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Alexithymia means having a hard time noticing, naming and sharing your own feelings. It is a trait that runs from mild to strong, not a diagnosis. Researchers measure three parts: trouble identifying feelings, trouble describing them, and a habit of focusing on outside events. Research suggests it can ease with practice and support.
Someone asks, "How are you feeling?" and your mind goes blank. You say "fine" or "just tired" and change the subject. Later your stomach is tight and your jaw aches, and you could not say why.
This has a name: alexithymia (say it: uh-lex-uh-THIGH-mee-uh). The word means "no words for feelings" (Davies & Griffin, 2025 (opens in a new tab)). It does not mean you have no feelings or do not care. It means your feelings are hard to notice, name or share.
A pattern I often see is capable, caring people who solve everyone else's problems and go quiet when asked what they feel. No one ever showed them how to read what is going on inside.
What is alexithymia?
Researchers call it a personality trait: a lasting way of thinking and reacting. It has three parts (Luminet & Nielson, 2025 (opens in a new tab)). The standard questionnaire, the 20-item Toronto Alexithymia Scale, measures the same three (Bagby et al., 1994 (opens in a new tab)).
| Part | In plain words | What it can sound like |
|---|---|---|
| Trouble identifying feelings | You sense something is off but cannot tell what | "I feel bad. I don't know why." |
| Trouble describing feelings | You sense it, but the words do not come | "I can't explain it." |
| Outward-focused thinking (externally oriented thinking) | Your attention goes to facts and tasks, not to what is happening inside | "Just tell me what needs to get done." |
Is alexithymia a diagnosis? How common is it?
No. Alexithymia is a trait, not a clinical diagnosis (Moriguchi & Komaki, 2013 (opens in a new tab)). It is not listed as a mental disorder in the DSM-5-TR, the manual clinicians use to diagnose.
It is also not something you either have or do not have. Everyone has some of it, from a little to a lot (Luminet & Nielson, 2025 (opens in a new tab)). In a Finnish survey of 1,285 adults, scores formed a bell curve, with most people in the middle (Salminen et al., 1999 (opens in a new tab)).
How common are high levels? A major review estimates 7 to 13 percent of the general population (Luminet & Nielson, 2025 (opens in a new tab)). The Finnish survey found 13 percent.
What does it look like day to day?
- You say "I'm fine" because you truly do not know what else to say.
- Your body speaks first: headaches, an upset stomach, a tight chest, poor sleep.
- You cry and do not know why, or you feel numb when you expected to feel something.
- You stay busy or scroll your phone so you do not have to sit with a feeling.
- Your partner says, "You never tell me how you feel," and you honestly do not know what to say.
In a national Finnish survey of 5,129 adults, higher scores went with more physical symptoms, even after accounting for depression, anxiety and physical illness (Mattila et al., 2008 (opens in a new tab)). Body symptoms have many causes, so please have a doctor check anything new or worrying.
Where does alexithymia come from?
Research points to a mix of causes.
Temperament and genes. A study of 8,785 Danish twin pairs estimated that genes explain about 30 to 33 percent of the differences in alexithymia. Life experiences explained the rest, mostly ones the twins did not share (Jørgensen et al., 2007 (opens in a new tab)).
Trauma and hard early experiences. A meta-analysis (a study that combines many studies) of 36,141 people found a modest link between childhood maltreatment and adult alexithymia. It was strongest for emotional neglect, emotional abuse and physical neglect (Ditzer et al., 2023 (opens in a new tab)). A major review notes it can also develop after trauma, in childhood or in adulthood (Luminet & Nielson, 2025 (opens in a new tab)). These are group patterns, not rules for one person.
Family patterns. Here is what I often see: families that lived through generations of hardship and trauma often learn to focus on safety and not talk about feelings, and that pattern can pass down. When survival is the job, naming feelings can feel like a luxury.
Research fits part of this. One main theory is that children learn feeling words and what body signals mean from caregivers, so a home that rarely talks about feelings can leave gaps (Luminet & Nielson, 2025 (opens in a new tab)). A review also found a small but consistent link between parents' and children's scores, which could come from genes, home life or both (Davies & Griffin, 2025 (opens in a new tab)).
If this is your story, it is not a flaw in you. It was a way to stay safe.
How does it connect to depression, anxiety and relationships?
Alexithymia is not depression or anxiety, but it often shows up with them.
Depression. Two meta-analyses, covering 19 and 35 studies, found that more alexithymia goes with more depression. The ties were strongest for trouble identifying and describing feelings (Li et al., 2015 (opens in a new tab); Liu et al., 2025 (opens in a new tab)). More in my article on depression symptoms, support and medication.
Anxiety. Reviews link alexithymia with anxiety disorders too (Karukivi & Saarijärvi, 2014 (opens in a new tab)), including panic disorder, which means repeated and unexpected panic attacks (Oussi et al., 2023 (opens in a new tab)).
Relationships. In a study of 155 married couples, higher alexithymia went with more loneliness, less close communication and lower marriage quality (Frye-Cox & Hesse, 2013 (opens in a new tab)). Not every study agrees. A study of parents-to-be found no direct link with relationship satisfaction (Karukivi et al., 2014 (opens in a new tab)).
Why does this matter before couples work?
Picture a couples session. A therapist asks, "What are you feeling right now?" and the room goes silent. You are not hiding anything. The answer is not there yet.
A partner who says "you never tell me how you feel" is often asking to feel close, not for a perfect speech. Learning to notice and name your feelings first may help you get more out of couples work. Here is why I often suggest individual therapy first.
Can alexithymia change?
Research suggests it can ease with help, though results are not guaranteed. It tends to be fairly steady over time, but scores can rise and fall with symptoms like depression (Karukivi & Saarijärvi, 2014 (opens in a new tab)). Reviews of treatment studies are encouraging:
- A 2026 meta-analysis of 59 studies found that therapy and skills programs lowered scores more than comparison conditions, a medium-sized average effect (Mazza et al., 2026 (opens in a new tab)).
- A review of 18 randomized trials (people assigned by chance to a treatment or comparison group) found that most therapies lowered scores. Most were cognitive behavioral therapy (CBT), which works on the links between thoughts, feelings and actions, including acceptance and commitment therapy (ACT) (Tsubaki & Shimizu, 2024 (opens in a new tab)).
- A major review found that programs teaching awareness of body sensations and feelings, with structured practice and homework, tended to work well (Luminet & Nielson, 2025 (opens in a new tab)).
The authors call for larger, stronger studies, so the news is hopeful but early.
What helps you get better at naming feelings?
Build a feelings vocabulary. Go beyond mad, sad, glad and fine. Try tense, let down, embarrassed, overwhelmed, lonely, relieved.
Check in daily: body first, then a word. Pause and ask, "Where do I feel something in my jaw, chest, stomach, shoulders or hands?" Describe it: tight, heavy, hot, buzzing, empty. Then pick one word; a guess is fine. Over time, you learn your body's early cues.
Write it down. Two or three lines at night: what happened, what my body did, and what word fits. In a meta-analysis of 146 randomized studies, writing or talking about personal feelings helped on average, though the effect was small (Frattaroli, 2006 (opens in a new tab)).
What can I try this week?
- Pick five feeling words. Put them on a sticky note. Use one a day.
- Do a 30-second body check three times a day. Notice, name, move on.
- Tell one safe person one sentence. "I think I feel ___ because ___." A guess counts.
A private starting point
My self-checks page has short check-ins for eight common concerns, and its introduction talks about trouble naming feelings. The checks are not a diagnosis, and your answers are not saved.
See the self-checksHow counseling can help
With 20+ years of experience as a Licensed Professional Counselor, I keep this work slow and practical. We start with the body, add words, then connect both to your life. I draw on CBT and ACT skills: noticing a feeling, naming it, making room for it, and choosing your next step based on what matters to you. Mindfulness skills can be part of that.
I go slow for a reason. Research suggests alexithymia can make therapy results somewhat smaller, but it does not usually stop people from making gains (Luminet & Nielson, 2025 (opens in a new tab)).
We also look at where your rules about feelings came from. This is not about blaming your family. It is about seeing the rules you were handed and deciding which ones still help. More about my counseling for depression and anxiety.
Common questions
Is alexithymia a mental illness?
No. It is a trait, not a diagnosis, though it often shows up alongside depression and anxiety.
Is alexithymia the same as autism?
No, though they can overlap. A review of 15 studies found alexithymia in about 50 percent of autistic people and about 5 percent of people who were not autistic (Kinnaird et al., 2019 (opens in a new tab)). It is common in autism, not universal.
Can I have it and not know?
Yes. If a trait makes feelings hard to notice, the trait can be hard to notice too. In my experience, a partner or friend often notices first.
Want to talk it through?
If this sounds like you, you can book a free 15-minute call. It is a short consultation, not counseling. We can see whether my approach fits. I see adults in person in Sugar Land or online anywhere in Texas, in English, Hindi or Gujarati.
This free 15-minute call does not establish a therapist-client/patient relationship as this is not counseling and/or life coaching.
Sources
- Davies RN, Griffin K. A systematic review of alexithymia in young people and their parents. Journal of Affective Disorders. 2025;390:119855. https://pubmed.ncbi.nlm.nih.gov/40652974/ (opens in a new tab)
- Luminet O, Nielson KA. Alexithymia: Toward an Experimental, Processual Affective Science with Effective Interventions. Annual Review of Psychology. 2025;76:741-769. https://pubmed.ncbi.nlm.nih.gov/39322432/ (opens in a new tab)
- Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research. 1994;38(1):23-32. https://pubmed.ncbi.nlm.nih.gov/8126686/ (opens in a new tab)
- Moriguchi Y, Komaki G. Neuroimaging studies of alexithymia: physical, affective, and social perspectives. BioPsychoSocial Medicine. 2013;7:8. https://pmc.ncbi.nlm.nih.gov/articles/PMC3621096/ (opens in a new tab)
- Salminen JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. Journal of Psychosomatic Research. 1999;46(1):75-82. https://pubmed.ncbi.nlm.nih.gov/10088984/ (opens in a new tab)
- Karukivi M, Saarijärvi S. Development of alexithymic personality features. World Journal of Psychiatry. 2014;4(4):91-102. https://pmc.ncbi.nlm.nih.gov/articles/PMC4274591/ (opens in a new tab)
- Kinnaird E, Stewart C, Tchanturia K. Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry. 2019;55:80-89. https://pubmed.ncbi.nlm.nih.gov/30399531/ (opens in a new tab)
- Mattila AK, Kronholm E, Jula A, et al. Alexithymia and somatization in general population. Psychosomatic Medicine. 2008;70(6):716-722. https://pubmed.ncbi.nlm.nih.gov/18596251/ (opens in a new tab)
- Jørgensen MM, Zachariae R, Skytthe A, Kyvik K. Genetic and environmental factors in alexithymia: a population-based study of 8,785 Danish twin pairs. Psychotherapy and Psychosomatics. 2007;76(6):369-375. https://pubmed.ncbi.nlm.nih.gov/17917473/ (opens in a new tab)
- Ditzer J, Wong EY, Modi RN, Behnke M, Gross JJ, Talmon A. Child maltreatment and alexithymia: A meta-analytic review. Psychological Bulletin. 2023;149(5-6):311-329. https://pubmed.ncbi.nlm.nih.gov/37261746/ (opens in a new tab)
- Li S, Zhang B, Guo Y, Zhang J. The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry Research. 2015;227(1):1-9. https://pubmed.ncbi.nlm.nih.gov/25769520/ (opens in a new tab)
- Liu Z, He S, Hou C. The effect of alexithymia on depression: evidence from meta-analysis. Frontiers in Psychology. 2025;16:1465286. https://pubmed.ncbi.nlm.nih.gov/40528844/ (opens in a new tab)
- Oussi A, Hamid K, Bouvet C. Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping. Journal of Behavior Therapy and Experimental Psychiatry. 2023;79:101835. https://pubmed.ncbi.nlm.nih.gov/36680910/ (opens in a new tab)
- Frye-Cox NE, Hesse CR. Alexithymia and marital quality: the mediating roles of loneliness and intimate communication. Journal of Family Psychology. 2013;27(2):203-211. https://pubmed.ncbi.nlm.nih.gov/23544920/ (opens in a new tab)
- Karukivi M, Tolvanen M, Karlsson L, Karlsson H. Is alexithymia linked with marital satisfaction or attachment to the partner? A study in a pregnancy cohort of parents-to-be. Comprehensive Psychiatry. 2014;55(5):1252-1257. https://pubmed.ncbi.nlm.nih.gov/24813790/ (opens in a new tab)
- Mazza A, Davis P, Johnson L, Larkin F, Cole SN. Identifying therapies to effectively reduce alexithymia: A systematic review and meta-analysis. Journal of Affective Disorders. 2026;400:121167. https://pubmed.ncbi.nlm.nih.gov/41525940/ (opens in a new tab)
- Tsubaki K, Shimizu E. Psychological Treatments for Alexithymia: A Systematic Review. Behavioral Sciences (Basel). 2024;14(12):1173. https://pubmed.ncbi.nlm.nih.gov/39767314/ (opens in a new tab)
- Frattaroli J. Experimental disclosure and its moderators: a meta-analysis. Psychological Bulletin. 2006;132(6):823-865. https://pubmed.ncbi.nlm.nih.gov/17073523/ (opens in a new tab)
This article is general information, not a diagnosis or a substitute for care. If you are in crisis, call or text 988, or call 911.
