Alexithymia

Alexithymia, also called emotional blindness,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> is a neuropsychological phenomenon characterized by significant challenges in recognizing, expressing, feeling, sourcing,<ref>Template:Cite book</ref> and describing one's emotions.<ref>Template:Cite journal</ref><ref name="Bagby-1994">Template:Cite journal</ref><ref name="Preece-2017">Template:Cite journal</ref> It is associated with difficulties in attachment and interpersonal relations.<ref name="Feldman">Template:Cite journal</ref> There is no scientific consensus on its classification as a personality trait, medical symptom, or mental disorder.<ref name="von Rad (1984)">Template:Cite journal</ref><ref name="Assogna et al. (2012)">Template:Cite journal</ref>

Alexithymia occurs in approximately 10% of the population and often co-occurs with various mental or neurodevelopmental disorders.Template:Sfn It is present in 50% to 85% of individuals with autism spectrum disorder (ASD).<ref>Template:Cite book</ref>

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 regardless of sex.<ref>Template:Cite book</ref><ref>Template:Cite journal</ref><ref>Template:Cite book</ref><ref name="Feldman" />

Etymology

The term alexithymia was introduced by psychotherapists John Case Nemiah and Peter Sifneos in 1970 to describe a particular psychological phenomenon.<ref>Template:Cite book</ref><ref name=Bar-On>Template:Cite book pp. 40–59</ref><ref name="Taylor2831">Taylor 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</ref><ref name="Duden Medizin">Template:Cite book</ref> Its etymology comes from Ancient Greek. The word is formed by combining the alpha privative prefix {{#invoke:Lang|lang}} ({{#invoke:Lang|lang}}, meaning 'not') with {{#invoke:Lang|lang}} ({{#invoke:Lang|lang}}, referring to 'words') and {{#invoke:Lang|lang}} ({{#invoke:Lang|lang}}, denoting 'disposition,' 'feeling,' or 'rage'). The term can be likened to "dyslexia" in its structure.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

In its literal sense, alexithymia signifies "impermeable to emotions".<ref name="Duden Medizin" /> This label reflects the difficulty experienced by individuals with this condition in recognizing, expressing, and articulating their emotional experiences. Non-medical terminology, such as "emotionless" and "impassive", has also been employed to describe similar states.<ref>Template:Cite journal</ref> Those who exhibit alexithymic traits or characteristics are commonly referred to as alexithymics or alexithymiacs.<ref>Template:Cite journal</ref>

Classification

Template:As of, scholars have not reached a consensus about the classification of alexithymia. The DSM-5 and the ICD-11 classify alexithymia as neither a symptom nor a mental disorder.<ref name=ICD11>World Health Organization (2022). International Classification of Diseases, eleventh revision – ICD-11. Genova – icd.who.int Template:Webarchive.</ref> Cognitive behavioral and psychoanalytic theorists have proposed conceptualizations, including lists of characteristic signs and symptoms.<ref name="Taylor-2021">Template:Cite journal</ref><ref name="Preece-2020" /><ref>Template:Cite journal</ref>

Cognitive behavioral model

The cognitive behavioral model, also known as the attention-appraisal model, proposes three descriptive components:<ref name="sciencedirect.com">Template:Cite journal</ref><ref>Template:Cite journal</ref>

1. difficulty identifying feelings (DIF)
2. difficulty describing feelings (DDF)
3. externally oriented thinking (EOT), characterized by a tendency to not focus attention on emotions.

Psychoanalytic model

The psychoanalytic model suggests four components:Template:Sfn

1. difficulty identifying feelings (DIF)
2. difficulty describing feelings to other people (DDF)
3. a stimulus-bound, externally oriented thinking style (EOT)
4. constricted imaginal processes (IMP) characterized by infrequent daydreaming

Constricted imaginal processes, defined as a lack of spontaneous imagining, does not correlate with the other components.<ref name="Preece-2020" /><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name="onlinelibrary.wiley.com">Template:Cite journal</ref> Such findings have led to ongoing debate in the field about whether IMP is indeed a component of alexithymia.<ref name="Taylor-2021" /><ref name="Preece-2020" /><ref name="Vorst-2001">Template:Cite journal</ref> For example, in 2017, Preece and colleagues introduced the attention-appraisal model of alexithymia, wherein 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.<ref name="Preece-2017" /><ref name="Preece-2020" /> 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. Whereas psychoanalytic formulations tend to continue to place importance on IMP,<ref>Template:Cite journal</ref> the attention-appraisal model (presently the most widely used cognitive-behavioral model of alexithymia)<ref name="tandfonline.com">Template:Cite journal</ref> excludes IMP from the construct.<ref name="onlinelibrary.wiley.com" /> In practice, since the constricted imaginal processes items were removed from earlier versions of the TAS-20 in the 1990s,<ref>Template:Cite journal</ref> the most used alexithymia assessment tools (and consequently most alexithymia research studies) have only assessed the construct in terms of DIF, DDF, and EOT.<ref name="Bagby-1994" /><ref name="Preece-2018">Template:Cite journal</ref> 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;<ref name="Western Cultures 2022">Template:Cite journal</ref> 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.<ref name="Western Cultures 2022" /><ref>Template:Cite journal</ref> Such findings of valence-specific effects in alexithymia are also supported by brain imaging studies.<ref>Template:Cite journal</ref>

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.<ref>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref> 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).<ref>Template:Cite journal</ref><ref name="Western Cultures 2022"/>

Psychologist R. Michael Bagby and psychiatrist Graeme J. Taylor have argued that the alexithymia construct is inversely related to the concepts of psychological mindedness<ref>Taylor & Taylor (1997), pp. 77–104</ref> and emotional intelligenceTemplate:Sfn<ref>Template:Cite journal</ref> and there is "strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress".Template:Sfn

Assessment

Alexithymia is most commonly assessed using self-report questionnaires, such as the Perth Alexithymia Questionnaire (PAQ)<ref>Template:Cite journal</ref> or 20-item Toronto Alexithymia Scale (TAS-20).<ref>Template:Cite journal</ref> These tools assess the DIF, DDF, and EOT components of alexithymia. Studies that have directly compared these measures have consistently found the PAQ to be the best performing psychometrically, with strong evidence for it providing a comprehensive and reliable alexithymia profile.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> The TAS-20 is an older measure (introduced in 1994, compared to the PAQ in 2018) and is also still used,<ref>Template:Cite journal</ref> though recent studies have highlighted a number of validity and reliability concerns with the TAS-20, such as parts of the measure having low reliability,<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> and parts being confounded by how distressed respondents currently are (i.e., measuring distress rather than alexithymia).<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Several observer-rated or interview-based measures of alexithymia also exist,<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> but so far these have been rarely used in research or clinical settings due to long administration times.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Signs and symptoms

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;<ref name=Bar-On/> 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.<ref>Template:Cite journal</ref> Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterizes alexithymia.<ref name=Bar-On/>

Some alexithymic individuals may appear to contradict the above-mentioned characteristics because they can experience chronic dysphoria or manifest outbursts of crying or rage.Template:SfnTemplate:SfnTemplate:SfnTemplate:Sfn However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings.Template:Sfn

According to Henry Krystal, individuals exhibiting alexithymia think in an operative way and may appear to be super-adjusted 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.Template:Sfn<ref>Template:Cite journal</ref> 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.Template:Sfn

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.<ref>Template:Cite journal</ref> The core issue is that people with alexithymia have poorly differentiated emotions, limiting their ability to distinguish and describe them to others.<ref name=Bar-On/> 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.<ref>Template:Cite journal</ref>

Associated conditions

Alexithymia frequently co-occurs with other disorders. Research indicates that alexithymia overlaps with autism spectrum disorders (ASD).<ref name="revneurol.org">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name = Hill>Template:Cite journal</ref> 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".<ref name = Hill /><ref name=FrithAlex>Template:Cite journal</ref> Fitzgerald & Bellgrove pointed out that, "Like alexithymia, Asperger's syndrome is also characterised by core disturbances in speech and language and social relationships".<ref name="Fitzgerald & Bellgrove 2006">Template:Cite journal</ref> Note that, Asperger's syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer a diagnosis in the WHO's ICD-11 or the APA's DSM-5-TR.<ref>Template:Cite book</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> 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.<ref name="Hill & Berthoz 2006">Template:Cite journal</ref> The exact nature of the overlap is uncertain. Alexithymic traits in AS may be linked to clinical depression or anxiety;<ref name=FrithAlex/> the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety.<ref name=Tani>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref>

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.<ref>Template:Cite journal</ref> Another study found higher levels of alexithymia among Holocaust survivors with PTSD compared to those without.<ref>Template:Cite journal</ref> Higher levels of alexithymia among mothers with interpersonal violence-related PTSD were found in one study to have proportionally less caregiving sensitivity.<ref name="Schechter-2005">Template:Cite journal</ref> 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.<ref name="Schechter-2005" />

Single study prevalence findings for other disorders include 63% in anorexia nervosa,<ref name = Cochrane>Template:Cite journal</ref> 56% in bulimia,<ref name = Cochrane /> 45%<ref name=Honkalampi>Template:Cite journal</ref> to 50%<ref>Template:Cite journal</ref> in major depressive disorder, 34% in panic disorder,<ref name = Cox>Template:Cite journal</ref> 28% in social phobia,<ref name = Cox /> and 50% in substance abusers.<ref>Template:Cite journal</ref> Alexithymia is also exhibited by a large proportion of individuals with acquired brain injuries such as stroke or traumatic brain injury.<ref name="Williams 2010">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Alexithymia is correlated with certain personality disorders, particularly schizoid, avoidant, dependent and schizotypal,<ref>Template:Cite journal</ref>Template:Sfn substance use disorders,<ref name=Li_and_Sinha_2006>Template:Cite journal</ref><ref name=Lumley_et_al_1994>Template:Cite journal</ref> some anxiety disorders<ref name="Jones_1984">Template:Cite journal</ref> and sexual disorders<ref name="Michetti_et_al_2006">Template:Cite journal</ref> as well as certain physical illnesses, such as hypertension,<ref>Template:Cite journal</ref> inflammatory bowel disease,<ref>Template:Cite journal</ref> diabetes<ref>Template:Cite journal</ref> and functional dyspepsia.<ref name=Jones_et_al_2004>Template:Cite journal</ref> Alexithymia is further linked with disorders such as migraine headaches, lower back pain, irritable bowel syndrome, asthma, nausea, allergies and fibromyalgia.Template:Sfn There is a positive relationship between alexithymia and non-suicidal self-injury.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

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, perverse sexual behavior or anorexia nervosa.Template:Sfn 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.Template:Sfn People with alexithymia also show a limited ability to experience positive emotions leading KrystalTemplate:Sfn and Sifneos (1987) to describe many of these individuals as anhedonic.<ref name=Taylor2831/>

Alexisomia is a clinical concept that refers to the difficulty in the awareness and expression of somatic, or bodily, sensations.<ref name="Oka-2020">Template:Cite journal</ref> The concept was first proposed in 1979 by Yujiro Ikemi when he observed characteristics of both alexithymia and alexisomia in patients with psychosomatic diseases.<ref name="Oka-2020" />

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.<ref>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref> In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex.<ref>Template:Cite journal</ref> These studies have some shortcomings, however, and the empirical evidence about the neural mechanisms behind alexithymia remains inconclusive.<ref>Template:Cite journal</ref>

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.Template:Sfn 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.Template:Sfn A similar line of interpretation has been taken up using the methods of phenomenology.<ref>Template:Cite journal</ref> 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".Template:Sfn 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".Template:Sfn 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.Template:Citation needed

The attention-appraisal model of alexithymia by Preece and colleagues describes the mechanisms behind alexithymia within a cognitive-behavioral framework.<ref name="sciencedirect.com"/> 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.<ref name="tandfonline.com"/><ref>Template:Cite journal</ref>

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.<ref>Template:Cite journal</ref> 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 Rs6295 polymorphism within the HTR1A gene.<ref>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref> 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.<ref name= ReferenceA>Template:Cite journal</ref> 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".<ref>Template:Cite journal</ref>Template:Update inline 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.<ref name="Williams 2010"/><ref>Template:Cite journal</ref> Alexithymia is also associated with newborn circumcision trauma.<ref>Template:Cite journal</ref>

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".<ref name=Vanheule>Template:Cite journal</ref> Inadequate "differentiation" between self and others by alexithymic individuals has also been observed.<ref>Template:Cite journal</ref>Template:Sfn Their difficulty in processing interpersonal connections often develops where the person lacks a romantic partner.<ref name="pmid28810935">Template:Cite journal</ref>

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."<ref name=Vanheule/>

Chaotic interpersonal relations have also been observed by Sifneos.<ref>Template:Cite journal</ref> Due to the inherent difficulties identifying and describing emotional states in self and others, alexithymia also negatively affects relationship satisfaction between couples.<ref>Template:Cite journal</ref>

In a 2008 study<ref name="Colin Hesse 2008">Template:Cite journal</ref> 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.<ref name="Colin Hesse 2008"/>

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.<ref>Template:Cite book</ref>

Treatment

Generally speaking, approaches to treating alexithymia are still in their infancy, with not many proven treatment options available.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

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.<ref>Template:Cite journal</ref> 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).<ref name="Preece-2017" /><ref name="Preece-2020">Template:Cite journal</ref>

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.<ref>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref> All these comorbidity issues complicate treatment because it is difficult to find people who exclusively have alexithymia.

See also

• Antisocial personality disorder
• Emotional dysregulation
• Psychological mindedness
• Reduced affect display
• Somatization disorder
• Somatosensory amplification

Further reading

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