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Coined in 1972 by the Harvard psychiatrist Dr. Peter Sifneos, alexithymia refers to a condition in which a person experiences an emotional flatness, inability to verbalize feelings, and an outward appearance of emotionlessness. The person has trouble evaluating their own emotions and bodily sensations, cannot effectively communicate their feelings to others, and possess a very limited emotional vocabulary. They might know that they feel butterflies in the stomach, or that they sweat before taking an exam, but the alexithymic person would not realize they were experiencing anxiety.

Being so out of touch with their own emotions, the alexithymic often feels separated from the rest of society. Their inability to properly analyze their own emotional sensations can even lead them to somaticize, or confuse an emotional pain for a physical one.

The cause of alexithymia is unknown, but Sifneos has theorized a disconnection between the limbic system and neocortex, most notably the verbal centers, since seizure patients who have had that connection severed often become emotionally "flat."

Alexithymia is usually regarded as a disturbance of affect regulation (Talyor, Bagby and Parker, 1997). The literal meaning of the word alexithymia is `no words for feelings'. The construct alexithymia has undergone a continuing development for the past years, according to recent definitions alexithymia consists of the following salient features:

  1. Difficulties defining emotions and differentiating emotions and the bodily sensations of emotional arousal.
  2. Difficulties in describing emotions to other people, verbalizing.
  3. Limited imaginative processes, a lack of fantasy.
  4. a stimulus bound, externally oriented cognitive style.
  5. (Taylor, Bagby and Parker, 1997)

Measuring alexithymia
Alexithymia is usually measured with the Toronto Alexithymia Scale(TAS-20), developed by the Taylor group. A shortcoming of this test is that it doesn't fully cover the alexithymia spectrum (Zech, Luminet, Rimé, and Wagner, 1999; Berthoz, Perez-Diaz, Consoli, and Jouvent, 2000; Vorst, and Bermond, 2001). Only the features 1, 2 and 4 are in the TAS-20. According to Nemiah and Sifneos (1970), the founders of alexithymia, besides the three scales used in the TAS-20 (identification, verbalizing and externally oriented cognitive style) reduced emotionality and reduced imagination are also part of the alexithymia construct. The alexithymia questionnaire developed by Vorst and Bermond (2001), the so called Bermond Vorst Alexithymia Questionnaire (BVAQ), has the remaining scales incorporated and therefore it covers the whole alexithymia spectrum with the use of five subscales (reduced emotionality and imagination, reduced capacities to verbalize, identify and analyze emotions). By applying a second order factor analysis to these subscales, two underlying dimensions emerge: an affective dimension (emotionality and fantasy), and a cognitive dimension (verbalizing, analyzing and identifying). The cognitive component of the BVAQ has a strong resemblance with the summed score of the TAS-20 (Zech, Luminet, Rimé, and Wagner, 1999; Berthoz et al.,2000; Vorst and Bermond, 2001).

Alexithymia Types
Combining the extreme scores on the affective and cognitive component of the BVAQ allows for the creation of four main types of alexithymia (Moormann, Bermond and Rood, 2004; Bermond, Vorst and Moormann, 2006; Moormann et al., In press). The four main types can be described in short as follows:

  • Type I alexithymia
    Individuals diagnosed with type 1 alexithymia are characterized by low emotionality, a reduced fantasy and have difficulties with verbalizing, identifying and analyzing their emotions. These individualss can't talk about their feelings, but also don't know what they are feeling.
  • Type II alexithymia
    People identified as type II alexithymia experience emotions, but have difficulties with verbalizing, identifying and analyzing them. In contrast to type I alexithymia they have a well developed imagination. Type II alexithymia has often been found amongst victims of sexual abuse (Moormann, Albach, Bermond, and Van Dorp, 1997; Moormann, Bermond, Albach, 2004).
  • Type III alexithymia
    Type III alexithymia is the counterpart of type II alexithymia. These individuals report that they are capable of verbalizing, identifying and analyzing their emotions, but they have a low emotionality and have a decreased imagination.
  • Lexithymia
    In contrast to a-lexithymia, lexithymia features a high emotionality, a rich fantasy and a well developed capacity to verbalize, analyze and identify emotions. Lexithymia is comparable to the construct of emotional intelligence (Goleman, 1995; Parker, Taylor, and Bagby, 2001).
In addition to the four main types, two residual types can be constructed:
Modal type, individuals that fall in this category have an average score on both components
Mixed Profiles, individuals that fall in this category have an extreme score (high or low) on one component and an average score on the other.

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