Alexithymia

Here's another word I hadn't heard before until recently: alexithymia. According to wikipedia, it is a decreased ability to identify, understand, and describe one's own emotions. It is supposed to be common (10%) with a high comorbidity.

Does this sound like anyone you know?


Nick Frye-Cox, a doctoral student in the Department of Human Development and Family Studies, says people with alexithymia can describe their physiological responses to events, such as sweaty palms or faster heartbeats, but are unable to identify their emotions as sad, happy or angry. In addition, those with alexithymia have difficulty discerning the causes of their feelings or explaining variations in their emotions, he said.
***
“People with alexithymia are always weighing the costs and benefits, so they can easily enter and exit relationships. They don’t think others can meet their needs, nor do they try to meet the needs of others.”

This is going to blow your minds, but alexithymia has been linked to lack of empathy:

Because awareness of emotional states in the self is a prerequisite to recognizing such states in others, alexithymia (ALEX), difficulty in identifying and expressing one's own emotional states, should involve impairment in empathy. Using functional magnetic resonance imaging (fMRI), we compared an ALEX group (n = 16) and a non-alexithymia (non-ALEX) group (n = 14) for their regional hemodynamic responses to the visual perception of pictures depicting human hands and feet in painful situations. Subjective pain ratings of the pictures and empathy-related psychological scores were also compared between the 2 groups. The ALEX group showed less cerebral activation in the left dorsolateral prefrontal cortex (DLPFC), the dorsal pons, the cerebellum, and the left caudal anterior cingulate cortex (ACC) within the pain matrix. The ALEX group showed greater activation in the right insula and inferior frontal gyrus. Furthermore, alexithymic participants scored lower on the pain ratings and on the scores related to mature empathy. In conclusion, the hypofunction in the DLPFC, brain stem, cerebellum, and ACC and the lower pain-rating and empathy-related scores in ALEX are related to cognitive impairments, particularly executive and regulatory aspects, of emotional processing and support the importance of self-awareness in empathy.

This is all sort of interesting and new to me. It's only been relatively recently that I've identified my emotions as being present, but difficult to identify, whether nervousness, love, or even just a general inability to give feelings that context that they need to become emotions. Consequently they aren't meaningful to me in the way that I imagine they are for others -- I don't feel the same way about them.

"What is it Like to Never Have Felt an Emotion?"

Asks the BBC in this article of the same name sent to me by a reader about alexithymia. It makes some interesting points. I'll highlight a few.

The causes:

Today, it seems clear that there may be many types of alexithymia. While some might have trouble expressing emotions, others (like Caleb) might not even be conscious of the feelings in the first place. Richard Lane, at the University of Arizona compares it to people who have gone blind after damage to the visual cortex; despite having healthy eyes, they can’t see the images. In the same way, a damaged neural circuit involved in emotional processing might prevent sadness, happiness or anger from bursting into consciousness. (Using the analogy of the Russian doll, their emotions are breaking down at the second shell of feeling – their bodies are reacting normally, but the sensations don’t merge to form an emotional thought or feeling.) “Maybe the emotion gets activated, you even have the bodily responses, but it happens without you being consciously aware of the emotion,” he says.

Along these lines, a few recent fMRI scanning studies have found signs of a more basic perceptual problem in some types of alexithymia. Goerlich-Dobre, for instance, found reduced grey matter in areas of the cingulate cortex serving self-awareness, potentially blocking a conscious representation of the emotions. And André Aleman at the University Medical Centre in Groningen, the Netherlands, detected some deficits in areas associated with attention when alexithymics look at emotionally charged-pictures; it was as if their brains just weren’t registering the feelings. “I think this fits quite well with [Lane’s] theory,” says Aleman – who had initially suspected other causes. “We have to admit they are right.”

Interestingly, this connection to other physical disorders:

Further work could also pin down the puzzling link to so-called “somatic disorders”, such as chronic pain and irritable bowel syndrome, that seem to be unusually common in people with alexithymia. Lane suggests it’s down to a kind of “short-circuit” in the brain, created by the emotional blindness. Normally, he says, the conscious perception of emotions can help damp down the physical sensations associated with the feeling. “If you can consciously process and allow the feeling to evolve – if you engage the frontal areas of the brain, you recruit mechanisms that have a top down, modulatory effect on bodily processes,” says Lane. Without the emotional outlet, however, the mind could get stuck on the physical feelings, potentially amplifying the responses. As Goerlich-Dobre puts it: “They are hypersensitive to bodily perceptions, and not able to focus on anything else, which might be one reason why they develop chronic pain.” (Some studies, have in fact found that alexes are often abnormally sensitive to bodily sensations, although other experiments have found conflicting evidence.)

My neurotherapist actually suggested that what I perceive to be food allergies (I basically eat the same 10 foods for 90% of my nutrition) might actually be emotional distress that I am not aware of but that is still registering physically in these negative ways. 

The way one of the sufferers connects with emotions is often an academic exercise:

Physical sensations certainly seem to dominate Caleb’s descriptions of difficult events, such as periods of separation from his family. “I don’t miss people, as far as I can tell. If I’m gone, and don’t see someone for a long period, it’s a case of out of sight, out of mind,” he says. “But I do feel physically a kind of pressure or stress when I’m not around my wife or my child for a couple of days.”
***Caleb, too, has visited a cognitive behavioural therapist to help with his social understanding, and through conscious effort he is now better able to analyse the physical feelings and to equate it with emotions that other people may feel. Although it remains a somewhat academic exercise, the process helps him to try to grasp his wife’s feelings and to see why she acts the way she does.

And finally the obligatory knock on sociopaths, because heaven forbid someone confuse your total lack of emotions and affective empathy with something as so way different as psychopathy:

Ultimately, he wants to emphasise that emotional blindness does not make one unkind, or selfish. “It may be hard to believe, but it is possible for someone to be cut off completely from the emotions and imagination that are such a big part of what makes us humans,” he says. “And that a person can be cut off from emotions without being heartless, or a psychopath.”

"When the Ether Stares Back" (part 2)

My response:

I really like the passage about people recognizing their emotions through the physical manifestations. I have said before that I feel emotions, but I have difficult identifying them (alexithymia) or contextualizing them in any meaningful way (or if I do, it's erratic). Only in the past five years or so have I spent any great effort in trying to identify my emotional reactions. Before I wouldn't even label them, e.g. I wouldn't know if I was feeling betrayed or incensed or jealous or whatever, I just knew that I really wanted to hurt a particular person. Now I really do try to play detective with my emotions, using certain clues in my own reactions and what prompted them to figure out what exactly I am feeling (as opposed to just being aware of what I am thinking). It's a lot (I imagine) like how a doctor will use certain physical symptoms to diagnose. Thanks for the heads up on "The Growth of the Mind and the Endangered Origins of Intelligence". I'll have to check it out.

About the relationship, I'm not sure if you will be able to stop the chain reaction of apathy. I think the pull might be too strong. I feel that way sometimes when I am around other sociopaths, even the ones that like me and want what's best for me. There is just not enough social/emotional glue sticking us together, really.

The reader responds:

And you're right. It lasted about forty five days. Today we occasionally call one another when we want/need something.  But otherwise it didn't last.  Overall, a lack of either partner ACTUALLY caring, drove the "relationship" to the brink of the abyss, and plummeted over the edge and into the black.  


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Borderline personality disorder vs. sociopathy

This was an interesting article from the Psychology Today blog relating an experiment done examining the brain activity of sociopaths and comparing it to that of people with borderline personality disorder. Why these two disorders? Apparently, sociopathic and borderline traits occur with equal frequency among violent offenders, but they reach their antisocial behavior in different ways:

Typically, antisocial offenders with borderline personality disorder are emotionally reactive, unable to regulate emotions, bereft of cognitive empathy (knowing how another person feels), rageful, and reactively aggressive. By contrast, antisocial offenders with high psychopathic traits can be characterized as emotionally detached, cognitively empathic, morally problematic, exploitative, and proactively and reactively aggressive.

The experiment:

The investigators took MRI scans of the two groups of antisocial offenders, with the aim of exploring differences in the cerebral structure of their brains. All offenders had been convicted for capital, violent crimes (including severe bodily injury such as murder, manslaughter, robbery, or rape) from high-security forensic facilities and penal institutions and were formally diagnosed with antisocial personality disorder. There was also a comparison group of healthy men.

The results:

The antisocial offenders with borderline personality disorder had alterations in the orbitofrontal and ventromedial prefrontal cortex regions, which are involved in emotion regulation and reactive aggression; there were also differences in the temporal pole, which is involved in the interpretation of other peoples’ motives. By contrast, the antisocial offenders with high psychopathic traits showed reduced volume mostly in midline cortical areas, which are involved in the processing of self-referential information and self reflection (i.e., dorsomedial prefrontal cortex, posterior cingulate/precuneus) and recognizing emotions of others (postcentral gyrus). 

I thought this was interesting. I wrote previously about the connection between sociopathy and alexithymia, or the decreased ability to identify, understand, and describe one's own emotions. This trait has been linked to a lack of empathy, the idea being that if you are unable to understand your own emotions, you don't stand much of a chance of understanding the emotional worlds of others. I feel like I don't understand my emotions, that they feel out of context to me, like I'm getting only snippets of a movie played backwards. This feeling probably contributes to my weak sense of self. This brain scan study seems to comport with this theory -- that sociopaths suffer from an ability to process self-referential information and to self-reflect, and that consequently sociopaths have flexible understandings of not only morality, but basically every human trait.

Chocolate Autizzy (autism) x Dorian (psychopathy)

Confessions of a Sociopath author M.E. Thomas (Jamie) talk about the difficulties in finding a therapist that will treat psychopaths or other types of emotionally disabled people (e.g. alexithymia, anhedonia, major depression, etc.), childhood trauma, defense mechanisms, wanting to have loving relationships, hurt people hurt people, politics, etc.