Dictionary Definitions of Alexithymia

There are various definitions of Alexithymia in dictionaries and encyclopedias, and the differences often reflect the speciality or objectives of the author.

Dictionary definitions

A succinct and accurate definition can be found in the American Psychiatric Glossary. The entry was probably written by John C. Nemiah, one of the psychiatrists responsible for coining the term, who was acting as a consulting editor.

American Psychiatric Glossary, 7th edition, p.6.

Alexithymia A disturbance in affective and cognitive functioning that overlaps diagnostic entries but is common in psychosomatic disorders, addictive disorders, and post-traumatic stress disorder. The chief manifestations are difficulty in describing or recognising one's own emotions, a limited fantasy life, and general constriction in the affective life.

J. C. Nemiah(?), R. J. Campbell (ed.), 1994.

A different entry appears in an earlier Psychiatric reference work, also edited by the psychoanalyst R. J. Campbell.

Psychiatric dictionary, 1989, p.28.

Alexithymia Difficulty in describing or recognizing one's emotions; suggested by P. Sifneos to describe those patients who define emotions only in terms of somatic sensations or of behavioral reactions rather than relating them to accompanying thoughts. "They … give the impression that they do not understand the meaning of the word 'feeling'." (Short-term Psychotherapy and Emotional Crisis, 1972). Their emotional functioning in general appears constricted and their phantasy life is limited and lackluster.

Some believe alexithymia reflects an absence of the ego functions that subserve affect and phantasy, but most writers explain it as due to primitive ego defenses that hide and distort the conscious experience of affect and phantasy.

R. J. Campbell, 1989.

The final paragraph is potentially misleading. It is wrong to say that "most writers" explain alexithymia in terms of ego defences; most do not, and many writers explicitly caution against doing so. On a charitable analysis, Campbell is writing principally for a psychoanalytic audience and he presumably means 'most psychoanalytic writers' on the topic, referring indirectly to Joyce McDougall and Henry Krystal, whose explanations contrast with—and in this respect, contradict—those of Sifneos, Nemiah and their colleagues.

By contrast, the following definition is written specifically with the neuropsychological audience in mind:

The Blackwell Dictionary of Neuropsychology, 1996.

alexithymia A disruption of both affective and cognitive processes, alexithymia is a collection of traits rather than a psychiatric syndrome. Alexithymics are incapable of expressing emotions in the sense that, while the emotion may be experienced, the emotion cannot be associated with a mental representation and so formally expressed. Alexithymia has classically been described in patients with psychosomatic disorders, but also in alcoholics, drug addicts, and patients with traumatic stress disorders.

Alexithymia has been reported in commisurotomy patients, and following right hemisphere stroke. These may be regarded as primary alexithymias, while secondary alexithymias may be associated more closely with psychogenic processes of denial and repression. It has also been suggested that alexithymia reflects a variation in cerebral organisation, and that this may be demonstrated by LEMs [Lateral Eye Movements]; others have proposed that alexithymia results from a functional disconnection between the cerebral hemispheres.

The Blackwell Dictionary of Neuropsychology, p.43-4.

The secondary alexithymia mentioned in the entry above corresponds to Sifneos's version of the primary/secondary distinction, referring to neurogenic/psychogenic causes respectively; it does not correspond to the original distinction introduced by Freyberger, between alexithymia as a persistent trait (primary) and alexithymia as a transient state of suppressed emotionality in reaction to immediate psychological trauma (secondary). Krystal represents both versions in the definition below.

Psychoanalytic Terms and Concepts, 1990, p.11.

Alexithymia: A cognitive style and affective disturbance commonly found in patients suffering from psychosomatic, addictive, or post-traumatic conditions. The alexithymic state is characterized by poorly differentiated and poorly verbalized affects that do not serve the signal function adequately (do not communicate effectively). Psychosomatic patients, for instance, often ignore psychic and somatic danger signals, presenting a stoical appearance, sometimes with a stiff posture and wooden facies. Addictive patients particularly fear the somatic components of affects and try to block them, especially by chemical means. Post-traumatic patients are often unable to experience pleasure (a condition known as anhedonia).

Individuals suffering from alexithymia think in an operative way and may appear to be superadjusted to reality. In psychotherapy, however, a cognitive disturbance becomes apparent as the patients tends to recount trivial, chonologically ordered actions, reactions, and events of daily life with monotonous detail. In general, these individuals lack imagination, intuition, empathy, and drive-fulfillment fantasy, especially in relation to objects. Instead, they seem oriented toward things and even treat themselves as robots. These problems seriously limit their responsiveness to psychoanalytic psychotherapy; psychosomatic illness or substance abuse is frequently exacerbated should these individuals enter psychotherapy.

The term was introduced by Sifneos in 1967 and further clarified and elaborated by Nemiah and Sifneos in 1970. In the large body of literature that treats the concept, some authors attribute the manifestations to primary neuroanatomical deficits, while others point to various psychological problems, primary and secondary. McDougall and others see the phenomena from a psychoanalytic point of view as a group of developmental defenses closely allied with denial and splitting. A similar group of defenses, described in 1963 by Marty and his co-workers in France, was named la pensée opératoire.

Henry Krystal, 1990.

This is a good definition, but there are some minor inaccuracies. First, it is careless to suggest that alexithymics "ignore" their affects as this misleadingly implies a deliberate act; better to say "neglect" or "are oblivious to". Strictly speaking, it is incorrect to talk of "individuals suffering from alexithymia" because alexithymia is a collection of traits, not an illness; better to say "exhibiting" or "manifesting". The third paragraph is wrong about the year in which the term was introduced. For the record, Sifneos described the clinical features in 1967, and theorized about the etiology with Nemiah in 1970, but he first used the term in 1972. So although the syndrome was conceived in the 1960s, it wasn't officially named until much later.

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