Alexithymia: Emotional Blindness

Author: Dr.Hossain Al-Amin,MBBS,FRSPH,MPH, Co-Author: Intefar Samim Sami,EEE,University of Chittagong

Introduction

Dyslexia, a neurological condition characterized by persistent difficulties with reading, writing, and spelling, is a challenge that extends far beyond the academic realm.? While the primary symptoms of dyslexia are well-documented, the long-term impact of this disorder on an individual's emotional and social well-being is often overlooked.

One of the most significant long-term consequences of dyslexia is the development of alexithymia, a condition characterized by a diminished ability to identify and describe one's own emotions (Hoeft, F. et al., 2007).? Individuals with dyslexia often struggle to articulate their feelings, leading to a sense of emotional detachment and difficulty in forming meaningful connections with others.(Hurford, P, D. and Hurford, D, J., 2016)(Gray, S, E., 2008)

The connection between dyslexia and alexithymia can be attributed to the underlying neurological differences that characterize both conditions. Dyslexia is associated with atypical brain structure and function, particularly in the language processing regions of the brain.(Hoeft, F. et al., 2007)(Adel, A. and Saleh, M., 2022) These same regions have been linked to the emotional processing and regulation, suggesting that the cognitive challenges faced by individuals with dyslexia may extend to the emotional domain.(Eden, F, G. et al., 1996)

Furthermore, the persistent academic and social struggles experienced by individuals with dyslexia can lead to a negative self-perception, feelings of inadequacy, and social isolation.(Hurford, P, D. and Hurford, D, J., 2016) These emotional challenges can, in turn, exacerbate the symptoms of alexithymia, creating a vicious cycle that can be difficult to break.

Alexithymia affects up to 13% of the population, with a higher prevalence observed in males compared to females. Studies have reported that over 30% of prisoners in China experience alexithymia (Kong, Wang, & Zhang, 2019). Individuals with alexithymia often struggle to maintain relationships and participate in social situations, emphasizing the need for better understanding and management of this condition.

Key Features of Alexithymia

Alexithymia is characterized by:

• Difficulty Identifying Feelings: Individuals often struggle to recognize and differentiate between emotions.
• Limited Ability to Communicate Feelings: There is a notable difficulty in expressing emotions to others.
• Focus on External Events: A tendency to concentrate on external occurrences rather than internal experiences.
• Problems with Introspection: Challenges in self-awareness and introspection.
• Concrete Thinking Style: Preference for logical, concrete thinking over imaginative or abstract thought.

Famous Individuals with Alexithymia

1. Anthony Hopkins : Sir Anthony Hopkins, the acclaimed actor known for his roles in "The Silence of the Lambs" and "The Father," has spoken openly about his struggles with understanding emotions, which is indicative of alexithymia. He Quotes,"I don’t know what sadness is. I don’t know what it means to cry."
2. Elon Musk: Elon Musk, the CEO of SpaceX and Tesla, has been open about his experiences with Asperger's syndrome, a condition often associated with alexithymia. He Quotes,"I think it’s important to have a future that is inspiring and appealing. I just don’t feel the same depth of emotions that other people do."
3. Bill Gates:Bill Gates, co-founder of Microsoft, has shown traits of alexithymia, particularly in his logical and methodical approach to problems, often focusing on facts and data rather than emotions.He Quotes,"We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction."
4. Temple Grandin: Temple Grandin, an autism advocate and professor of animal science, has alexithymia, a common trait among individuals with autism.She Quotes,"I am different, not less."

Causes of Alexithymia

The precise cause of alexithymia remains unclear, but several factors are believed to contribute:

Genetics

Research indicates a genetic component to alexithymia. A study on twins suggests that individuals are more likely to have alexithymia if a close relative also has it (Jorgensen et al., 2007).

Environmental Factors

Environmental influences, including childhood trauma, physical or mental health conditions, and socioeconomic factors, play a significant role in the development of alexithymia (Jorgensen et al., 2007).

Brain Injury

Studies report that individuals with damage to the anterior insula, a region of the brain, exhibit increased levels of alexithymia (Bernhardt et al., 2014).

Risk Factors

Risk factors for alexithymia include:

• Being male (Kong et al., 2019)
• Advancing age
• Low level of education
• Low socioeconomic status
• Low emotional intelligence

Diagnosis

Diagnosing alexithymia involves evaluating an individual's ability to identify, describe, and understand their emotions. Several tools are used by clinicians:

Toronto Alexithymia Scale (TAS-20)

This self-report questionnaire measures three dimensions: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking (Bagby, Parker, & Taylor, 1994).

Beth Israel Hospital Psychosomatic Questionnaire (BIQ)

Another self-report tool that assesses similar dimensions of alexithymia (Sifneos,1973).

Observer Alexithymia Scale (OAS)

This scale allows clinicians or close acquaintances to rate an individual's alexithymic traits based on observed behaviors (Haviland et al., 2000).

Interviews and Clinical Assessments

Structured or semi-structured interviews conducted by mental health professionals provide a nuanced understanding of a person's emotional awareness and expression.

Treatments

While there is no specific cure for alexithymia, several treatments can help individuals manage and improve their emotional awareness and expression:

Psychotherapy

• Cognitive Behavioral Therapy (CBT): Aids in recognizing and altering distorted thinking patterns to enhance emotional awareness.
• Psychodynamic Therapy: Focuses on understanding underlying emotional conflicts and improving emotional insight.
• Mindfulness-Based Therapy: Encourages awareness of thoughts and feelings in the present moment.

Skills Training

• Emotional Skills Training: Teaches individuals how to identify and label their emotions.
• Social Skills Training: Enhances interpersonal communication and understanding of others’ emotions.

Psycho-education

Educates individuals about emotions, their functions, and ways to recognize and express them.

Medication

While no specific medication treats alexithymia, addressing co-occurring conditions such as depression or anxiety can be beneficial.

Conclusion

Alexithymia, a condition marked by difficulties in emotional recognition and expression, has been studied for over four decades. Individuals can take steps toward emotional recognition by being mindful of their physiological responses, such as heart rate, and documenting their emotional patterns. Recognizing and working with both positive and negative emotions can lead to a more fulfilling life.

References

• Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (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.
• Bernhardt, B. C., Valk, S. L., Silani, G., Bird, G., Frith, U., & Singer, T. (2014). Selective disruption of sociocognitive structural brain networks in autism and alexithymia. Cerebral Cortex, 24(12), 3258-3267.
• Haviland, M. G., Warren, W. L., & Riggs, M. L. (2000). An observer scale to measure alexithymia. Psychosomatics, 41(5), 385-392.
• Jorgensen, M. M., Zachariae, R., Skytthe, A., & Kyvik, K. O. (2007). Genetic and environmental factors in alexithymia: A population-based twin study. Psychotherapy and Psychosomatics, 76(6), 369-375.
• Kong, F., Wang, X., & Zhang, M. (2019). The prevalence of alexithymia and its relationship with demographic variables among undergraduates in China. Psychiatry Research, 271, 510-516.
• Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255-262.
• Adel, A. and Saleh, M. (2022) "Phonological Deficit Traits in Verbal Language of Dyslexics," IntechOpen. Available at: https://doi.org/10.5772/intechopen.99871.
• Eden, F, G. et al. (1996) "The Visual Deficit Theory of Developmental Dyslexia," Elsevier BV, 4(3),p. S108-S117. Available at: https://doi.org/10.1006/nimg.1996.0061.
• Gray, S, E. (2008) "Understanding Dyslexia and its Instructional Implications: A Case to Support Intense Intervention," Taylor & Francis, 47(2),p. 116-123. Available at: https://doi.org/10.1080/19388070701878790.
• Hoeft, F. et al. (2007) "Functional and morphometric brain dissociation between dyslexia and reading ability," National Academy of Sciences, 104(10),p. 4234-4239. Available at: https://doi.org/10.1073/pnas.0609399104.
• Hurford, P, D. and Hurford, D, J. (2016) "The Dyslexia Dilemma: A History of Ignorance, Complacency and Resistance in Colleges of Education," OMICS Publishing Group, 2(3). Available at: https://doi.org/10.4172/2472-1786.100034.
• Kong, F., Wang, X., & Zhang, M. (2019). The prevalence of alexithymia and its relationship with demographic variables among undergraduates in China. Psychiatry Research, 271, 510-516.
• Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255-262.
• Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (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.