With its perhaps mysterious name, alexithymia is a personality trait that continues to attract research attention due to its relationship to psychological distress. Defined as difficulty identifying one’s own feelings and then putting them into words, alexithymia also includes a preference to “keep it light” when talking to other people. In other words, rather than dig into the feeling side of life, people high in alexithymia distance themselves from their own, and other people’s, emotions.

Perhaps you’ve worked with someone who always seems a bit standoffish in conversations involving anything other than the business at hand. You, in fact, find it a little puzzling that they seem so remote, but it doesn’t seem to be specific to anything you do or say. At casual get-togethers, or just while chatting in the break room, they send off vibes that lead you to steer clear of anything personal. You can know someone like this for years but never really feel that you’ve gotten close to them. The word “introvert” doesn’t seem to apply to them, so it must be something else.

Alexithymia’s Role in Psychological Distress

According to Bond University’s Michael Lyvers and colleagues (2023), people high in alexithymia suffer considerably due to their inability to understand, if not experience, the full range of human emotions. They report the prevalence in the population as being as high as 10 to 15 percent of the population, though it is likely to be far greater for people in clinical samples with mood or anxiety disorders. In nonclinical samples, alexithymia is associated with a host of other psychological symptoms including negative moods, risky use of alcohol or cannabis, disordered eating patterns and excessive internet use.

Why is alexithymia such a high risk factor for other problems? In the words of the Australian research team, “Emotional self-awareness is the necessary foundation for emotional self-regulation, which in turn allows positive interactions with others” (p. 13507). Thinking about that work colleague, after all, doesn’t their emotional distancing eventually serve as a turn-off? True, you might exchange the basics of communication, especially if you have work-related issues to discuss. However, there’s nothing else about them that proves particularly enticing beyond those necessities of communication.

One possibility to account for the fact that some people develop alexithymia traces the chain of events back to early childhood, when people form attachments to the caregivers on whom they rely. Continued experiences by their caregivers in which they are disappointed or rejected lead them to learn not only that others can’t be trusted, but also that it’s too painful to dwell on the hurt and pain that emerge from this poor caregiving.

Although other research teams have identified such possible early life contributors to alexithymia in adulthood, what is new about the approach that Lyvers et al. decided to follow is an emphasis on the sense of compassion. The lack of attention and affection alexithymic individuals received in infancy and early childhood causes them to believe that they are not worthy of compassion, not even from themselves. This idea of self-compassion causes them to believe that they have to “tough it out” when things get hard so as not to appear weak.

Other contributors to distress in those high in alexithymia include being afraid to experience happiness, a positive emotion that clearly contributes to mental health and well-being. In general, fear of happiness is a contributor to depression, so it makes sense that alexithymia would become a predisposing factor in and of itself.

Testing Alexithymia’s Predicted Contributors

With the prediction that fear of compassion would prove to be a unique contributor to alexithymia, and hence to psychological distress, the Bond. U. researchers recruited an online sample of 206 nonclinical young adults (ages 18-30), reasoning that this period of life would be especially important in studying this personality trait given what the authors describe as the “alarming” rise in rates of psychological distress, suicide, and self-harm in this age group.

To assess alexithymia, Lyvers et al. administered the Toronto Alexithymia Scale, a 20-item standard instrument used extensively in prior research. Items on this scale measure difficulty identifying and describing feelings and the “externally-oriented” quality of thinking that forms the third piece of alexithymia, measured with items such as “I prefer talking to people about their daily activities rather than their feelings.”

The 38-item measure of fear of compassion included three components. Fear of self-compassion: (“I feel that I don’t deserve to be kind and forgiving to myself”), fear of compassion from others (“Wanting others to be kind to oneself is a weakness”), and fear of compassion toward others (“People will take advantage of me if they see me as too compassionate”). This last facet of fear of compassion is an interesting one. People who endorse this item not only resist any offers of help presented to them, but dismiss compassion altogether as a desirable personal quality. Refusing to show or accept compassion can only contribute to a sense of loneliness and despair.

The complete set of instruments also included a nine-item measure of fear of happiness (e.g. “I find it difficult to trust positive feelings”) a standard 21-item mood questionnaire tapping into recent feelings of anxiety (“I was aware of dryness in my mouth”), depression (“I felt downhearted and blue”), and stress (“I found it hard to wind down”).

Although a correlational study by design, the authors used a statistical approach that allowed them to formulate a model testing both direct effects of alexithymia on mood along with the indirect effects associated with fear of compassion and happiness. Consistent with prior studies on fear of happiness, this factor (as predicted by alexithymia) contributed to mood. However, on its own, fear of compassion also contributed to negative mood reflecting, in the words of the authors, “a fundamental deficit of emotional self-regulation” (p. 13513).

From Fear to Acceptance

The ability to experience both happiness and compassion, so central for both well-being and good relationships, appears to lie at the crux of alexithymia’s detrimental effect on mental health. Fear of compassion is particularly interesting as one of these contributors given that it’s so much more than just wanting to avoid positive emotions. Compassion is at the root of good relationships, even ones in which people aren’t particularly all that close to each other. Imagine that coworker of yours who scoffs at any thought of accepting other people’s mistakes. It can’t be very reassuring to think about this person as someone who could help you someday, because chances are they won’t.

From the standpoint of the individual high in alexithymia, though, what are the options? The Bond U. researchers point to an approach known as “Compassion Focused Therapy” in which individuals develop the ability to establish “the compassionate self” that can serve as an “adaptive resource” in times of trouble (p. 13513). This can be half the battle in trying to help alexithymic individuals start to understand and accept the many varieties of human emotions, especially when they need to muster up the inner resources to confront challenges.

To sum up, people high in alexithymia got to that point as adults through an early life that was almost invariably loaded with rejection, dismissiveness, and disappointment when it comes to trusting others (and ultimately, themselves). The path to fulfillment for these individuals is still possible to find as long as they can rewire their ability to rely on, and enjoy, their full range of emotions.