Alexithymia and psychosomatic symptoms

In my clinical practice, I frequently come across clients suffering from pain without physical causes. Through thorough clinical interviews, I often find out that many of these clients suffer from Alexithymia, a difficulty in identifying and describing one’s emotions and in distinguishing different emotions from bodily sensations of emotional arousal. There are multiple factors contributing to the development of this personality construct, including genetic factors, early childhood environment, and trauma.

The ability of identifying and describing subjective emotions is related to the parents’ ability to be attuned to the child’s emotions. The parents also need to be able to regulate the emotional states of the child. Furthermore, it is also important for the parents to translate the child’s states of emotional arousal into words so that the child can communicate to others. If the parents are unable to help the child to construct his or her emotional memory, the child is more likely to have difficulty to connect the non-verbal and verbal components of one’s emotions. That is, the child may be unable to realise and name he or she is anxious when experiencing palpitations, sweating and fast breathing. Without establishing such emotional memory, the child cannot distinguish his anxiety when having those somatic symptoms again.  Sometimes, if the parents are abusive, they may be unreliable in regulating their child’s emotional states. As a result, the child did not develop ability to reflect on and regulate their emotions. 

If a person can connect one’s physiological arousal of emotions to verbal representations, it is more likely that one’s emotional states be regulated. If he or she has difficulty for such connection, it is likely that a prolonged and repetitive physiological arousal be generated. As a result, the person experiences these unpleasant somatic sensations without knowing the underlying meaning of the physiological arousal. This is one of the most common underlying mechanisms of experiencing of pain without physical causes of my clients. 

The deficit in cognitively processing one’s emotional states is also related to many maladaptive emotional regulation behaviors. These may include excessive drinking, binge eating, or drug abuse. Sometimes, a person may also engage in self-harming behavior as a maladaptive emotional regulation strategy.

Through psychotherapy, it is possible to enhance the ability to identify and describe one’s emotional states of a person with Alexithymia. There are interventions available in helping the person to recognise, differentiate and label one’s subjective emotional states. As people with Alexithymia often have limited capacity in imagination and it is important for one to connect nonverbal and verbal components of emotional states, interventions promoting imagination can enhance the person’s awareness of one’s emotional states and subsequent regulation of the emotions. 

There are different underlying causes of various psychosomatic symptoms, such as pain. In fact, Alexithymia may only be one of the factors contributing to these symptoms. It is beyond dispute that enhancing the ability to identity and describe emotional states of people with psychosomatic symptoms is beneficial.  This capability and the ability to regulate one’s negative emotions are of paramount importance for a person to be able to function well in different aspects, including work, relationship and physical well-being.

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