Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


alexithymiaAlexithymia: “A patient and his wife were sitting in front of me. The issue was that he was physically abusing her, but she felt that she would be worse-off without him.

I asked him how he felt after he harmed her. He said “I feel bad”.

I asked him how he felt before he struck her, and he replied “I feel bad.”

I told him that “bad” is not an emotion and did he, in fact, know what he felt.

He replied that he certainly did and took a crumbled piece of paper from his pocket and read from it. He then proudly stated “well, in group (therapy), they told me to write down these emotions they were discussing. So I guess I feel jealous…or frustrated…or maybe angry…or could be frightened…not certain.”

I then asked him how she felt when he struck her. He replied “I have not a clue…maybe pain?”

“Alexithymia” is a marked dysfunction in emotional awareness, social attachment, and interpersonal relating. These individuals have difficulty in distinguishing and appreciating the emotions of others, leading them to be un-empathetic with ineffective emotional responding to others. Alexithymia is a personality trait that places individuals at risk for physical disorders while reducing the likelihood that they will respond to conventional care. They are not “psychologically minded” and lack “emotional intelligence,” the connection between their physical and their emotional world. This personality trait appears to be enduring.

Such individuals have deficiencies in identifying, describing, and working with their own feelings, and a lack of understanding of the feelings of other. They have restricted imagination with concrete thinking and inability to use emotional response to solve problems. For example, their dream life is not rich. They may dream of going for a walk, sitting by a stream, or cleaning a room. They lack intuition and live a rather robotic existence.

A distinguishing factor is their inability to elaborate feelings beyond restricted adjectives such as “happy” or “unhappy”. There is often an impaired quality of life, inability to emotionally relate to others or benefit from social interaction.

There is evidence that there may be a genetic basis for alexithymia, a problem with areas of the brain communicating and a deficit in capacity for learning emotional cues and differentiating between bodily sensations and the emotions triggering them.

Alexithymic patients are unlikely to benefit from traditional psychological approaches, to effectively understand the emotional cause and impact of their illness or injury, and/or to benefit from usual and customary treatment for medical and surgical care.

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