Alexithymia is a difficulty identifying, understanding, and putting words to your own emotions. The term comes from Greek and translates roughly as no words for feelings, and people who live with it often sense that something is happening inside them without being able to say what. It is far from rare, either. Research estimates that around one in ten people show clinically meaningful levels of it.
What makes alexithymia complicated is its status. It does not appear in the diagnostic manuals clinicians use, so it is often dismissed as a personality quirk or missed entirely. Yet its effects on relationships, physical health, and mental wellbeing are well documented, and many people only discover the word after years of feeling disconnected from their own inner life. That gap between how real it feels and how rarely it gets named is where this conversation needs to start.
Not formally. Alexithymia is not listed as a standalone condition in the DSM-5, the manual most clinicians in the United States use to diagnose mental health conditions. Psychiatrist Peter Sifneos introduced the term in 1973 after noticing that many of his patients with psychosomatic illness struggled to describe what they felt. Five decades of research later, most experts describe it as a personality trait that exists on a spectrum rather than a disorder you either have or do not have.
That distinction is where the controversy lives. One recent review confirms it is not a discrete psychiatric diagnosis, while also noting that it appears in roughly 9 to 10 percent of the general population and is linked to depression, anxiety, eating disorders, substance use, and a range of physical conditions. Researchers still disagree on how best to measure it, how much it overlaps with other conditions, and how often it is a lasting trait versus a response to illness or trauma. Those are legitimate scientific questions.
The cost of leaving it unrecognized is just as real. A clinical review published in Psychopathology points out that, despite being a long established concept, alexithymia remains unfamiliar to many clinicians. Without formal recognition, there is no routine screening, less training, and a real risk that people spend years in treatment for symptoms while the underlying difficulty goes unnamed.
Our stance as therapists is clear. A missing diagnostic code does not make an experience less real, and it does not make it less worth treating. Alexithymia shapes how people relate, how they cope, and how they respond to therapy itself. We treat it as clinically meaningful, we assess for it when the signs are there, and we build it into treatment rather than waiting for the manuals to catch up.
Alexithymia does not mean a person has no feelings. Emotions are present, sometimes intensely so. The difficulty lies in recognizing them, telling them apart, and expressing them. Common symptoms include:
The physical side deserves particular attention. Interoception research suggests alexithymia may involve a broader difficulty perceiving internal body signals, not only emotional ones, such as sensing your own heartbeat. This helps explain why so many people with alexithymia arrive in a doctor’s office with physical complaints long before anyone considers an emotional explanation.
In our clinic, alexithymia rarely walks in under its own name. People come for something else, a partner who says they feel shut out, stress symptoms with no clear cause, or a persistent numbness they cannot explain. We often notice it when we ask how a moment felt and the answer describes what happened instead.
There is no blood test or scan for alexithymia. Assessment relies on validated questionnaires and structured interviews, ideally combined with a clinician’s observation over time.
|
Tool |
Format |
What it measures |
|
Toronto Alexithymia Scale (TAS-20) |
20 item self-report |
Difficulty identifying feelings, difficulty describing feelings, externally oriented thinking |
|
Toronto Structured Interview for Alexithymia (TSIA) |
Clinician-led interview |
All four classic features, including imaginative capacity |
|
Bermond-Vorst Alexithymia Questionnaire (BVAQ) |
Self-report |
Cognitive and emotional dimensions, including emotional reactivity |
|
Perth Alexithymia Questionnaire (PAQ) |
24 item self-report |
Identifying and describing positive and negative emotions separately |
The TAS-20 is by far the most widely used. Scores range from 20 to 100, with 61 or higher generally indicating alexithymia, 52 to 60 suggesting possible alexithymia, and 51 or lower indicating it is unlikely.
Most free online versions are adaptations of the TAS-20, and they can be a useful first step. They give language to an experience many people have never been able to describe, and that recognition alone can prompt someone to seek support.
They also carry an obvious limitation. Self-report questionnaires ask a person to rate their own emotional awareness, which is precisely the ability alexithymia affects. Someone who struggles to recognize their feelings may also struggle to recognize how much they struggle. A score is a signpost, not a conclusion.
In our clinic, assessment usually takes place within the first sessions of our individual work. A questionnaire like the TAS-20 may be part of it, but we pair it with conversation, attention to how a person describes experiences, and a look at related concerns such as anxiety, depression, or trauma. That fuller picture is what makes treatment specific rather than generic.
Alexithymia rarely stays contained. It is closely tied to depression, anxiety, PTSD, eating disorders, and substance use, and it often shows up as physical complaints that do not respond to medical treatment. In relationships, partners may feel unheard or emotionally locked out, while the person with alexithymia feels misunderstood and unsure what is being asked of them.
It also affects therapy itself. Outcome research has found that people with high alexithymia tend to get less out of standard psychotherapy, while also showing that alexithymia scores can decline during treatment, and those declines track with overall improvement. In other words, alexithymia is a reason to adapt therapy, not a reason to give up on it.
The exact cause is not fully understood, but researchers generally describe two broad forms.
Primary alexithymia is a stable trait that tends to be present from early on. Twin studies point to a genetic contribution, and research reviews link it to childhood trauma and early caregiving relationships where emotions were rarely named, noticed, or responded to. A child who never learns a language for feelings often grows into an adult who does not have one.
Secondary, or acquired, alexithymia develops later in life. It can follow psychological trauma, particularly when emotional numbing became a way to survive it. It is also common after brain injury and in neurological conditions such as Parkinson’s disease and multiple sclerosis, as well as in some chronic illnesses.
Alexithymia is also strongly associated with autism, with roughly half of autistic people showing high levels. Researchers increasingly believe that some emotional difficulties once attributed to autism itself may actually come from co-occurring alexithymia. The two are related, but they are not the same thing.
None of these causes reflect a lack of caring or a character flaw. Alexithymia is a difference in emotional processing, and it can be understood and worked with.
There are no official treatment guidelines for alexithymia, but that does not mean there is nothing to be done. Research and clinical experience point toward several approaches that help:
How therapy is delivered matters as much as which method is used. Asking someone with alexithymia “how did that make you feel?” again and again can feel like being asked to read a language they were never taught. In our work, we tend to start from what is easier to access, events, physical sensations, behavior, and build toward emotional language gradually. The therapist often helps translate at first, offering possible words for an experience and letting the client test which ones fit.
Progress can be slow, but it is real. Many people describe the first time they accurately name a feeling in the moment as surprisingly powerful, a small but genuine sense of being able to understand themselves.
If you recognized yourself somewhere in this article, you do not need a formal diagnosis to deserve support. You can reach our team whenever you feel ready to start that conversation.
What does alexithymia mean?
Alexithymia means difficulty identifying, understanding, and describing your own emotions. The word comes from Greek and translates roughly as no words for feelings.
Is alexithymia a mental illness?
No. It is not a formal diagnosis in the DSM-5. Most researchers describe it as a personality trait on a spectrum, though it is closely linked to several mental health conditions and can significantly affect wellbeing.
How do I know if I have alexithymia?
Common signs include trouble naming emotions, confusing feelings with physical sensations, and difficulty describing your inner experience to others. Questionnaires such as the TAS-20 can offer an indication, but a professional assessment gives a more reliable picture.
What causes alexithymia?
It can be a lifelong trait shaped by genetics and early environment, or it can develop later after trauma, brain injury, or certain neurological and chronic illnesses.
Can alexithymia be treated?
Yes. There is no official treatment protocol, but therapy focused on emotional awareness, labeling, body awareness, and practical skills can reduce alexithymia and improve related symptoms.
Do people with alexithymia feel emotions?
Yes. People with alexithymia experience emotions, sometimes strongly. The difficulty is in recognizing, distinguishing, and expressing them, not in having them.
Is alexithymia the same as autism?
No. They often occur together, and around half of autistic people show high levels of alexithymia, but many people with alexithymia are not autistic and the two are distinct.
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