|The Original Paper on Alexithymia|
The Prevalence of 'Alexithymic' Characteristics in Psychosomatic Patients
P.E. Sifneos, Department of Psychiatry, Beth Israel Hospital and Harvard Medical School, Boston, Mass.
Psychotherapy and Psychosomatics, 22, pp.255-262
This paper was presented at the 9th European Conference on Psychosomatic Research, Vienna in April 1972, and was reprinted in the book Topics of Psychosomatic Research, (Basle: Karger, 1973), edited by Hellmuth Freyberger.
Abstract. An attempt is made in this paper to investigate the prevalence among patients who suffer from various psychosomatic diseases, of a relative constriction in emotional functioning, poverty of fantasy life, and inability to find appropriate words to describe their emotions. For the lack of a better term, I call these characteristics 'alexithymic'.
Twenty-five psychosomatic patients outnumbered 25 control patients by better than two to one as far as possession of these 'alexithymic' characteristics. The question is raised whether these defects are due to biological or developmental factors, and the conclusion is reached that patients with these characteristics may not be good candidates for dynamic psychotherapy.
The paragraph below introduces the term and the observations which motivated it. (Note the modest qualifier, "for lack of a better term".)
It is of interest to notice that many, but not all, of the patients who suffered from psychosomatic disorders and whom I had the opportunity to interview over several years (1954-1968) while directing the Psychiatric Clinic at the Massachusetts General Hospital, showed a marked difficulty to communicate with the interviewer, they gave the overall impression of being dull, and they used actions to avoid conflicting or frustrating situations. In addition to a relative constriction in emotional functioning, their most striking characteristic was the inability to find appropriate words to describe their feelings. For lack of a better term, I proposed the word 'alexithymic' (from the Greek a = lack, lexis = word, thymos = a mood or emotion) to describe this specific difficulty which appears more likely to be due to a combination of neurophysiological and psychological defects rather than to purely psychological ones.
Sifneos concludes that dynamic psychotherapy is inappropriate for alexithymics because their inability to articulate their emotions prohibits the insights required for the healing process. He suggests alternatives that may be more beneficial.
The implication of the observations about 'alexithymic' patients presented in this paper points to the conclusion that these individuals are not good candidates for dynamic psychotherapy, because their defects, such as for example, their inability to express their emotions verbally, or their diminution of fantasy life would jeopardize a form of treatment which emphasizes verbal expression and requires a capacity for emotional interaction. On the contrary, for psychosomatic patients with alexithymic difficulties, different and less disturbing or intensive kinds of psychiatric treatments such as, supportive psychotherapy, behavior therapy, hypnosis, case work, and so on, may be much more appropriate.
In the final paragraph, Sifneos states that further investigation is required to ascertain the causes of the deficits for the sake of developing effective therapies.
In sum, then, these alexithymic characteristics not only seem to be present quite often in patients suffering from psychosomatic disorders, but also defy our usual psychodynamic ways of understanding psychological processes in general, and psychosomatic diseases in particular. Possibly because they may be due to neurophysiological, neuroanatomical, biochemical defects, or developmental difficulties involving the learning process, they require a systematic investigation. Only after the etiological factors which are responsible for these defects are clearly understood, shall we be able to develop appropriate treatment modalities to correct these broad emotional difficulties. I hope that this paper may stimulate some interest and lead to further investigation of this fascinating area of psychosomatic medicine.
The definition of alexithymia is within the context of psychosomatic medicine. The question of whether alexithymia occurs in non-psychosomatic control groups was not mooted at this stage, and no conclusion is drawn about whether it a predisposing factor for psychosomatic disease.