Alexithymia

The alexithymia construct is used to describe a cluster of cognitive and affective characteristics typical of many people with psychosomatic illnesses and mental health problems (Taylor & Taylor, 1997). The term was first introduced by Sifneos (1973) and is derived from Greek, and means having a lack of words for emotion. The construct evolved from earlier clinical observations (e.g. Reusch, 1948) that certain individuals responded poorly to forms of psychotherapy requiring a degree of insight into inner experiences (Taylor & Taylor, 1997). As a personality trait, alexithymia is characterised by a number of salient cognitive and affective features. Notable among these are a decreased ability to identify and communicate feelings, difficulty distinguishing between feelings and the bodily sensations of emotional arousal, a cognitive tendency toward external events or cues, and a paucity of imaginative thought as evidenced by a lack of experience of dreams or fantasy (Roedema & Simons, 1999; Taylor, 2000). In terms of clinical presentation, people scoring highly on measures of alexithymia typically report decreased or flattened emotional experiences and a reduced conception of emotions as part of their awareness. There is also a marked reduction in their performance on measures of emotional recognition, empathy, labelling and behaviour (Frawley & Smith, 2001).

Since its inception the alexithymia construct has attracted an increasing amount of attention from researchers, with the primary focus resting on examining its relationship with medical and psychiatric disorders (Parker, Keightley, Smith & Taylor, 1999). Measurement amongst clinical populations indicates it to be a correlate of a range of physical, psychosomatic (see Taylor, 2000 for detailed descriptions) and psychiatric conditions (Parker, Taylor & Bagby, 1994). Furthermore, high measures of alexithymia have been associated with predictions both of the onset of illness and disease, and of poor outcomes in terms of psychotherapeutic intervention and prognosis (Taylor & Taylor, 1997; Roedema & Simons, 1999). Whilst some authors advocate a direct causal relationship between alexithymia and illness, notably Martin and Pihl’s (1985) stress-alexithymia hypothesis, research findings have yet to demonstrate this with any degree of certainty. As most of the clinical studies have been cross-sectional in design, it is difficult to ascertain whether what is being measured as alexithymia is a stable personality trait or a symptom of the relevant illness.