What Is Alexithymia? The Overlooked Condition That Explains Why Traditional Depression Treatment Fails
- Jay Getten
- Sep 4
- 38 min read
What Is Alexithymia? The Overlooked Condition That Explains Why Traditional Depression Treatment Fails
What Is Alexithymia? The Hidden Condition Affecting Millions
A Conversation That Happens Every Day
"Alexithymia? I have never heard of it."
This response happens countless times every day, in doctors' offices, therapy sessions, and conversations between healthcare providers. It's what patients say when they first hear the term. It's what many healthcare professionals and mental health providers say too. To be completely honest, most mental health providers, including the author of this article, had never heard of alexithymia until relatively recently, despite practicing for years.
The Hidden Epidemic
Here's a startling fact: alexithymia is estimated to impact 13% of the population (Obrębska & Rohoza, 2021). To put that in perspective, that's roughly 44 million Americans, more people than the entire population of California. Yet alexithymia remains frequently overlooked and misunderstood by many physical and mental health providers, despite research showing it significantly impacts both mental and physical health treatment outcomes.
What Exactly Is Alexithymia?
The term "alexithymia" originates from Greek and means "no words for feelings." Alexithymia refers to a condition characterized by the following features:
Why Haven't You Heard of It?
If alexithymia affects 1 in 8 people, why isn't it better known? Several factors contribute to this recognition gap:
The Cost of Not Knowing
The effects of this recognition gap are significant. Individuals with undiagnosed alexithymia may experience prolonged periods of ineffective treatment and may be classified as "treatment-resistant" when the underlying issue is unrecognized alexithymia. They can also present with physical symptoms that lack clear medical explanations. These individuals may not respond to standard interventions, which can lead to additional mental health concerns over time due to ongoing difficulties in identifying or expressing emotions.
A Personal and Professional Journey
The recognition of alexithymia often represents a turning point, both for individuals who finally understand why they've struggled and for healthcare providers who discover a missing piece of the puzzle in treating certain patients. Many people describe learning about alexithymia as a "lightbulb moment" that suddenly makes sense of years of confusion and failed treatments.
The Promise of Recognition
Understanding alexithymia opens doors to more effective, personalized treatment approaches. Rather than trying to force people into traditional emotion-focused therapies that may be fundamentally incompatible with their neurological processing patterns.
What This Article Will Show You
This article examines the effects of alexithymia on various areas of health and healthcare, including physical symptoms, mental health conditions, relationships, and addiction. It also reviews new approaches for addressing the needs of those affected by this condition. The aim is to increase understanding and provide information that may assist individuals in identifying alexithymia in themselves or others and promoting suitable care.
A Call for Transformation
Alexithymia remains a significant area of under-recognition within contemporary healthcare. However, with ongoing research and increased awareness, there is an important opportunity for this condition to receive appropriate acknowledgement and attention. For the estimated 44 million Americans and additional millions globally affected by alexithymia, enhanced recognition is both necessary and timely.
What Does Alexithymia Look Like? Core Features and Signs
The Main Signs of Alexithymia
Individuals with alexithymia commonly encounter several distinct challenges. They may have difficulty identifying their emotions, distinguishing between emotional states and physical sensations, and expressing their feelings verbally. Some individuals also demonstrate a limited ability to visualize or imagine, show a preference for logical or structured thinking, have trouble understanding others' viewpoints, and find it challenging to recognize or describe emotions in others (Zdankiewicz-Ścigała et al., 2021). The characteristics of alexithymia are complex and can vary significantly among individuals, often involving multiple factors that are not immediately apparent.
Where Does Alexithymia Come From?
Alexithymia develops through a combination of genetics and life experiences what scientists call "nature and nurture." The condition has biological roots, but symptoms can become more severe based on a person's environment and life experiences. Research shows that limited bonding with caregivers early in life and physical or emotional abuse can make alexithymia symptoms worse. Even without trauma or chaotic environments, alexithymia by itself can lead to poor emotional regulation and more intense symptoms of depression and anxiety (Sfeir et al., 2020).
The Body-Brain Connection: Understanding Interoception
Recent studies have demonstrated a significant association between alexithymia and difficulties in interoception, specifically the capacity to perceive and interpret internal bodily states. Current scientific perspectives characterize alexithymia as encompassing both diminished beneficial body awareness and heightened maladaptive attention to bodily sensations, which may contribute to anxiety (Shah et al., 2021). These findings challenge earlier conceptions that framed alexithymia solely as a lack of emotional awareness.
The Paradox: Sensing But Not Understanding
A groundbreaking 2021 study discovered something surprising about people with alexithymia, showed three different patterns of body awareness.
Researchers found that difficulty interpreting bodily signals is a strong predictor of alexithymia, identifying the condition with over 92% accuracy (Scarpazza et al., 2021). This may explain why those with alexithymia struggle to understand their emotions. A 2024 study also reported that 32% of psychiatric hospital patients have high alexithymic traits, with emotion regulation challenges and interoceptive awareness closely linked to the disorder (Yildirim et al., 2024).
What Is Interoception and Why Does It Matter?
Interoception refers to the body's ability to detect and interpret physical and emotional signals occurring internally. It enables individuals to identify states such as hunger, thirst, fatigue, excitement, or distress. This internal awareness contributes to the development of self-perception, understanding emotional concepts, and influences emotional experiences (Aaron, 2016).
Some researchers suggest that alexithymia may be related primarily to impaired interoceptive awareness rather than constituting a mental illness. Reduced awareness of internal physical states can affect emotional processing, including the experience of emotions (Aaron, 2016). Individuals with alexithymia may have difficulty identifying their own emotions and sometimes confuse these feelings with other internal bodily states, such as hunger, fatigue, or excitement (Zdankiewicz-Ścigała et al., 2021).
Ongoing Complexity
A 2023 study looking at the relationship between alexithymia and alcohol use found something interesting: while alexithymia was strongly linked to difficulties regulating emotions, it didn't show a significant connection to general interoceptive sensibility when measured with comprehensive assessment tools. This suggests that interoceptive challenges in alexithymia may be more specifically related to emotional contexts, rather than reflecting a broad problem with sensing internal bodily states (Lyvers et al., 2023).
What This Means for Treatment
Healthcare providers are changing their approach to alexithymia as research highlights its roots in interoceptive processing difficulties, not just emotional awareness issues. This perspective helps explain why the condition is missed in mental health settings and why it shows up as unexplained physical symptoms in medical contexts. As a result, professionals now consider therapy methods that address interoceptive awareness along with traditional emotion-focused treatments.
Alexithymia and Health
Alexithymia has been observed as a factor associated with resistance to physical and mental health treatments. People with alexithymia may more frequently present with somatic conditions that are difficult to explain, such as gastrointestinal, dermatologic, chronic pain (including fibromyalgia), and seizure disorders (Elboğa, 2020; Iyar et al., 2019; Singh, 2021; Zdankiewicz-Ścigała et al., 2021). Furthermore, research indicates an association between alexithymia and an increased likelihood of suicidal behaviors, sleep paralysis, and dissociative experiences among individuals with co-occurring psychiatric conditions (Obrębska & Rohoza, 2021; Pinna et al., 2020; Reyno et al., 2020).
How Alexithymia Affects Physical Health
The Body Connection
Alexithymia doesn't just affect emotions - it has a significant impact on physical health too. Research shows connections between alexithymia and various physical conditions, including inflammatory bowel disease, severe asthma, and high blood pressure (Wielopolski et al., 2017). When people with alexithymia pay increased attention to their body's physical responses, it can influence how they perceive physical symptoms, potentially leading to more negative health assessments and outcomes (Aaron, 2016).
Pain: A Complex Relationship
Multiple Pain Sites and Unexplained Symptoms
People who experience pain in multiple areas of their body or have unexplained pain sensations show significantly higher levels of alexithymia symptoms compared to other groups (Iyar et al., 2019). This connection is so strong that research has identified alexithymia before surgery as the strongest predictor of who will develop chronic pain one year after breast cancer surgery (Aaron, 2016). Similarly, a 2017 study found significant connections between how severe someone's tinnitus (ringing in the ears) is and their alexithymic difficulties with emotion regulation (Wielopolski et al., 2017).
Fibromyalgia: A Deeper Understanding
A 2018 study of 205 women with fibromyalgia found that 26% had significant alexithymia, which directly predicted poorer mental health quality of life (Tesio et al., 2018). Alexithymia impacted quality of life through both direct and indirect effects, together accounting for 61% of the variation in mental health outcomes among participants.
The Science Behind the Connection
How the Brain and Body Interact
Recent research from 2021 to 2024 has helped explain the biological mechanisms behind alexithymia's impact on physical health. A 2021 study of fibromyalgia patients found that alexithymia plays a major role in the relationship between body awareness and emotion regulation. Both body awareness issues and mental health symptoms accounted for about 30% of the differences in how well people could regulate their emotions (Müller et al., 2021).
A 2023 study looking at pain experiences in people with eating disorders found that alexithymia, along with depression, significantly influences the connection between having an eating disorder and experiencing altered pain perception. People with alexithymic traits showed both decreased pain sensitivity and increased nerve-like pain characteristics (Wittkopp et al., 2023).
The Chemical Pathway: Tryptophan and Pain
Recent studies on fibromyalgia have identified disruptions in tryptophan metabolism as a potentially significant factor in understanding the physical manifestations of alexithymia. Evidence suggests that up to 95% of tryptophan is metabolized via the kynurenine pathway, rather than being converted into serotonin. This metabolic shift results in elevated production of quinolinic acid, which is neurotoxic, alongside reduced synthesis of the neuroprotective kynurenic acid. The resulting chemical imbalance may contribute to both chronic pain and depressive symptoms, as inflammatory mediators drive this pathway, leading to neuroinflammation and altered pain perception (Alfaro-Rodríguez et al., 2024).
When the Body "Speaks" Instead of Words
Psychogenic Non-Epileptic Seizures (PNES)
Interoception issues associated with alexithymia may manifest as neurological symptoms. Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures but do not present corresponding brain seizure activity, as they occur due to psychological rather than neurological factors. Research indicates that individuals with PNES report elevated rates of alexithymia and experience more frequent seizure episodes. One proposed explanation is that when individuals with alexithymia encounter distress and cannot verbally express their emotions, physical symptoms that resemble seizures may occur (Poli et al., 2022).
What This Means for Healthcare
A New Approach to Unexplained Symptoms
These findings indicate that healthcare providers should consider the potential impact of alexithymia on pain perception and unexplained physical symptoms. In clinical settings where patients exhibit physical complaints without clear medical causes, evaluating these symptoms from an alexithymia-informed perspective may yield more precise information. Research suggests that conventional pain management strategies may be insufficient for individuals with alexithymia, as their distinct processing of bodily signals may require treatments addressing both biological and psychological factors.
The Bigger Picture
A substantial body of research indicates that the early identification and management of alexithymia may lead to significant improvements in physical health outcomes, a decrease in healthcare utilization and costs, and a reduced risk of chronic pain conditions. This development marks an important paradigm shift—reframing alexithymia from merely a psychological concern to a critical factor influencing both physical health and the effectiveness of medical interventions.
Alexithymia and Mental Health
The Hidden Connection
Alexithymia has strong connections to multiple mental health conditions, including depression, panic disorders, eating disorders, alcohol dependence, PTSD, and personality disorders. Despite these widespread connections, alexithymia remains significantly under-recognized and under-diagnosed in the United States. This lack of recognition creates major challenges across healthcare settings and for clinicians (Da Silva et al., 2018; Wielopolski et al., 2017), often showing up as patients with chronic mental health conditions that seem stuck at the same level for years, despite trying multiple different treatments.
Depression and Alexithymia: Understanding the Link
Research Findings
A 2024 study of 2,747 patients found that negative life events and alexithymia account for about 34.2% of depressive symptoms. Difficulty identifying and describing feelings were the strongest predictors of depression severity, while externally oriented thinking had no significant link (Xie et al., 2024). These findings highlight which aspects of alexithymia matter most for treatment approaches.
The Scale of the Problem
What's remarkable about this study is that 67% of patients had moderate to severe depression scores, yet alexithymia explained more of their depressive symptoms than negative life events alone. This supports the idea that alexithymia acts as a vulnerability factor that spans across different mental health conditions, rather than being specific to just one disorder.
Personality Disorders: The Brain Connection
How the Brain Works Differently
Many features seen in personality disorders are connected to alexithymia through specific brain pathways. Recent 2025 brain imaging research using EEG technology has revealed that alexithymia involves over-reliance on the right side of the brain and reduced coordination between brain hemispheres. The study found disrupted patterns in specific brain wave frequencies (alpha, theta, and gamma waves) that appear central to how alexithymia affects the brain (Clinical Medicine, 2025).
Empathy: A Complex Picture
A comprehensive brain imaging study conducted in 2020 revealed notable insights regarding empathy in individuals with alexithymia. The results indicate that alexithymia is associated with a specific deficit in emotional resonance, rather than a general inability to comprehend others (Goerlich et al., 2020).
Borderline Personality Disorder: A Strong Connection
Borderline Personality Disorder (BPD) has been found to have a strong association with alexithymia. Research indicates that 71.3% of individuals diagnosed with BPD also exhibit alexithymia, with many individuals experiencing challenges in identifying and communicating their emotions. The study further reports a significant correlation between alexithymia symptoms and the frequency and intensity of self-harming behaviors among individuals with BPD (Poli et al., 2022).
Trauma and Treatment Challenges
Why Standard Treatments Sometimes Fail
Recent studies have examined alexithymia's association with trauma-related conditions. One 2024 study investigating cognitive behavioral therapy outcomes for PTSD reported that approximately 40% of individuals with PTSD also have alexithymia, which may reduce the effectiveness of trauma-focused treatments reliant on emotional engagement and processing (Baldwin & Torous, 2024). This observation has implications for treatment planning and helps clarify why certain therapies may not be effective for some individuals.
New Approaches That Show Promise
Research on mindfulness-based cognitive therapy (MBCT) for somatic symptom disorder has shown that both reducing alexithymia and improving self-compassion play crucial roles in reducing physical and psychological distress. Changes in alexithymia showed significant indirect effects on symptom improvement, suggesting that addressing alexithymia directly can be an important part of treatment (Yang et al., 2024).
What This Means
The research clearly shows that alexithymia isn't just a side effect of other mental health conditions it's often a core factor that influences how severe symptoms are and how well people respond to treatment.
The Puzzling Mix: When Body Awareness Goes Both Ways
Different Types Within Alexithymia
The presence of different subgroups within people who have alexithymia makes traditional medical and mental health treatments even more complicated. Recent research has identified distinct patterns where some people have both low body awareness in some areas and heightened sensitivity in others, creating a complex clinical picture that requires individualized assessment and treatment approaches.
The Body Awareness Paradox
Less Is More and More Is Less
Low interoceptive accuracy restricts an individual’s awareness of physical sensations associated with emotional experiences, thereby inhibiting the development of conscious recognition of their emotional states. In contrast, heightened interoceptive accuracy may lead to an increased amplification of bodily sensations that distract from interpreting their emotional significance. For instance, individuals may misattribute somatic cues arising from emotional experiences as symptoms of physical illness rather than identifying them as emotional states (Aaron, 2016).
Simultaneous Opposites
In clinical practice, it is observed that some patients can experience both reduced and increased body awareness at the same time. These individuals may have decreased sensitivity to certain physical sensations, such as not noticing hunger or thirst, while exhibiting heightened attention to others, like focusing intensely on their heart rate or breathing. This pattern can also appear within the same limb, where a person reports numbness in one area and increased sensitivity in another nearby region. This suggests that different aspects of body awareness may function independently within the same individual.
The Brain Science Behind the Paradox
What Brain Imaging Reveals
Recent EEG studies have identified neural patterns that may illuminate the source of these conflicting responses. Findings indicate that alexithymia is characterized by changes in brain activation and network coordination, as opposed to an absence of emotional experience. These neurological differences correspond with variations in bodily awareness processing noted by clinical practitioners.
What This Means for Treatment
One Size Definitely Doesn't Fit All
These findings have major implications for treatment planning:
The Individual Approach
The observation that individuals may exhibit both hyper- and hypo-arousal patterns indicates the importance of treatment approaches tailored to address multiple body awareness processing styles simultaneously. This could account for the limited effectiveness of standardized protocols for patients with alexithymia and highlights the value of developing personalized, alexithymia-informed strategies. Addressing these differences requires treatment plans flexible enough to accommodate distinct needs rather than applying a uniform approach.
The Bottom Line
Understanding these different subgroups within alexithymia helps explain why some people don't respond to traditional treatments and why a more nuanced, individualized approach is necessary. Rather than assuming all people with alexithymia have the same type of body awareness issues, healthcare providers need to assess each person's unique pattern and tailor interventions accordingly.
Alexithymia and Neurodiversity: A Hidden Connection
The Numbers Tell a Story
Research has found that alexithymia is more prevalent in neurodivergent populations, particularly among individuals with ADHD and autism spectrum disorder (ASD). A 2019 review of 15 studies involving 366 autistic individuals reported that 49.93% of those with ASD had alexithymia, compared to 4.89% of neurotypical individuals, a 6.5-fold higher risk. For people with ADHD, estimates suggest that over 40% also experience alexithymia (Kiraz et al., 2020). These findings indicate differences in emotional processing across these populations (Kinnaird et al., 2019).
Challenging Old Assumptions: The Empathy Myth
What We Used to Think vs. What We Know Now
For many years, limited empathy was considered a defining feature of autism. However, recent studies have offered new perspectives. A study found that autistic individuals had higher scores than neurotypical groups on all measures of alexithymia, particularly relating to identifying and describing emotions. Research suggests that autistic people with higher levels of alexithymia tend to have more difficulty with empathy. Some researchers propose that emotional processing challenges previously attributed to autism may be more closely related to the common occurrence of alexithymia, rather than being inherent to autism itself (Aaron, 2016).
A Paradigm Shift
This represents a major change in how we understand neurodiversity. Rather than viewing emotional processing difficulties as core features of autism, contemporary research suggests that alexithymia represents a distinct subgroup within the autistic population who may benefit from targeted interventions addressing their specific body awareness and emotional processing needs (Kinnaird et al., 2019).
The Misdiagnosis Pattern
Recent investigations have revealed complex relationships between alexithymia, autism, and ADHD that challenge previous assumptions. A comprehensive 2022 study of functional neurological symptom disorder found that 40% of patients screened positive for both autistic traits and alexithymia, with those showing higher autistic traits also having significantly elevated levels of alexithymia, depression, and anxiety (Bell et al., 2022).
Research examining social media discussions from 2012-2022 showed a progressive convergence in how ADHD and autism are talked about in public forums, with autism mentions in ADHD discussions overtaking other conditions by 2021. This reflects growing recognition of their co-occurrence and shared features, including alexithymic traits (Jiang et al., 2025).
Clinical Practice Findings: Reframing Depression
Many adults with ADHD and autism continue to be diagnosed and treated for depression before receiving identification and support for their neurodivergent conditions. Recent clinical data reveals a compelling pattern.
This suggests that clinically significant alexithymic traits are more prevalent and pronounced than previously reported, with many patients describing their difficulties in emotional awareness, identification, and expression as more representative of their lived experience than classic depression symptoms (Behavioral Health Consulting Solutions [BHCS], 2025).
The Broader Mental Health Picture
Research Findings
A 2023 review of 20 studies on psychiatric conditions in autistic adults reported that between 15.4% and 79% received psychiatric diagnoses, with depression (10%-54%) and anxiety (10%-54%) being the most frequently identified (Curnow et al., 2023). The review also noted that many interventions for autistic adults are not specifically adapted to their needs and may prioritize neurotypical behaviors, rather than focusing on underlying alexithymic traits associated with emotional and social challenges.
A Concerning Gap
The review indicated that merely 5% of funded autism research involved autistic adults, underscoring a substantial deficiency in the current understanding of adult autism characteristics. The findings further noted that autistic adults place a high value on outcomes such as enhanced quality of life, decreased anxiety and depression, improved social well-being, and greater engagement in daily activities. Each of these domains is notably influenced by the presence of alexithymia.
Dissociation and Identity Integration
Beyond PTSD: A New Understanding
Dissociation has traditionally been associated with conditions such as PTSD or schizophrenia. Recent research, however, indicates that alexithymia may play a significant role in dissociative experiences, particularly within neurodiverse populations. This correlation is linked to disconnections between conscious aspects of self-experience and emotional or physical perceptions. Such disconnections can affect the integration of thoughts, feelings, and experiences into consciousness and memory, which may influence emotional awareness, emotion regulation, and self-reflection abilities (Reyno et al., 2020).
The Neurodivergent Experience
For neurodivergent individuals, dissociation can be heightened due to the interaction of neurological differences, social expectations, and emotional experiences. While alexithymic traits may protect against sensory and emotional overload, they can also hinder self-awareness and genuine expression.
What This Means for Treatment
A New Approach
This evolving understanding suggests that alexithymia may represent a common pathway through which neurodivergent individuals experience emotional and social difficulties, rather than being secondary to autism or ADHD. The clinical implications are significant: interventions targeting alexithymia may be more effective than traditional approaches that focus solely on autism or ADHD symptoms.
The research supports a neurodiversity-informed approach that:
The Path Forward
As we learn more about alexithymia in neurodivergent people, effective screening and treatment can improve outcomes. This may explain why standard mental health treatments often fall short, while approaches informed by alexithymia are more effective. The emphasis should be on supporting the unique emotional and sensory processing of neurodivergent individuals to enhance their quality of life.
Alexithymia and Addictions: When Emotions Can't Be Felt
The Widespread Connection
Alexithymia has been associated with various addictive behaviors, including substance use and behavioral dependencies, which can influence treatment outcomes. Research has linked the condition to increased use of marijuana, caffeine, mobile phones (compulsive use), gambling (compulsive), and methamphetamine, with more severe alexithymia symptoms correlating with greater cravings. Studies also show a strong relationship between cigarette or other nicotine use and alexithymic behaviors. Smoking is often used as a method to address physical and emotional sensations related to body awareness processing difficulties in individuals with alexithymia (Huang et al., 2022; Sfeir et al., 2020).
Alcohol: A Complex Relationship
The Numbers and Patterns
Among individuals with alcohol use disorders, an estimated 30-67% also display symptoms of alexithymia. Those who have both alexithymia and alcohol addiction tend to experience more pronounced interpersonal challenges, greater severity of alcohol dependence, and higher rates of relapse. This relationship is associated with several factors: alexithymic symptoms can affect how people handle stress due to limited emotional awareness, difficulty in recognizing stressful situations, and a preference for action-oriented strategies over reflective thinking. These characteristics are linked to increased alcohol consumption as a means of managing emotions (Thorberg et al., 2019).
New Understanding: It's About Emotion Regulation
Recent studies have contributed to knowledge of alexithymia's connection with addictive behaviors. A 2023 study on alcohol use among young adults indicated that alexithymia was associated with problematic drinking patterns, and this association was mediated by emotion regulation deficits rather than body awareness deficits. The research identified emotion regulation difficulties as the main factor linking alexithymia and problematic alcohol consumption (Lyvers et al., 2023). These findings may affect treatment strategies.
Eating Disorders: A Complex Pattern
The Strong Connection
Alexithymia often occurs with eating disorders such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. It is particularly common in anorexia nervosa, affecting up to 77% of female patients (Vuillier et al., 2020). Recent studies link alexithymia to the relationship between ADHD and binge eating, noting that those with eating disorders have greater difficulty identifying and expressing emotions than those without (El Archi et al., 2021).
Treatment Success When Alexithymia is Addressed
Recent research has strengthened understanding of alexithymia's central role in eating disorder treatment. A 2021 specialized inpatient treatment study of 67 female eating disorder patients found significant improvements in alexithymia, dissociation, and emotional regulation following intensive treatment. Most importantly, changes in emotion regulation processes were directly linked to improved eating disorder symptoms, highlighting alexithymia as a key therapeutic target rather than a secondary issue (Monteleone et al., 2021).
A groundbreaking 2024 online intervention study using Dialectical Behavior Therapy (DBT) principles demonstrated significant improvements in eating disorder symptoms alongside reductions in alexithymia, with medium to large effect sizes. Participants particularly valued learning to understand and process their emotions, confirming alexithymia's central role in eating disorder maintenance and recovery (Anastasiadou et al., 2024).
Digital Age Addictions
Smartphone Addiction and Attachment Issues
Recent research has identified patterns of smartphone use among specific populations. A 2023 study reported that alexithymia is associated with smartphone usage through insecure attachment patterns. The relationship between alexithymia and smartphone use was mediated by both anxious and avoidant attachment styles. These findings indicate that individuals with alexithymic traits may utilize smartphones as a strategy for emotional regulation, particularly when experiencing challenges in interpersonal relationships related to attachment insecurity (Jin et al., 2023).
The Treatment Gap: Why Standard Approaches Often Fail
The Relapse Problem
Relapse rates for substance use disorders are between 40% and 60% (American Addiction Centers, 2022). The prevalence of alexithymia in individuals with addictions may contribute to ongoing challenges with long-term treatment outcomes. Clinical data indicate that many patients with alexithymia have participated in multiple inpatient and outpatient addiction treatment programs. After receiving an alexithymia diagnosis, these patients reported that alexithymia was not assessed or discussed during their addiction treatment (Behavioral Health Consulting Solutions [BHCS], 2025).
Why Traditional Treatment Falls Short
When an individual's addiction is influenced by challenges in identifying, understanding, and regulating emotions, treatment approaches that do not address these emotional processing difficulties may be less effective in achieving long-term results. Addressing the underlying causes, rather than only the symptoms, can support more sustainable outcomes.
Innovative Treatment Approaches
A More Comprehensive Model
The 2024 proposal for Schema Therapy for Addiction Treatment (STAT) presents an integrative framework that conceptualizes addiction as a chronic, multifaceted condition requiring a comprehensive approach encompassing behavioral, cognitive, and emotion-focused interventions. This therapeutic model is particularly applicable to individuals with alexithymia, as it systematically addresses attachment concerns, trauma histories, and deficits in emotion regulation that are prevalent in both populations (Lacy, 2024).
What This Means for Treatment
These findings indicate that alexithymia may play a role in addiction vulnerability and suggest that treatment approaches could include emotion regulation skills development, interoceptive awareness training, and interventions addressing neurobiological factors common to both conditions. The results also indicate that addiction treatment programs might consider screening for alexithymia, developing tailored interventions for emotional processing challenges, and implementing personalized, alexithymia-informed treatment strategies rather than standardized approaches.
The Bottom Line
Understanding the connection between alexithymia and addictions represents a crucial step forward in improving treatment outcomes. Rather than focusing solely on the addictive behavior itself, addressing the underlying emotional processing difficulties may provide a more effective pathway to lasting recovery and improved quality of life.
Alexithymia Throughout Life
From Childhood to Adulthood
Since alexithymia has biological roots, symptoms often appear in early childhood, though the condition can also develop during adolescence and adulthood. Many patients report that their ability to manage alexithymic symptoms decreases as they age. Studies show a general age-related decline in emotion recognition capabilities, with sensitivity to internal emotional experiences lessening during adult development, creating an increasingly challenging trajectory for those with underlying alexithymic traits (Reyno et al., 2020).
Childhood and Adolescent Early Warning Signs
Alexithymia is linked to increased negative behaviors in children, especially among autistic youth, potentially contributing to their emotional and social challenges (Vaiouli et al., 2022). It often correlates with immature coping strategies, resulting in more physical and verbal aggression; teenagers with alexithymia show higher rates of aggression, anger, and hostility (Sfeir et al., 2020).
Hope for Early Intervention
A 2023 systematic review assessed Dialectical Behavior Therapy (DBT) as a treatment and reported evidence that DBT interventions can improve cognitive functioning in adolescents, including attention regulation, working memory, and cognitive flexibility, which are areas related to alexithymia. The study noted that cognitive inflexibility, a core component of alexithymia, could be more responsive to intervention during adolescence (Daray et al., 2023).
Age-Related Changes in the Brain
Recent brain imaging research has shown how alexithymia affects individuals across different developmental periods, with particular attention to age-related changes in body awareness processing. Established research demonstrates that increasing age is linked to decreased brain activation during tasks involving internal body awareness, with evidence suggesting that the impact of age on alexithymia may be influenced by this decline in body awareness abilities.
A 2022 systematic review examining DBT-based interventions for alexithymia found preliminary evidence that these treatments can be effective, though the authors noted limitations including small sample sizes and high variability between programs. The review emphasized that more standardized interventions and controlled trials are needed, particularly for adolescent populations where early intervention may be most beneficial (Cavicchioli et al., 2022).
Critical Windows for Intervention
These findings suggest that adolescence represents a critical period where alexithymic traits may be particularly responsive to intervention, while also highlighting the importance of understanding age-related brain changes that contribute to alexithymia development. The research supports early identification and intervention approaches that can address alexithymic traits before they become more entrenched in adulthood.
Alexithymia's Impact on Relationships
The Relationship Challenge
The impact of alexithymia on relationships cannot be overstated, especially among neurodiverse individuals who often feel misunderstood and invalidated during interactions with neurotypical people. Studies show that alexithymia better explains the difficulties autistic individuals have in identifying the emotional aspects of verbal, visual, and auditory communication, significantly impacting emotion regulation, interpersonal relationships, and emotional identification (Vaiouli et al., 2022).
How Alexithymia Affects Relationships
The Vicious Cycle
Alexithymia's neurological and physical differences, combined with complete lack of awareness of the condition, cause relationship distress across multiple environments. Individuals with higher levels of alexithymia not only have difficulties with the cognitive processing of their emotions, but they also show a less complex and integrated sense of self and others.
The lack of internal integration contributes to interpersonal troubles, which decreases individual autonomy, environmental understanding, and self-acceptance over time. This may intensify emotional processing deficits with a defensive mindset, further limiting relationship capacities with increasing age (Reyno et al., 2020).
Behavioral Manifestations
Because of their difficulties in expressing genuine emotions, people with alexithymia frequently display higher levels of anger and more aggressive behaviors (Sfeir et al., 2020). This supports studies showing that perpetrators of domestic violence have higher levels of alexithymia and ADHD (Romero-Martínez et al., 2020).
People with alexithymia who have less severe presentations report that their inability to identify or communicate emotions has drastically impacted their relationships. Similarly, the lack of awareness of the emotional needs of significant others, children, friends, and coworkers frequently has negative consequences in their lives.
Current Research Findings
Specific Mechanisms
Contemporary research continues to validate the profound impact of alexithymia on interpersonal relationships, with new studies revealing specific mechanisms through which emotional processing deficits disrupt social functioning. Recent investigations have demonstrated that alexithymia significantly impairs interpersonal relationships through its effects on emotion regulation difficulties, with individuals showing reduced capacity for empathic processing and perspective-taking that directly impacts relationship quality (Zdankiewicz-Ścigała et al., 2021).
A 2021 study using advanced analytical methods found that higher levels of alexithymia correlated with increased psychological rigidity, fewer positive emotions, and lower body awareness in non-distracting and attention regulation contexts. The results indicate that interventions targeting relationship dynamics may be more effective when they address body awareness and emotional processing deficits associated with alexithymia, rather than focusing only on social skills training (Koster et al., 2021).
The Therapy Challenge
When Treatment Becomes Part of the Problem
Many patients living with alexithymia experience significant shame and frustration because of their past relationships with therapists, with some reporting they felt they "could not even do therapy right." Research has found that alexithymic traits like difficulty recognizing feelings serve as important predictors of the severity of remaining depressive symptoms after psychotherapy treatment.
Poor treatment outcomes may be associated with negative perceptions of alexithymic patients by their providers, potentially leading to devaluation of alexithymic patients by therapists or beliefs that the patients are not a good fit for treatment. Many therapists working with alexithymic patients describe feelings of boredom or patients seeming closed off during sessions (Da Silva et al., 2018).
The Need for Specialized Approaches
This pattern of therapeutic relationship difficulties highlights the critical need for alexithymia-informed therapeutic approaches that can work effectively with the unique emotional processing style of these individuals, rather than expecting them to conform to traditional emotion-focused therapeutic models that may be fundamentally incompatible with their neurological processing patterns.
Moving Forward
Understanding alexithymia's impact on relationships across the lifespan provides important insights for both individuals and healthcare providers. Early identification and intervention during adolescence may offer the best opportunities for improvement, while relationship-focused interventions that address the underlying neurobiological differences may be more effective than traditional approaches that assume typical emotional processing capabilities.
Treating Alexithymia: A New Approach to an Old Problem
The Recognition Gap
Alexithymia is not assessed or recognized in most clinical settings. This lack of consideration by health systems could explain findings in recent studies showing that 50% of all depression treatments are ineffective (Cuijpers et al., 2021). Patients with alexithymia show heightened suicide rates and decreased response to conventional treatment approaches like antidepressant medication and talk therapy. Some researchers believe that traditional depression treatment methods are not effective due to different brain structural differences in people with alexithymia compared to other populations presenting with depressive symptoms (Förster et al., 2020).
A comprehensive 2024 systematic review of psychological treatments for alexithymia found that although alexithymia affects 10% of the general population and 25% of psychiatric patients, there has been a shortage of intervention studies. The review identified that several effective psychological treatments, including cognitive behavioral therapy (CBT), have been tested in recent years, but emphasized the need for more comprehensive approaches (Loas et al., 2024). This research gap represents a critical barrier to effective treatment for millions of individuals.
Medications: A Complex Picture
The Screening Imperative
With the abnormally high occurrence of alexithymia in neurodiverse populations, it's vital for healthcare providers to screen for the condition before determining treatment approaches. Recent studies found that antidepressants can increase alexithymic symptoms, increase depressive symptoms, create resistance to antidepressant treatment, and lead to higher rates of suicidality in neurodiverse adults with co-occurring alexithymia (Costa et al., 2020; Kiraz et al., 2020).
The Antidepressant Problem: Emotional Blunting
A 2021 review found that emotional blunting is a common side effect of antidepressants, especially SSRIs and SNRIs, and may result in some individuals discontinuing treatment. Emotional blunting can be linked to either medication use or the underlying depression itself, with many patients reporting a reduction in emotional response associated with their antidepressant regimen (Fava et al., 2021; McAllister-Williams et al., 2022). Clinicians typically respond by adjusting the dosage or prescribing an alternative medication; however, there is currently no standardized clinical definition or universally effective treatment for antidepressant-induced emotional blunting (Fava et al., 2021).
The Scale of the Problem
A large multi-country survey published in 2022 reported that almost three-quarters of patients in the acute phase of depression experienced severe emotional blunting, while one-quarter of patients in remission continued to report emotional blunting. Additionally, more than one-third of participants considered discontinuing or had stopped their antidepressant due to these effects, and about 45% attributed these effects directly to their medication (McAllister-Williams et al., 2022).
Clinical Observations
Neurodiverse individuals have reported that antidepressant medications may exacerbate symptoms related to low life satisfaction and emotional blunting characteristics of alexithymia. In a survey of nearly 2,000 adults undergoing antidepressant therapy, over half indicated experiencing emotional side effects including feelings of emotional numbness (60%), not feeling like themselves (52%), reduced positive emotions (42%), and diminished concern for others (39%) (Kajanoja et al., 2018). Clinical reports further suggest that, in several cases, antidepressant treatment intensified alexithymic symptoms, which frequently resolved following discontinuation of the medication (Behavioral Health Consulting Solutions [BHCS], 2025).
Alternative Medication Approaches
Emerging Alternatives
Emerging treatments may provide alternatives. A longitudinal study from Spain (2024) showed that switching patients from SSRI/SNRI medications to vortioxetine resulted in significant improvements in emotional blunting, depressive symptoms, sleep, motivation, and overall functioning. Two-thirds of patients no longer reported emotional blunting and over half achieved remission from depressive symptoms within 8 weeks (Navarro et al., 2024).
Stimulant Medications: A Promising Direction
For patients with co-occurring ADHD and alexithymia, stimulant medications show promise in reducing alexithymia symptoms and enhancing emotional awareness. One pioneering study noted additional benefits of psychostimulants including a decrease in alexithymia symptoms and an increase in emotional awareness over a 6-month period.
Following the introduction of a psychostimulant medication, highly alexithymic patients experienced significant decreases in alexithymia symptoms as well as improvements in emotional awareness. The promising results indicate that pre-treatment with stimulant medication can strengthen patients with ADHD and alexithymia's ability to benefit from psychotherapy (Matuszak et al., 2013).
The Dopamine Connection
Dopamine dysfunction in the brain has been associated with emotional-processing deficits observed in alexithymia. Studies report a higher prevalence of alexithymia in patients with neurological disorders involving dopamine dysfunction, such as Parkinson's disease and ADHD (Kiraz et al., 2020; Okita et al., 2016). This may relate to the observed effectiveness of stimulant treatment in individuals with alexithymia. Clinical reports indicate that in several patients with both ADHD and alexithymia, discontinuation of antidepressants followed by the introduction of stimulants resulted in no longer meeting criteria for alexithymia (Behavioral Health Consulting Solutions [BHCS], 2025). Current neuroscience research continues to examine whether modulation of dopamine pathways could benefit alexithymia, particularly in cases where serotonin-focused treatments are less effective (McAllister-Williams et al., 2022).
Therapy: Rethinking Traditional Approaches
Why Traditional Therapy Often Fails
It is essential for therapists to assess or screen for alexithymia during clinical practice. Many contemporary psychotherapeutic frameworks focus on emotional processes, which may not be suitable for individuals with alexithymia. These patients often have difficulty identifying specific emotions, understanding their emotional responses, or recognizing the physical manifestations of emotion, and this capability cannot be developed through intentional effort. The emotional challenges faced by people with alexithymia are physiological in origin. Therefore, expecting these individuals to engage in emotionally focused therapy without accommodation is comparable to requiring a person with physical paralysis to access services in an environment that does not support mobility needs.
The Traditional Therapy Problem
Research shows that traditional talk therapy techniques have made little impact on alexithymic patients' lives, caused frustration among therapists, and are linked with poor psychotherapy outcomes (Aaron, 2016). The inability to express the emotional nature of problems impairs patients' capacity to efficiently communicate with therapists. Patients may present with vague complaints that make it difficult to establish treatment plans. Even after engaging in therapy for some time, patients with alexithymia tend to articulate emotions as physical complaints and describe change in a more rational rather than emotional way (Da Silva et al., 2018).
Innovative Therapeutic Approaches
Multi-Modal Success Stories
Recent therapeutic research has revealed promising developments in treating alexithymia through integrated and specialized approaches that target the core body awareness and emotional processing deficits. A significant 2021 study demonstrated that an integrative educational package combining Motivational Interviewing, Acceptance and Commitment Therapy, and Compassion-Focused Therapy significantly improved alexithymia scores in women with multiple sclerosis, suggesting that multi-modal approaches may be particularly effective (Mirzaei et al., 2021).
Targeted Therapy Approaches
Several therapeutic interventions have demonstrated promise in addressing alexithymia. Cognitive-Analytical Therapy, for example, has been shown to significantly reduce alexithymia and related interpersonal issues in patients with functional dyspepsia, underscoring the utility of treatments targeting relational and emotional processing deficits (Rahmati et al., 2021). Furthermore, Reality Therapy has proven effective in lowering alexithymia levels among women experiencing emotional challenges, with sustained gains observed at follow-up evaluations (Omidvar et al., 2024).
The Body Awareness Connection
A particularly noteworthy 2022 study examining the multidimensional nature of body awareness found that lower scores on body awareness dimensions involving an accepting attitude toward bodily signals were specifically related to alexithymia and emotion dysregulation, which in turn predicted depression. This highlights the importance of interventions that target body awareness acceptance and training (Vigouroux et al., 2022).
Mindfulness-Based Approaches
A 2024 study on mindfulness-based cognitive therapy (MBCT) for somatic symptom disorder demonstrated that both alleviation of alexithymia and improvement in self-compassion play crucial mediating roles in reducing physical and psychological distress, with changes in alexithymia showing significant indirect effects on symptom improvement (Yang et al., 2024).
Early Intervention and Specialized Approaches
The Importance of Early Action
Early intervention may help reduce symptoms of alexithymia. Studies indicate that implementing curricula focused on awareness, expression, and regulation of emotions is associated with improved social skills and academic performance in 5th and 6th grade students exhibiting alexithymia. Additionally, a 4-week expressive writing model has been linked to fewer doctor's visits, lower depression scores, and less sleep disturbance among patients with higher levels of alexithymia.
Individualized Treatment Approaches
Research indicates that individuals with alexithymia may benefit from tailored interventions based on their level of body awareness. Those with low body awareness often respond positively to therapies that direct attention toward internal stimuli, such as body scan meditation and awareness training. Conversely, individuals with high body awareness may be more prone to developing somatic symptom disorders and may derive less benefit from body-focused approaches; instead, they may require interventions that facilitate differentiation between emotional and physical sensations (Aaron, 2016).
The Future of Alexithymia Treatment
The findings indicate that approaches such as emotional awareness, body awareness training, and compassion-based interventions may have potential benefits for individuals with alexithymia, which differs from traditional talk therapy methods that have shown limited effectiveness in this context. Recognizing that alexithymia may require specialized and individualized treatment rather than standardized options is important. As research continues, the possibilities for more effective treatments may increase for those affected by this condition.
Moving Forward: The Urgent Need for Change
A Call to Action
Alexithymia is a complex condition that requires significantly more attention within the medical and behavioral health communities. Better support for this population needs to begin at universities, where medical and behavioral programs must start educating aspiring clinicians about alexithymia and its impact on health. At the clinical level, health systems must do a better job of screening for alexithymia, understanding its co-occurring conditions, and developing interventions that address the unique features of the condition.
The Scale of the Problem
If the current estimate that alexithymia affects 13% of the population is accurate, approximately 44 million Americans may have alexithymia. It is unclear how many individuals have been identified or treated for this condition, and how many have not received identification or treatment. These figures refer to many people who may have experienced difficulties with treatment or communication with healthcare providers, potentially due to undiagnosed alexithymia.
Findings from the Research
The research presented throughout this article demonstrates that alexithymia represents a fundamental challenge to traditional mental health treatment approaches. The condition's high prevalence in neurodiverse populations, its profound impact on physical and mental health outcomes, and its resistance to conventional therapeutic and pharmacological interventions underscore the urgent need for alexithymia-informed care models.
Essential Changes in Clinical Practice
The evidence strongly supports several critical shifts in clinical practice:
The Revolutionary Potential
The mounting evidence suggests that addressing alexithymia could revolutionize treatment outcomes across multiple conditions, from depression and anxiety to chronic pain and addiction. As our understanding of this condition continues to evolve, it becomes increasingly clear that alexithymia represents not merely a co-occurring condition, but a key to understanding and treating a significant portion of individuals who have been failed by traditional mental health approaches.
A Paradigm Shift
This represents more than just adding another assessment tool or treatment technique. It's a fundamental shift in how we understand human emotional processing and mental health treatment. Rather than assuming all people process emotions in the same way, we need to recognize and honor the neurobiological diversity in how people experience, interpret, and express their internal emotional and physical states.
The Path Forward
The time has come to move alexithymia from the margins of clinical practice to its center, recognizing it as a critical factor in personalized, effective healthcare that honors the unique neurobiological diversity of human emotional processing.
Hope for the Future
Although the current landscape for the recognition and treatment of alexithymia involves certain challenges, recent research has provided significant progress. Advances in understanding the neurobiological mechanisms, the development of effective interventions, increased awareness among healthcare professionals, and acknowledgment of the necessity for personalized care have all contributed to improved outcomes. For individuals affected by alexithymia, these developments increase the likelihood of appropriate evaluation, targeted treatment, and support that aligns with their specific neurobiological profiles. The progression of mental health care increasingly values tailored approaches over uniform solutions, emphasizing the diverse nature of emotional processing. Recognizing and addressing alexithymia is now considered an essential component of comprehensive mental health strategies.
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