing one's own emotions. 1, 2
Core Features of Alexithymia
Alexithymia encompasses several distinct characteristics that define this emotional processing disturbance:
- Difficulty recognizing and verbalizing feelings - individuals cannot find words to describe their emotional states 1, 2
- Tendency to describe physical symptoms instead of emotions - endless description of bodily sensations rather than emotional experiences 2, 3
- Concrete, externally-focused thinking - speech and thought closely tied to external events with minimal introspection 2, 4
- Impoverished fantasy life - marked paucity of imagination and daydreaming 2, 4
- Inability to distinguish between emotions and bodily sensations - confusion between physical and emotional experiences 5
Important Clinical Distinctions
Alexithymia represents a stable personality trait rather than a temporary emotional state. Research demonstrates that alexithymia levels remain constant even when emotional distress fluctuates significantly, confirming it as a trait rather than state phenomenon 6. This distinguishes it from temporary emotional numbing that can occur after trauma or during depression 4.
Alexithymia differs fundamentally from the inability to cry or show emotion outwardly - it specifically involves the internal experience and cognitive processing of emotions, not just their external expression 1, 2. Some individuals with alexithymia may still cry or display emotions physically, but they cannot identify or articulate what they're feeling internally.
Clinical Context and Associated Conditions
Alexithymia appears across multiple psychiatric and medical conditions:
- Functional neurological disorders - described as "panic without panic" where individuals experience physiological anxiety symptoms without recognizing the emotional experience 1
- Depression and alcoholism - higher rates observed in these populations 3
- Psychosomatic illnesses - initially described in this context and considered a risk factor for physical disease 2, 4
- PTSD and complex trauma - can overlap with emotional processing difficulties 1
Alexithymic individuals demonstrate lower internal locus of control and reduced family cohesion compared to non-alexithymic individuals, suggesting broader psychosocial impacts 3.
Assessment Approaches
The most validated measurement tools include:
- Toronto Alexithymia Scale (TAS) - 26-item self-report with stable factor structure and internal consistency 2
- Beth Israel Questionnaire (BIQ) - 17-item interviewer-completed forced-choice questionnaire 2
Other scales lack sufficient validation and reliability for clinical use 2.
Treatment Considerations
There is no single treatment modality for alexithymia given its nature as a spectrum disorder 4. Therapeutic approaches depend critically on whether alexithymia is primary (inherent personality trait) or secondary (resulting from trauma, depression, or pathological grief) 4.
- Skills Training in Affect and Interpersonal Regulation (STAIR) combined with exposure therapy shows efficacy for improving mood regulation skills in trauma-related emotional processing difficulties 1, 7
- Psychoanalytic-oriented and behavioral approaches demonstrate some benefit, though controlled studies are limited 4
- Psychotropic medications lack controlled study evidence specifically for alexithymia 4
Blocking of affect has dire effects on psychosomatic health and capacity for intimacy, manifesting as muscular rigidity, weariness, and anhedonia 4. Recognition of these subtle presentations is essential for diagnosis.
Critical Clinical Pitfall
Do not confuse alexithymia with flat affect or emotional lability from neurological conditions - these represent distinct phenomena. Flat affect involves reduced outward emotional expression from organic brain changes, while pseudobulbar affect causes involuntary crying/laughing episodes dissociated from actual mood 8. Alexithymia specifically involves the cognitive inability to process and articulate internal emotional experiences, regardless of outward expression 1, 2.