Alexithymia occurs in approximately 10% of the general population and often co-occurs with various mental disorders, particularly with
neurodevelopmental disorders.[10] Difficulty in recognizing and discussing emotions may manifest at
subclinical 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 1973 to describe a particular psychological phenomenon.[14][15][16] 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.[17]
In its literal sense, alexithymia signifies "no words for emotions".[16] 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.[18] Those who exhibit alexithymic traits or characteristics are commonly referred to as alexithymics or alexithymiacs.[19]
Classification
Alexithymia is considered to be a personality trait that places affected individuals at risk for other medical and mental disorders, as well as reducing the likelihood that these individuals will respond to conventional treatments to these disorders.[20] The
DSM-V and the
ICD-11 neither classify alexithymia as a
symptom nor as mental disorder.[21] It is a dimensional personality trait that varies in intensity from person-to-person. A person's alexithymia score can be measured with questionnaires such as the
Toronto Alexithymia Scale (TAS-20),[4] the Perth Alexithymia Questionnaire (PAQ),[22] the Bermond-Vorst Alexithymia Questionnaire (BVAQ),[23] the Levels of Emotional Awareness Scale (LEAS),[24] the Online Alexithymia Questionnaire (OAQ-G2),[25] the Toronto Structured Interview for Alexithymia (TSIA),[26] or the Observer Alexithymia Scale (OAS).[20] It is distinct from the psychiatric
personality disorders, such as
antisocial personality disorder.[27]
However, there is no consensus on the definition of alexithymia, with debate between cognitive behavioral and psychoanalytic theorists.[28][29][30]
The cognitive behavioral model (i.e., the attention-appraisal model of alexithymia) defines alexithymia as having three components:[31][32]
difficulty identifying feelings (DIF)
difficulty describing feelings (DDF)
externally oriented thinking (EOT), characterized by a tendency to not focus attention on emotions.
The psychoanalytic model defines alexithymia as having four components:[33]
difficulty identifying feelings (DIF)
difficulty describing feelings to other people (DDF)
a stimulus-bound, externally oriented thinking style (EOT)
constricted imaginal processes (IMP) characterized by infrequent daydreaming
In
empirical research, it is often observed that constricted imaginal processes, defined as a lack of spontaneous imagining (
daydreaming; compare
aphantasia), when measured, do not statistically correlate with the other components of alexithymia.[29][34][35][36][37] Such findings have led to ongoing debate in the field about whether IMP is indeed a component of alexithymia.[28][29][23] 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][29] 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,[38] whereas the attention-appraisal model (presently the most widely used cognitive-behavioral model of alexithymia)[39] excludes IMP from the construct.[37] In practice, since the constricted imaginal processes items were removed from earlier versions of the TAS-20 in the 1990s,[40] 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][22] 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;[41] 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.[41][42] Such findings of valence-specific effects in alexithymia are also supported by brain imaging studies.[43]
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.[44] 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.[45] 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).[46][41]
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;[14] 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.[51] Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterizes alexithymia.[14]
Some alexithymic individuals may appear to contradict the above-mentioned characteristics because they can experience chronic
dysphoria or manifest outbursts of crying or rage.[52][53][54][55] However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings.[33]
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.[56][57] 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.[33]
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.[58] The core issue is that people with alexithymia have poorly differentiated emotions, limiting their ability to distinguish and describe them to others.[14] 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.[59]
Associated conditions
Alexithymia frequently
co-occurs with other disorders. Research indicates that alexithymia overlaps with
autism spectrum disorders (ASD).[25][60][61] 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".[61][62] Fitzgerald & Bellgrove pointed out that, "Like alexithymia,
Asperger's syndrome is also characterised by core disturbances in speech and language and social relationships".[63] 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.[64] The exact nature of the overlap is uncertain. Alexithymic traits in AS may be linked to
clinical depression or
anxiety;[62] the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety.[65] 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 symptom.[66]
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.[67] Another study found higher levels of alexithymia among
Holocaust survivors with PTSD compared to those without.[68] Higher levels of alexithymia among mothers with interpersonal violence-related PTSD were found in one study to have proportionally less caregiving sensitivity.[69] 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.[69]
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,
perversesexual behavior or anorexia nervosa.[89] 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.[88] People with alexithymia also show a limited ability to experience positive emotions leading Krystal[90] and Sifneos (1987) to describe many of these individuals as
anhedonic.[15]
Alexisomia is a clinical concept that refers to the difficulty in the awareness and expression of somatic, or bodily, sensations.[91] The concept was first proposed in 1979 by Yujiro Ikemi when he observed characteristics of both alexithymia and alexisomia in patients with psychosomatic diseases.[91]
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.[92] 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.[93] In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the
anterior cingulate cortex.[94] These studies have some shortcomings, however, and the empirical evidence about the neural mechanisms behind alexithymia remains inconclusive.[95]
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.[96] 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.[97] A similar line of interpretation has been taken up using the methods of
phenomenology.[98] 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".[99] 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".[99] 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.[31] 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.[39][100]
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.[101] 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
Rs6295polymorphism within the HTR1A gene.[102] 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.[103] 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.[104] 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".[105][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.[75][106]
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".[107] Inadequate "differentiation" between self and others by alexithymic individuals has also been observed.[108][109] Their difficulty in processing interpersonal connections often develops where the person lacks a romantic partner.[110]
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."[107]
Chaotic interpersonal relations have also been observed by Sifneos.[111] Due to the inherent difficulties identifying and describing emotional states in self and others, alexithymia also negatively affects relationship satisfaction between couples.[112]
In a 2008 study[113] 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.[113] 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.[114]
Treatment
Generally speaking, approaches to treating alexithymia are still in their infancy, with not many proven treatment options available.[115][116]
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.[117] 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][29]
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.[118] 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.[119] All these comorbidity issues complicate treatment because it is difficult to find people who exclusively have alexithymia.
^Hoerricks J (2023). "Chapter 2: What is autism?". No Place for Autism?. Lived Places Publishing. p. 62.
ISBN978-1915271815.
^Sifneos PE (1973). "The prevalence of 'alexithymic' characteristics in psychosomatic patients". Psychotherapy and Psychosomatics. 22 (2): 255–262.
doi:
10.1159/000286529.
PMID4770536.
^
abcBagby 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.
PMID8126686.
^
abcFeldmanhall 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.
PMID23245426.
S2CID32358430.
^von Rad M (1984). "Alexithymia and symptom formation". Psychotherapy and Psychosomatics. 42 (1–4): 80–89.
doi:
10.1159/000287827.
PMID6514973.
^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.
PMID22273734.
^Karren K (2014). Mind/body health: The effects of attitudes, emotions, and relationships. Boston, MA: Pearson. p. 68.
ISBN978-0-321-88345-2.
^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.
S2CID147645682.
^Nadal KL, ed. (2017). "Alexithymia". The SAGE Encyclopedia of Psychology and Gender. SAGE Publications. p. 58.
ISBN978-1-4833-8427-6.
^
abTaylor 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
^
ab"Stichwort Alexi | thymie". Duden. Das Wörterbuch medizinischer Fachausdrücke. Software für PC-Bibliothek. Mannheim: Bibliographisches Institut.
^Mark A (2005). "Organizing emotions in health care". Journal of Health Organization and Management. 19 (4–5): 277–289.
doi:
10.1108/14777260510615332.
PMID16206913.
^
abVorst 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.
^Lane RD, Quinlan DM, Schwartz GE, Walker PA, Zeitlin SB (1990-09-01). "The Levels of Emotional Awareness Scale: a cognitive-developmental measure of emotion". Journal of Personality Assessment. 55 (1–2): 124–134.
doi:
10.1080/00223891.1990.9674052.
PMID2231235.
^Bagby RM, Taylor GJ, Parker JD, Dickens SE (2006). "The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity". Psychotherapy and Psychosomatics. 75 (1): 25–39.
doi:
10.1159/000089224.
PMID16361872.
S2CID28825301.
^Bach M, de Zwaan M, Ackard D, Nutzinger DO, Mitchell JE (1994-05-01). "Alexithymia: relationship to personality disorders". Comprehensive Psychiatry. 35 (3): 239–243.
doi:
10.1016/0010-440X(94)90197-X.
PMID8045115.
^
abcdePreece 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.
PMID32463926.
S2CID218984376.
^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.
PMID26168310.
^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.
PMID27217088.
S2CID2734992.
^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.
ISSN0269-9931.
S2CID143728880.
^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.
PMID10088984.
^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.
^Nemiah CJ (1978). "Alexithymia and Psychosomatic Illness". Journal of Continuing Education. 39: 25–37.
^Sifneos PE (1967). "Clinical Observations on some patients suffering from a variety of psychosomatic diseases". Acta Medicina Psychosomatica. 7: 1–10.
^
abHill 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.
PMID15162941.
S2CID776386.
^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.
PMID17080269.
S2CID28686022.
^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.
PMID14981336.
S2CID45311366.
^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.
PMID23864438.
S2CID20228527.
^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.
PMID6878595.
^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.
^
abCox 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.
PMID7648842.
^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.
PMID2386256.
^
abWilliams 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.
PMID19548166.
S2CID34126700.
^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.
PMID16151475.
S2CID22350032.
^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.
PMID9556198.
S2CID46763537.
^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.
PMID1856712.
S2CID12385601.
^Hoppe KD, Bogen JE (1977). "Alexithymia in twelve commissurotomized patients". Psychotherapy and Psychosomatics. 28 (1–4): 148–155.
doi:
10.1159/000287057.
PMID609675.
^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.
PMID9220088.
S2CID29419777.
^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.
PMID15741757.
S2CID37677853.
^Maclaren K (2006). "Emotional Disorder and the Mind-Body Problem: A Case Study of Alexithymia". Chiasmi International. 8: 139–55.
doi:
10.5840/chiasmi2006819.
^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.
PMID22222552.
S2CID26543708.
^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.
PMID25247748.
S2CID7545489.
^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.
PMID17917473.
S2CID5879112.
^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.
PMID9014000.
^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.
PMID8659637.
^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.
S2CID144200365.
^
abColin 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.
S2CID144438014.
^de Vries MF, de Vries MF (January 2001). Struggling with the Demon: Perspectives on Individual and Organizational Irrationality. Psychosocial Press.
^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.
PMID30605861.
S2CID58594332.
^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.
S2CID42495760.
Nemiah JC, Freyberger H, Sifneos PE (1970). "Alexithymia: A View of the Psychosomatic Process". In Hill O (ed.). Modern Trends in Psychosomatic Medicine. Vol. 3. pp. 430–439.
Taylor GJ, Bagby RM, Parker JD (1997). Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge: Cambridge University Press.
ISBN978-0-521-45610-4.
External links
Look up alexithymia in Wiktionary, the free dictionary.