# Alexithymia... a no-mood disorder that's turning up... **URL:** \ **Category:** Lounge\ **Created:** [September 5, 2007, 1:42pm UTC](https://pheromonetalk.com/t/alexithymia-a-no-mood-disorder-thats-turning-up/5417 "2007-09-05T13:42:08Z")\ **Posts on this page:** 2\ **Page:** 1
**Author:** ![tacitus](https://avatars.discourse-cdn.com/v4/letter/t/6a8cbe/32.png) [@tacitus](https://pheromonetalk.com/u/tacitus)\ **Post date:** [September 5, 2007, 1:42pm UTC](https://pheromonetalk.com/t/alexithymia-a-no-mood-disorder-thats-turning-up/5417/1 "2007-09-05T13:42:08Z")
Once the distortions are cleared away, most patients who come to the emergency room tell stories that seem to grow out of the problems they claim to have and the pain they claim to feel. These stories reverberate with emotions congruent to their themes. But occasionally, patients who clearly have problems and are in great emotional pain tell noncongruent stories. **They will insist that they have no problems, that life is fine and that they have no idea what is wrong. Their story is that they have no story. These patients seem unable to find the words necessary to describe their feelings.** In 1972, Peter Sifneos introduced to psychiatry the term _alexithymia_, which (derived from the Greek) literally means having no words for emotions (a=lack, lexis=word, thymos=emotions). Alexithymia is not a diagnosis, **but a construct useful for characterizing patients who seem not to understand the feelings they obviously experience, patients who seem to lack the words to describe these feelings to others**. Identifying this deficit in expressivity is important because doing so gives the clinician a leg up in making a diagnosis and charting a therapeutic course. Many individuals with alexithymia have somatic complaints. Considerable empirical evidence links prolonged states of emotional arousal, and the concomitant physiological arousal, with susceptibility to certain somatic disorders. **Clearly, someone who cannot verbally express negative emotions will have trouble discharging and neutralizing these emotions, physiologically as well as psychically**. All feelings, whether normal or pathological, are ultimately bodily feelings. Those with alexithymia lack a lived understanding of what they experience emotionally. From the perspective of development, alexithymia implies a glitch in the process that permits the expression of feelings in words that capture the body’s involvement in these feelings. Perhaps the child’s mother failed to sufficiently encourage a language of feelings (surely excluding her from the pantheon of Winnicott’s “good enough” mothers). Alternatively, emotional trauma later in life may compromise the connection between what is felt and what can be grasped about this feeling and can be put into words, particularly if that link were tenuous to begin with. If a patient has no story to tell a clinician, even at a time when emotions are stirred high enough to prompt an ER visit, **it seems a good bet that person has no story to tell themselves either. Having no story almost certainly implies an impaired identity: Who we know ourselves to be depends heavily on the story we tell ourselves about who we are**. The inability to express emotions verbally implies a deficient interior life. Inevitably, those who cannot match words to feelings will live out that deficit in their contacts with others as well. To have no words for one’s inner experience is to live marginally, for oneself and for others. “Kisha,” 16, was brought to the ER by her mother after she held a curling iron to the outside of her upper left arm, causing a large, painful burn. Kisha had just started her junior year in high school and also worked as a cashier in a convenience store. She was an average student, but her mother assured me she was one of the most popular girls in her class. Kisha lived with her parents, two sisters and brother. She had never used illicit drugs or abused alcohol. “I’m a virgin,” she said easily and proudly when I asked if she had a current boyfriend, which she did not. Kisha denied physical and sexual abuse, and her mother later corroborated her denial. Asthma, occasional bronchitis and seasonal allergies were her only concessions to good health. Kisha acknowledged feeling depressed recently, although she did not admit to having any of the symptoms of a major depressive episode. Her appetite had not changed, and she was sleeping up to 10 hours a day, the norm for her. My best diagnostic call was depressive disorder, not otherwise specified. Asked how she felt during the interview, Kisha answered with an easy smile, “I feel fine.” It seemed to me the happy face owed more to practice than to spontaneity. I doubted her affect reflected her mood, then or earlier that day. When I asked Kisha why she burned herself so seriously, she looked at me blankly and said she did not know. She denied anything had changed in her life recently. She acknowledged no disappointment or setback, no problems at home or at school. According to Kisha, everything was fine. The burn that brought Kisha to the ER on the evening I interviewed her was not her first act of self-mutilation. Seven months earlier, she had jumped out of a second-story window. Inexplicably, she did not go to a hospital, either for medical treatment or for psychiatric evaluation. I was the first mental health clinician Kisha had spoken to. During the previous year, Kisha also had made modest cuts with a razor on the underside of one forearm and on her cheek. “I was just bored,” was her explanation. Asked why she jumped out of the window, her only response was, “I have no idea.” She denied this potentially lethal act had anything to do with what was going on in her life at the time. Despite my persistent efforts to elicit more information about the reason for Kisha’s self-destructive behavior, she did not offer a scintilla of explanation. **That she was acknowledging no reasons for what she had done did not strike her as the least bit odd.** Kisha’s mother told me with understatement that her daughter “keeps it all inside.” Clearly, Kisha was not the only minimizer in this family. The mother also volunteered that Kisha had trouble getting over disappointments. The day before she burned herself with the curling iron, a woman who had promised to take Kisha to a museum in another city abruptly canceled the trip. At the time she jumped from the window, Kisha was having problems with a boyfriend, and the relationship soon ended. Kisha vigorously denied she had difficulty getting over disappointments in general or that a particular disappointment had anything to do with any of her self-destructive acts. Her mother thought differently. Kisha had no words for the feelings that led her to do these things. But her silence spoke volumes. Clearly, she had emotions she did not acknowledge or understand. This young woman put a smile on her despair. She gave no hint of what was going on under the mask. **Most patients who come to the ER after harming themselves seem eager to discuss the meaning of their behavior. Rather complex issues are clarified, often with startling insight**. These patients are willing to have their initial, often self-deceiving explanations challenged and to allow the subtext of their destructive act to be interpreted to them. But after Kisha burned her arm, no words came to name the emotions that drove her to do this. She clarified nothing, for herself or for me. Kisha was alexithymic. ---
**Author:** ![Lor](https://sea2.discourse-cdn.com/flex016/user_avatar/pheromonetalk.com/lor/32/759_2.png) [@Lor](https://pheromonetalk.com/u/Lor)\ **Post date:** [September 5, 2007, 2:15pm UTC](https://pheromonetalk.com/t/alexithymia-a-no-mood-disorder-thats-turning-up/5417/2 "2007-09-05T14:15:19Z")
im willing to bet that this is something that can have adult onset after something like PTSD. very interesting tacitus.