Alexithymia: when feelings have no words

“How are you feeling?” – “Fine.” Or “bad”. Nothing more precise comes to mind, and the question itself is puzzling. A partner says it is hard to know what is going on inside you, and even calls it coldness. And when a therapist or a friend asks what the feeling is right now, the mind simply goes blank. Only when the stomach starts to ache or a heavy tiredness sets in does it become clear that something has been upsetting all day.

In the early 1970s Peter Sifneos, a Greek-born psychiatrist working in Boston, noticed a pattern in some of his patients. They came with psychosomatic conditions and, when asked about their feelings, described bodily sensations in detail but not what they were actually going through. Sifneos called this alexithymia, from Greek words meaning “no words for feelings”. Today the term covers three things: difficulty recognising one’s own feelings, difficulty describing them to others, and a habit of focusing on external events rather than on inner experience.

Alexithymia is not an illness or a diagnosis but a personality trait that people have to different degrees. Population studies suggest that about 10% of adults have it.

Feelings, but no words

The most important thing to understand is that people with alexithymia do have feelings. They get angry, feel joy, worry and love. What is missing is the bridge between a feeling and the word for it. A feeling arrives as a vague sense that something is off, and it is hard to tell what exactly is wrong. Behind “bad” there may be sadness, anger, fear or shame, and the whole emotional vocabulary comes down to “fine” and “not great”.

So a person often finds out about their feelings late: the evening has already gone wrong, the argument has already happened, or someone close says, “You’ve been on edge all day.” Then it all makes sense, but at the time it was just tension.

When the body speaks instead

One of the most interesting explanations was put forward by British researchers Rebecca Brewer, Richard Cook and Geoffrey Bird. They found that people with alexithymia report difficulty sensing not only emotions but other signals from their own body too, such as hunger, tiredness and temperature. They also perceive emotional states as more similar to bodily ones. So the difficulty may be less about the feelings themselves and more about a general inability to sense and understand one’s own body.

This explains a lot. If anxiety, hunger and tiredness feel almost the same, a knot in the stomach could mean nerves before a difficult conversation or a missed lunch. The emotion stays in the body as a lump in the throat, tension in the shoulders or a stomach ache. Perhaps that is why people who find it especially hard to identify their feelings are more likely to have persistent physical symptoms without a clear medical cause. Alexithymia is also more common among people with chronic pain and eating disorders.

Not coldness

From the outside, alexithymia often looks like detachment. Conversations stay on facts and plans, and the person with alexithymia may find it harder to read from someone’s face what they are feeling, or to guess what is going on with a partner. But this is not indifference: there is simply no clear sense of what is going on inside.

Autism shows this well. For a long time, difficulties understanding emotions were seen as an inherent part of autism. But about half of autistic people have alexithymia, and research has shown that many of these difficulties, such as recognising other people’s feelings and empathising with them, are linked to alexithymia rather than to autism as such. In one experiment, participants with and without the diagnosis empathised with others to the same extent when their levels of alexithymia matched.

Close relationships can be difficult too. People with alexithymia feel lonely more often, and conversations between partners are less often truly open, even when both genuinely value each other. Sometimes one person wants to talk about feelings while the other shows care through actions, and both end up feeling misunderstood.

Where it comes from

A large Danish twin study found that genes explain about a third of the differences between people. The rest comes from the environment, mostly from experiences unique to each person rather than shared by the whole family.

Much can depend on childhood: whether feelings were noticed and named in the family. Some people recognise themselves in “that’s how we were brought up” or “we never talked about feelings at home”. When a child’s emotions were dismissed, ignored or forbidden (“stop crying”, “nothing happened”), the child had nowhere to learn the words for them. Among different forms of difficult childhood experience, emotional neglect is one of the most closely linked with alexithymia in adulthood.

Alexithymia can also change over time. It often grows stronger during depression and eases with recovery. After traumatic experiences, some researchers see it as a possible way of coping: when feelings are too painful, not noticing them can offer some protection.

Finding the words

It might seem that a word changes nothing: a feeling stays the same whatever it is called. But that is not quite true. In a 2007 study by Matthew Lieberman at the University of California, Los Angeles, people were shown photos of angry or frightened faces. When they chose a word for the emotion on a face, activity in the amygdala, a part of the brain involved in reacting to threat, went down. Putting a feeling into words seems to calm this alarm response a little.

Starting with the body. Instead of trying to find the right word straight away, it helps first to notice what is happening in the body: where the sensation is, whether it is hot or cold, tight or heavy, fast or slow. This is the first step towards a name.

Narrowing down “bad”. “Bad” is a perfectly good starting point. Then it can be narrowed: is it closer to anger, fear, sadness or tiredness? Over time, the vocabulary becomes richer.

Noticing afterwards: realising later (“oh, I was upset when my stomach started hurting”) is not a failure but progress. The gap between having a feeling and noticing it usually shortens with practice.

Writing things down: short notes about the day and how it felt can help put sensations into words.

Guesses instead of questions: for a partner, “you look tense” is often easier to respond to than “tell me how you feel”. A gentle guess offers a word that can be accepted or corrected.

When psychotherapy can help

It is worth seeing a psychotherapist if difficulty with feelings gets in the way of life: if it leads to loneliness or conflict in relationships, if physical symptoms without a clear cause won’t go away, or if low mood lingers for a long time.

A psychotherapist helps the person notice what is happening in the moment and find words for it together. Gradually it becomes clearer how bodily sensations connect to situations and feelings. Over time, feelings stop being a vague sense that something is off: the person starts to recognise and understand them.