#Alexithymia isn’t only a problem of not understanding our emotions

I’ve been reading up on alexithymia – inability to identify and describe emotions in the self. There appears to be a number of possible explanations for causes, which seems to be a bit of a mystery. Research suggests a brain-based source of the issue, with reduced connectivity and blood flow correlating with alexithymia. Additionally, the condition has been characterized as “an extremely arrested and infantile psychic structure”. Hm. Not sure how I feel about that.

I think we need a better way of understanding alexithymia — especially from the viewpoint of those affected. Just because we can’t think of ways to describe what we’re feeling in the moment, doesn’t mean we can’t put words to it later, when we’ve had a chance to think about it. This seems like a worthy exercise, since the neurotypical world deals widely in “emotional currency” — relying on emotion to orient individuals to one another, determine priorities, and measure success of interactions. Alexithymia combined with autism (which can already complicate matters with sensory overload and difficulty reading faces and social cues) can negatively impact an autistic individual in significant ways.

In times of stress, it can complicate sensitive social interactions with peers, medical personnel, mental health clinicians, and other influential figures who may misinterpret unexpected emotional responses as a threat – or a sign of dangerous pathology. This can put alexithymic individuals at risk for missed cues about pressing needs, or inappropriate treatments and medication, which may actually prevent effective emotional processing, and ironically make matters even worse.

Now, alexithymia has been studied for 40 years “from a distance” by researchers who do not experience it themselves, leading to attempts to categorize it along psychiatric lines (see Moorman, et al Emotion Regulation pp 27-42). Five different types have been proposed, centering around emotionality, fantasy life, and cognition. These categories are psychiatric in nature.

In addition to this approach, I think it’s also beneficial to understand alexithymia from the “inside-out”. Studying this cognitive/emotional/behavioral phenomenon from the viewpoint of the alexithymic individual could yield useful information, which not only allows the individual to better understand the nature of their situation, but may also help clinicians and other helpers find complementary / alternative means to communicate in situations where successful social interaction is critical.

To follow are some proposed descriptive sub-types (or categories, if you will) of alexithymia, which identify the nature of the communication issues and also indicate potential remedial approaches.

Alexithymia SubTypes

1. Lexical Deficit Alexithymia – (Shortage of good word choices) When words available do not adequately suffice to describe one’s feelings. This indicates insufficient vocabulary choices (a failing on the side of available terminology) rather than the individual’s inability to think of the right word. The right word for what they’re feeling may not even exist. Or it may not be well-known.

2. Hypervarithymic Alexithymia – (Hyper-variable absence of emotional sense) When emotions are overwhelming and changing too quickly for the individual to summarize what they’re feeling in the moment. The intensity is matched by the speed with which they change, which doesn’t lend itself to quick articulation.

3. Corporeal Alexithymia – (Bodily sensation competition for feeling senses) When physical sensations (including sensory overload) are so intense that they mix with emotions and obscure the true nature of the experience. Intrusions of noise, light, balance problems, taste, touch, can all distract from deciphering what’s going on in your emotions.

4. Temporathymia – (Time-lag absence of emotion processing) When there is a cognitive processing time lapse between when an impression is made… and the individual is able to sort out what emotions are being experienced… and then figures out how to describe them. It’s not that the words aren’t there – the emotions haven’t coalesced sufficiently to describe them.

5. Perceived Exathymic Alexithymia – (Exterior lack of emotional potential – It looks like they won’t understand you) When the emoting individual does not perceive or believe in the ability of others to fully comprehend the emotions they are trying to express and is therefore reluctant or refuses to communicate their experience, to avoid embarrassment or further confusion.

6. Endathymic Alexithymia – (Interior absence of emotion – Yeah… I’ve got nothing to share…) When the individual does not feel anything inside themself, either physically or emotionally, and there is literally nothing in their experience for them to describe. The feelings may come in a little bit, and they may have words put to them, eventually, but “in the moment”, nothing is there to even detect.

Possible Mitigating/Remedial Approaches

1. Lexical Deficit Alexithymia – Develop a lexicon that more fully describes complex combinations of emotion we actually feel. We frankly need more and better ways of describing our emotions, than the standard handful, or interspersing our sentences with “like”. There are new projects underway to do this – e.g.,  The Dictionary of Obscure Sorrows. We also need to use old words that have fallen out of use.

By enlarging our vocabulary and actively finding ways to put into words what it is we autistic folks are feeling (can also be through art and music), we might possibly dispel the misconception that we feel nothing, and that we can’t describe what we’re feeling because we’re internally deficient.

2. Hypervarithymic Alexithymia – Neurotypical people need to realize that this happens. Our emotional state can be so hyper, so variable, so overwhelming… and our processing speed can be significantly slower than the “norm”… that putting words to what we really feel can be all but impossible. Especially when we’re “put on the spot” and feeling the pressure to perform in ways that make sense to NT folks. The autistic internal world can be so much more vibrant and mutable than the allistic counterpart, and that variation needs to be taken into consideration.

Just understanding that this is the case with us, and not pressuring us to come up with an instant summary of our basic state, would be a step in the right direction. Also, I find body movements are helpful — waving of hands to illustrate the wild flow of information coursing through my system. And drawing. Perhaps some non-verbal approaches would help.

3. Corporeal Alexithymia – Sensory overwhelm is an issue for me, in most cases, alexithymia or not. Stress heightens sensory overwhelm. So, reducing stress, as well as learning how to identify the sensory factors coming into play, can be helpful. If I know that the overhead lights are bothering me, I can ask that they be turned off, and then it’s easier for me to think. In fact, turning off overhead lights can turn me into a completely different-presenting sort of person. It’s interesting to watch, from my own perspective. Doing things like wearing sunglasses or earplugs, wearing clothing without tags or scratchy interior seams, also goes a long way towards that.

For me, just knowing that my sensory issues are “spilling over” into my emotional processing is helpful. I can explain that to others, even if it doesn’t make sense to them… and/or I can stall for time with an explanation that “I’m still thinking”, while I collect myself.

4. Temporathymia – Because it takes time to sort through everything. The temporal aspects of the absence of emotion (that’s ‘-athymia’) can be confounding, especially in frenzied emotional circumstances. When I’m put on the spot by someone who wants to know right now what I’m thinking, I pause and say, “Well, it’s complicated. I’m not sure there’s an easy answer to that.” And they often back off, because they don’t want to hear a lengthy, detailed explanation… even if it’s far more accurate than what they’re expressing. The main thing, with me, is letting people know that it takes time to sort things out… it’s complicated… there’s a lot to consider. I’m a grown-up with a lot of life experience, so I have a lot of points to reference. NT people tend to accept that, whereas no explanation — just a blank stare — doesn’t play so well with them.

5. Perceived Exathymic Alexithymia – Why bother, if others aren’t going to get it? To the point above, telling someone, “It’s complicated. There’s no easy answer.” gets them to back down. Who has the time or the patience for my detailed explanations? Not many people. And telling them they’re going to get an earful, gives them the chance to withdraw their incessant demands for emotional processing from me.

6. Endathymic Alexithymia – Sometimes, there’s just nothing there. This especially happens when I’m tired, very stressed, or completely caught up in thinking about something engaging. If I’m locked onto one of my Compelling Subjects of Study (I like that better than “special interests”), I won’t feel anything — physical or emotional. I’m just thinking. Thinking hard. It takes me a while to shift my attention to my body and emotions. That’s usually about the time I realize I really need to empty my bladder.

So, while alexithymia may be brain-based, in my lived experience, it’s also a problem of not having adequate words to describe what we’re feeling at a given point in time. Either available words are too simplistic, or our feeling state is so intense and so variable, mutable, that we can’t come up with words quickly enough to describe them. Or we don’t think that others will understand, so we don’t even try. At least, I don’t. And then there’s the time factor. My processing speed is slow, whether I like it or not — especially if I’m shifting gears between different thought patterns.

 

Perhaps the problem of alexithymia isn’t entirely with us, or our brains.

Maybe, just maybe, it’s the world we live in, that’s deficient.

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