Research Definitions of Alexithymia

Research Definitions

The first mention of alexithymic traits occurred in Peter Sifneos's book Short-Term Psychotherapy and Emotional Crisis (Harvard University Press, 1972). The term was coined as an adjective, to describe certain patients with a broad range of common characteristics which Sifneos describes below.

Sifneos, 1972

The ability, then, not only to recognize and express emotions but also to verbalize them is significant. Some patients experience a difficulty in this area. When they are asked to talk about how they feel they mention repetitively and endlessly only somatic sensations, without being able to relate them to any accompanying thoughts, fantasies, or conflicts. Others seem to be unable to specify what it feels like to be angry or sad, and a few individuals fail to differentiate between pleasant and unpleasant emotions. They usually respond to such questioning by describing the actions they take under those circumstances and, when pressed for further details, show irritability and annoyance. Such patients seem to have limited vocabularies. They seem to have marked difficulty in finding appropriate words to describe their emotions. They usually look puzzled and give the impression they do not understand the meaning of the word "feeling". Because of these limitations, such patients tend to have difficulty in communicating with other people and appear uninteresting and dull. The interviewer, in turn, experienced in dealing with elaborate verbal communications of ordinary neurotic people, finds it difficult to evaluate such boring patients. Furthermore, because he is unable to make a psychodynamic formulation or to it the patient into a familiar diagnostic category, he tries to explain away the patient's difficulties by statements such as, "He seems to be denying his emotion."

I would like to introduce the word alexithymic (Greek a, lack, lexis, word, thymos, mood) to describe patients who present these difficulties. What is of interest is that during the evaluation interviews with them, a compromise is usually reached when finally the psychiatrist is forced to talk about the emotions of the patient by providing his own appropriate words to describe them. The patient, in turn, borrows these words gratefully, and by imitating, he parrots them back to his doctor without understanding their real meaning. Usually an impasse is reached.

Short-Term Psychotherapy and Emotional Crisis, pp.81-2.

The term is defined more succinctly in Sifneos's paper The Prevalence of 'Alexithymic' Characteristics in Psychosomatic Patients.

Sifneos, 1972/1973

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 1973, pp.255-6

Note that Sifneos again cites it in adjective form. In fact there are 16 occurrences of "alexithymic" as an adjective, but no instances of "alexithymia"as a noun. At this point there is still no such 'thing' as alexithymia, so the question of its status as a disorder, condition, state or trait does not arise.

Sifneos's colleague John Nemiah used the word alexithymic at a 1972 symposium in London (published in Physiology, Emotion and Psychosomatic Illness, 1972), but he did not offer a definition.

The first occurrence of the construct of alexithymia seems to be in Alexithymia: A view of the Psychosomatic Process, by Nemiah, Freyberger and Sifneos.

Nemiah, Freyberger & Sifneos, 1976

Since his initial delineation of the behaviour of such patients, Sifneos (1972) has introduced the word alexithymia (from Greek stems meaning 'without words for feelings') as a general term for the behavioural syndrome.

p.430

Note that it is defined here as a syndrome, i.e. a collection of traits indicative of a specific pathology.

The construct has been developed since then by Canadian psychiatrists, and has now evolved an operational meaning based on the standardized self-report questionnaire used to measure it (the TAS).

Taylor & Bagby, 2000.

Since the Heidelberg conference, there has been a consensus in the literature on the definition of the alexithymia construct. The salient features of the construct are (1) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal; (2) difficulty describing feelings to other people; (3) constricted imaginal processes, as evidenced by a paucity of fantasy; and (4) a stimulus-bound, externally oriented cognitive style. Although some so-called alexithymic individuals appear to contradict this definition of the construct because they experience chronic dysphoria or manifest outbursts of weeping or rage, intensive questioning usually reveals that "they know very little about their own feelings and, in most instances, are unable to link them with memories, fantasies, or specific situations".

"An Overview of the Alexithymia Construct", pp.41-2.

An alternative occurrence of the same definition:

Taylor, Bagby & Parker, 1997.

Since the Heidelberg conference the alexithymia construct has been refined theoretically, largely through a program of research that sought to validate the construct in the process of developing a reliable and valid instrument for measuring it. As it is presently defined, the alexithymia construct is composed of the following salient features: (i) difficulty identifying feelings and distinguishing betweeen feelings and the bodily sensations of emotional arousal; (ii) difficulty describing feelings to other people; (iii) constricted imaginal processes, as evidenced by a paucity of fantasies; and (iv) a stimulus-bound, externally oriented cognitive style.

Disorders of Affect Regulation, p.29.

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