Alexithymia: I Don’t Know What I’m Feeling

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In the 1970s, Harvard Professor and Psychiatrist Peter Sifneos coined the term alexithymia, which means lacking words for one’s emotions. Alexithymia can be further described as having problems identifying one’s emotion as well as identifying words to accurately express it. Emotions play two core functions in our lives: 1) expressing our emotions to others can help us develop or strengthen social ties; 2) emotions are messengers that bring our needs to our attention so that they can be met. For instance:

• Frustration is a sign that we need to do something different, because how we are currently approaching a situation is not achieving our desired outcome.

• Resentment tells us that an important boundary has been violated and it encourages us to (re)establish that boundary.

• Feeling ‘off-balance’ tells us we need to engage in self-care practices to become more balanced.

• Disgust tells us to avoid someone or something because it is deemed as unhealthy or even toxic.

Why Alexithymia Occurs

During early childhood, our caregivers are the most influential source of our development. They model how to respond to life challenges, modeling emotional responses that range from helplessness, frustration, to confident or calm. Through our interactions with and observations of our parents, we learn go-to strategies that we begin to facilitate in our lives. We also learn which emotions are safe to express and which ones result in disconnection between us and our caregivers. Caregivers who are emotionally shut down or unexpressive will likely not model or invite warmth, curiosity, or joy. They tend to not engage in mirroring, something that is crucial for normal human development.

Tom Bunn, LCSW describes mirroring as “a set of behaviors that are intended to convey to the child that they are heard and that the parents understand their emotional state.” Mirroring can look like a caregiver matching our vocal tone, repeating what we say to them, or imitating our body language. Mirroring is like it sounds: we express ourselves in some way and we see representations of what we look like and sound like from the caregiver. Mirroring also helps children develop clarity around what their emotions are trying to convey. Are they tired or hungry? Are they feeling hurt, fear, or shame? Mirroring is referred to as “the wellspring of emotional literacy.” People who can name what they are feeling are far more likely to get their needs met. Whereas people who experience alexithymia tend to be confused by emotions and don’t know how to interpret them, let alone how to respond to them.

Mirroring during childhood produces several benefits:

1. It helps children better understand the link between facial expressions, body gestures, and emotions.

2. Mirroring helps children develop robust language for which to communicate their emotional experiences to others, fostering deeper social connection and intimacy.

3. It validates what children are feeling, and that helps children develop a healthy sense of themselves.

4. Mirroring helps children develop self-awareness; this gives them the capacity to attune to and address their immediate needs.

Alexithymia’s Core Impairments:

1. Shame

2. Emotional Dysregulation

3. Difficulty Connecting with Others

4. Overwhelmed by Others’ Emotional Expression

5. Limited Facial, Body, and Vocal Expression

How to Address Alexithymia

Initially, treating alexithymia may feel challenging as it can take time to develop emotional awareness. However, it is possible to make meaningful improvements, especially with the support of a therapist. As with all worthwhile skills, consistent skill engagement is key. I will give you some tips to help you along your journey.

We will look at two common scenarios: There are circumstances when we know what event or circumstances are causing an emotion to occur, and there are times when we experience an emotion but struggle to identify what event or circumstances brought it up. I provide steps for each scenario:

I don’t know what caused the emotion

1. Using an emotion wheel or a list of emotions, try to identify which emotion(s) you’re currently experiencing. Under its emotion regulation chapter, this DBT book has a helpful worksheet you can use to facilitate this exploration. You can then identify where in the body you’re experiencing sensations as certain emotions are felt in certain parts of the body.

2. Once you land on a specific emotion(s) and tune into your body sensations, what would those sensations and emotion say if they could only say one thing. Try to be spontaneous and brief. How might that statement align with a current or past life stressor? If you don’t have the answer to this last question, that’s totally okay. Try to just notice what you’re feeling emotionally and in your body. Ask yourself what you need in this moment and try to fulfill that need to the best of your ability. For instance, if you’re frustrated and physically exhausted, maybe you need a break.

I know what caused the emotion

1. If you’re struggling to identify which emotion(s) you’re experiencing but you know that it’s the result of an identifiable situation, ask yourself: “If someone else encountered this particular event or relational dynamic, what would they likely feel about it?” Resentful? Shame? Often times, if we apply the same situation to someone else, we can develop more clarity around what we could be feeling. Your answer will give you a jumping off point.

2. What about this event or relational dynamic would lead you to experience this specific emotion? Do you feel unfairly criticized by someone? Do you feel hurt by someone’s behavior that conveyed a lack of respect?

3. Determine what to do with this information. Even difficult emotions are friendly messengers, trying to help us protect ourselves or get our needs met in some way. When you understand what you’re feeling and why, you now have two options. Firstly, you can ignore the emotion and it will keep popping up, sending you the same message. Secondly, you can heed that emotion’s advice with some kind of appropriate action. Often, if you meet that emotion’s need, the difficult emotion will subside as it has served its purpose.

Lastly, participating in weekly therapy through a licensed mental health professional can help you grow beyond your current limitations.

*This blog is for informational purposes only and does not replace the need to consult with a mental health professional about your specific circumstances.