Research investigating the alexithymia construct is advancing rapidly and has broadened considerably in recent years as a result of interdisciplinary efforts, new methodologies, and experimental techniques. New developments in the field include a shift from measurement-based validational studies to experimental investigations, which explore the relation between alexithymia and various aspects of emotional processing; the use of functional brain imaging techniques to explore neural activity associated with alexithymia; and experimental studies that measure multiple indices of physiological response to standardized emotion-inducing stimuli. Developmental research and attachment studies are providing ways for investigating potential etiological sources of the construct; and experimental approaches are being used to explore relations between alexithymia and other health-related personality constructs. In addition, longitudinal and treatment studies are clarifying the relation between alexithymia and psychopathology and the extent to which alexithymia predicts treatment outcome. Investigators need to embrace the new methods and techniques for the field of research to further increase understanding of the alexithymia construct and its association with physical and mental illness.

Keywords:
Alexithymia, Emotional processing, Research trends, Neural correlates, Psychophysiology, Depression, Attachment, Predictive studies
1.
Sifneos PE: The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychother Psychosom 1973;22:255–262.
2.
Taylor GJ, Bagby RM, Parker JDA: Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge, Cambridge University Press, 1997.
3.
Sivak R, Wiater A, Lolas F: Alexitimia, La Difficultad Para Verbalizar Afectos. Buenos Aires, Paidós, 1997.
4.
Corcos M, Speranza M (eds): Psychopathologie de l’alexithymie. Paris, Dunod, 2003.
5.
Taylor GJ: Recent developments in alexithymia theory and research. Can J Psychiat 2000;45:134–142.
6.
Taylor GJ, Ryan D, Bagby RM: Toward the development of a new self-report alexithymia scale. Psychother Psychosom 1985;44:191–199.
7.
Bagby RM, Parker JDA, Taylor GJ: The Twenty-Item Toronto Alexithymia Scale-I: Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23–32.
8.
Taylor GJ, Parker JDA, Bagby RM: The Twenty-Item Toronto Alexithymia Scale. IV. Cross-cultural validity and reliability. J Psychosom Res 2003;55:277–283.
9.
Porcelli P, Meyer GJ: Construct validity of Rorschach variables for alexithymia. Psychosomatics 2002;43:360–369.
10.
Taylor GJ, Bagby RM, Luminet O: Assessment of alexithymia: Self-report and observer-rated measures; in Bar-On R, JDA (eds): The Handbook of Emotional Intelligence. San Francisco, Jossey-Bass, 2000, pp.301–319.
11.
Haviland MG, Warren WL, Riggs ML: An observer scale to measure alexithymia. Psychosomatics 2000;41:385–392.
12.
Vorst HCM, Bermond B: Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire. Pers Indiv Diff 2001;30:413–434.
13.
Haviland MG, Warren WL, Riggs ML, Nitch SR: Concurrent validity of two observer-rated alexithymia measures. Psychosomatics 2002;43:472–477.
14.
Lumley MA, Davis M, Labouvie-Vief G, Gustavson B, Clement R, Barry R, Simon T, Rivard R: Multiple measures of emotional abilities: Their interrelationships and associations with physical symptoms (abstr). Psychosom Med 2002;64:146.
15.
Martínez-Sánchez, F: The Spanish version of the Toronto Alexithymia Scale (TAS-20). Clínica Salud 1996;7:19–32.
16.
Arimura T, Komaki G, Murakami S, Tamagawa K, Nishikata H, Kawai K, Nozaki T, Takii M, Kubo C: Development of the structured interview by the modified edition of Beth Israel Hospital Psychosomatic Questionnaire (SIBIQ) in Japanese edition to evaluate alexithymia. Jpn J Psychosom Med 202;42:259–269.
17.
Subic-Wrana C, Bruder S, Thomas W, Gaus E, Merkle W, Köhle K: Distribution of alexithymia as a personality trait in psychosomatically ill inpatients measured with the TAS-20 and LEAS. Psychother Psychosom Med Psychol 2002;52:454–460.
18.
Lane RD, Sechrest L, Riedel R: Sociodemographic correlates of alexithymia. Compreh Psychiat 1998;39:377–385.
19.
Suslow T, Junghanns K: Impairments of emotion situation priming in alexithymia. Pers Indiv Diff 2002;32:541–550.
20.
Lundh L-G, Simonsson-Sarnecki M: Alexithymia and cognitive bias for emotional information. Pers Indiv Diff 2002;32:1063–1075.
21.
Bucci W, Kabasakalian-McKay R, and the RA Research Group: Scoring referential activity. Instructions for use with transcripts of spoken narrative texts. Ulm, Ulmer Textbank, 1992.
22.
Bucci W: Psychoanalysis and Cognitive Science: A Multiple Code Theory. New York, Guilford Press, 1997.
23.
Taylor GJ: Somatization and conversion: Distinct or overlapping constructs. J Amer Acad Psychoanal Dyn Psychiat 2003;31:485–506.
24.
Hoppe KD, Bogen JE: Alexithymia in twelve commissurotomized patients. Psychother Psychosom 1977;28:148–155.
25.
Lane RD, Ahern GL, Schwartz GE, Kaszniak AW: Is alexithymia the emotional equivalent of blindsight? Biol Psychiat 1997;42:834–844.
26.
Shallice T: ‘Theory of mind’ and the prefrontal cortex. Brain 2001;124:247–248.
27.
Berthoz S, Artiges E, Van de Moortele P-F, Poline J, Consoli SM, Martinot J-L: Effect of impaired recognition and expression of emotions on fronto-cingulate cortices: An fMRI study of men with alexithymia. Am J Psychiat 2002;159:961–967.
28.
Gündel H, López A, Deus J, Cardoner N, Mittag B, Ceballos-Baumann A, von Rad M, Pujol J: Anatomical variability of the anterior cingulate cortex in relationship to alexithymia (abstr). Psychosom Med 2002;64:110.
29.
Huber M, Herholz K, Thiel A, Müller-Küppers M, Ebel H, Subič-Wrana C, Heiss W-D: Different patterns of regional brain activation during emotional stimulation in alexithymics in comparison with normal controls. Psychother Psych Med Psychol 2002;52:469–478.
30.
Kano M, Fukodo S, Gyoba J, Kamachi M, Tagawa M, Mochizuki H, Itoh M, Hongo M, Yanai K: Specific brain processing of facial expressions in people with alexithymia: An H2 150-PET study. Brain 2003;126:1474–1484.
31.
Hariri AR, Bookheimer SY, Mazziotta JC: Modulating emotional responses: Effects of a neocortical network on the limbic system. NeuroReport 2000;11:43–48.
32.
Gazzaniga MS: Consciousness and the cerebral hemispheres; in Gazzaniga MS (ed), The Cognitive Neurosciences. Cambridge, MA, MIT Press, 1995, pp. 1391–1400.
33.
Aftanas LI, Varlamov AA, Reva NV, Pavlov SV: Disruption of early event-related theta synchronization of human EEG in alexithymics viewing affective pictures. Neuroscience Letters 2003;340:57–60.
34.
Bullmore E, Fletcher P: The eye’s mind: Brain mapping and psychiatry. Brit J Psychiat 2003;182;381–384.
35.
Krystal H: Integration and Self-Healing: Affect, Trauma, and Alexithymia. Hillsdale, NJ, Analytic Press, 1988.
36.
De Bellis MD, Keshavan MS, Shifflett H, Iyengar S, Beers SR, Hall J, Moritz G: Brain structures in pediatric maltreatment-related posttraumatic stress disorder: A sociodemographically matched study. Biol Psychiat 2002;52:1066–1078.
37.
Teicher MH: Wounds that time won’t heal: The neurobiology of child abuse. Cerebrum 2000;2:50–67.
38.
De Bellis MD, Baum AS, Birmaher B, Keshavan MS, Eccard CH, Boring AM, Jenkins FJ, Ryan ND: Developmental traumatology part I: Biological stress systems. Biol Psychiat 1999;45:1259–1270.
39.
Berenbaum H: Childhood abuse, alexithymia and personality disorder. J Psychosom Res 1996;41:585–595.
40.
Moormann PP, Bermond B, Albach F, van Dorp I: The etiology of alexithymia from the perspective of childhood sexual abuse; in Vingerhoets A, van Bussel F, Boelhouwer J (eds): The (Non) Expression of Emotions in Health and Disease. Tilburg, Tilburg University Press, 1997, pp 139–153.
41.
Kooiman CG, van Rees Vellinga S, Spinhoven P, Draijer N, Trijsburg RW, Rooijmans HGM: Childhood adversities as risk factors for alexithymia and other aspects of affect dysregulation in adulthood. Psychother Psychosom 2004;73:107–116.
42.
Joukamaa M, Kokkonen P, Veijola J, Läksy K, Karvonen JT, Jokelainen J, Järvelin M-R: Social situation of expectant mothers and alexithymia 31 years later in their offspring: A prospective study. Psychosom Med 2003;65:307–312.
43.
Kokkonen P, Veijola J, Karvonen JT, Läksy K, Jokelainen J, Järvelin M-R, Joukamaa M: Ability to speak at the age of 1 year and alexithymia 30 years later. J Psychosom Res 2003;54:491–495.
44.
Schore AN: The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology. Devel Psychopath 1996;8:59–87.
45.
Cassidy J: Emotion regulation: Influences of attachment relationships. Monogr Soc Res Child Dev 1994;59:228–249.
46.
Fonagy P, Target M: Attachment and reflective function: Their role in self-organization. Devel Psychopath 1997;9:679–700.
47.
Beckendam CC: Dimensions of emotional intelligence: Attachment, affect regulation, alexithymia and empathy. Doctoral dissertation, The Fielding Institute, Santa Barbara, CA, 1997.
48.
Scheidt CE, Waller E, Schnock C, Becker-Stoll F, Zimmermann P, Lücking H, Wirsching M: Alexithymia and attachment representation in idiopathic spasmodic torticollis. J Nerv Ment Dis 1999;187:47–52.
49.
Troisi A, D’Argenio A, Peracchio F, Petti P: Insecure attachment and alexithymia in young men with mood symptoms. J Nerv Ment Dis 2001;189:311–316.
50.
Lumley MA, Ovies T, Stettner L, Wehmer F, Lakey B: Alexithymia, social support and health problems. J Psychosom Res 1996;41:519–530.
51.
Posse M, Hallstrom T, Backenroth-Ohsako G: Alexithymia, social support, psychosocial stress and mental health in a female population. Nord J Psychiat 2002;56:329–334.
52.
Kojima M, Senda Y, Nagaya T, Tokudome S, Furukawa TA: Alexithymia, depression and social support. Psychother Psychosom in press.
53.
Simpson JA, Rholes WS, Nelligan JS: Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. J Pers Soc Psychol 1992;62:434–446.
54.
Berkman LF: The role of social relations in health promotion. Psychosom Med 1995;57:245–254.
55.
Maunder RG, Hunter JJ: Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosom Med 2001;63:556–567.
56.
Lumley MA, Stettner L, Wehmer F: How are alexithymia and physical illness linked? A review and critique of pathways. J Psychosom Res 1996;41:505–518.
57.
Picardi A, Pasquini P, Cattaruzza MS, Gaetano P, Melchi CF, Baliva G, Camaioni D, Tiago A, Abeni D, Biondi M: Stressful life events, social support, attachment security and alexithymia in vitiligo. Psychother Psychosom 2003;72:150–158.
58.
Lacey JI, Kagan J, Lacey BC, Moss HA: The visceral level: Situational determinants and behavioral correlates of autonomic response patterns; in Knapp PH (ed): Expression of the Emotions in Man. New York, International Universities Press, 1963, pp. 161–196.
59.
Lang PJ, Greenwald MK, Bradley MM, Hamm AO: Looking at pictures: Affective, facial, visceral, and behavioral reactions. Psychophysiol 1993;30:261–273.
60.
Luminet O, Rimé B, Bagby RM, Taylor GJ: A multimodal investigation of emotional responding in alexithymia. Cognition and Emotion, in press.
61.
Stern RM, Sison CEE: Response patterning, in Cacioppo JT, Tassinary LG (eds): Principles of Psychophysiology: Physical, Social, and Inferential Elements. Cambridge, Cambridge University Press, 1990, pp. 193–215.
62.
Stone LA, Nielson KA: Intact physiological response to arousal with impaired emotional recognition in alexithymia. Psychother Psychosom 2001;70:92–102.
63.
Mueller J: Physiological and subjective reactions of alexithymic patients to emotion-inducing films (abstr). Psychosom Med 2002;64:88.
64.
Philippot P: Inducing and assessing differentiated emotion-feeling states in the laboratory. Cognition and Emotion 1993;7:171–193.
65.
Hagemann D, Naumann E, Maier S, Becker G, Lürken A, Bartussek D: The assessment of affective reactivity using films: Validity, reliability and sex differences. Pers Indiv Diff 1999;26:627–639.
66.
Porges SW: Vagal tone: An autonomic mediator of affect, in Garber J, Dodge KA (eds): The Development of Emotion Regulation and Dysregulation. Cambridge, Cambridge University Press, 1991, pp 111–128.
67.
Schweiger E, Wittling W, Genzel S, Block A: Relationship between sympathovagal tone and personality traits. Pers Indiv Diff 1998;25:327–337.
68.
Byrne N, Ditto B, Silverman C: Alexithymia and autonomic reactivity to emotion-inducing films. Poster presentation at the second international conference on the (non)expression of emotions in health and disease. Tilburg, The Netherlands, June 9–11, 1999.
69.
Parker JDA, Bauerman TM, Smith CT: Alexithymia and impoverished dream content: Evidence from rapid eye movement sleep awakenings. Psychosom Med 2000;62:486–491.
70.
De Gennaro L, Ferrara M, Cristiani R, Curcio G, Martiradonna V, Bertini M: Alexithymia and dream recall upon spontaneous morning awakening. Psychosom Med 2003;65:301–306.
71.
Ogden TH: On not being able to dream. Int J Psychoanal 2003;84:17–30.
72.
Salminen JK, Saarijärvi S, Äärelä E, Tamminen T: Alexithymia – state or trait? One-year follow-up study of general hospital psychiatric consultation outpatients. J Psychosom Res 1994;38:681–685.
73.
Martínez-Sánchez, F, Ato-García M, Ortiz-Soria B: Alexithymia – state or trait? Spanish J Psychol 2003;6:51–59.
74.
Honkalampi K, Hintikka J, Saarinen P, Lehtonen J, Viinamäki H: Is alexithymia a permanent feature in depressed patients? Psychother Psychosom 2000;69:303–308.
75.
Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamäki H: Depression is strongly associated with alexithymia in the general population. J Psychosom Res 2000;48:99–104.
76.
Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamäki H: Alexithymia and depression. A prospective study of patients with major depressive disorder. Psychosomatics 2001;42:229–234.
77.
Saarijärvi S, Salminen JK, Toikka TB: Alexithymia and depression: A 1-year follow-up study in outpatients with major depression. J Psychosom Res 2001;51:729–733.
78.
Saarijärvi S, Salminen JK, Toikka T: Alexithymia and depression – a five-year follow-up study (abstr). J Psychosom Res 2002;52:365.
79.
Santor DA, Bagby RM, Joffe RT: Evaluating stability and change in personality and depression. J Pers Soc Psychol 1997;73:1354–1362.
80.
Costa PT Jr, McCrae RR, Zonderman AB, Barbano HE, Lebowitz, B, Larson DM, Lebowitz B: Cross-sectional studies of personality in a national sample: 2. Stability in neuroticism, extraversion and openness. Psychology and Aging 1986;1:144–149.
81.
Luminet O, Bagby RM, Taylor GJ: An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychother Psychosom 2001;70:227–282.
82.
Porcelli P, Bagby RM, Taylor GJ, DE Carne M, Leandro G, Todarello O: Alexithymia as predictor of treatment outcome in patients with functional gastrointestinal disorders. Psychosom Med 2003;65:911–918.
83.
Kosten TR, Krystal JH, Giller EL, Dan E: Alexithymia as a predictor of treatment response in post-traumatic stress disorder. J Traumatic Stress 1992;5:41–50.
84.
Bach M, Bach D: Predictive value of alexithymia: A prospective study in somatizing patients. Psychother Psychosom 1995;64:43–48.
85.
Yehuda R, Steiner A, Kahana B, Binder-Brynes K, Southwick SM, Zemelman S, Giller EL: Alexithymia in Holocaust survivors with and without PTSD. J Traumatic Stress 1997;10:93–100.
86.
Engel CC, Liu X, McCarthy BD, Miller RF, Ursano R: Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War-related health concerns. Psychosom Med 2000;62:739–745.
87.
Ford JD, Campbell KA, Storzbach D, Binder LM, Anger WK, Rohlman DS: Posttraumatic stress symptomatology is associated with unexplained illness attributed to Persian Gulf War military service. Psychosom Med 2001;63:842–849.
88.
Sifneos PE: Problems of psychotherapy of patients with alexithymic characteristics and physical disease. Psychother Psychosom 1975;26:65–70.
89.
Äärelä E, Saarijärvi S, Salminen JK, Toikka T: Alexithymic features do not predict compliance with psychotherapy in consultation-liaison patients. Gen Hosp Psychiat 1997;19:229–233.
90.
Beresnevaite M: Exploring the benefits of group psychotherapy in reducing alexithymia in coronary heart disease patients: A preliminary study. Psychother Psychosom 2000;69:117–122.
91.
Murray RL: Efficacy of meditation in the remediation of alexithymic characteristics (abstr). Psychosom Med 2002;64:127.
92.
Lane RD, Sechrest L, Riedel R, Shapiro DE, Kaszniak AW: Pervasive emotion recognition deficit common to alexithymia and the repressive coping style. Psychosom Med 2000;62:492–501.
93.
Myers LB: Alexithymia and depression: The role of defensiveness and trait anxiety. Pers Indiv Diff 19:489–492, 1995.
94.
Brosschot JF, Aarsse HR: Restricted emotional processing and somatic attribution in fibromyalgia. Int J Psychiat Med 2001;31:127–146.
95.
Parker JDA, Taylor GJ, Bagby RM: Alexithymia: Relationship with ego defense and coping styles. Compre Psychiat 1998;39:91–98.
96.
Kooiman CG, Spinhoven P, Trijsburg RW, Rooijmans HGM: Perceived parental attitude, alexithymia and defense style in psychiatric outpatients. Psychother Psychosom 1998;67:81–87.
97.
Segal H: Notes on symbol formation. Int J Psychoanal 1957;38:391–397.
98.
Pennebaker JW: Health effects of the expression (and non-expression) of emotions through writing; in Vingerhoets A, van Bussel F, Boelhouwer J (eds): The (Non) Expression of Emotions in Health and Disease. Tilburg, Tilburg University Press, 1997, pp. 267–278.
99.
Lumley MA, Kelley J, Kraft C, D’Souza P, Norman S: Alexithymia moderates the effects of emotional disclosure in chronic pain. Paper presented at the Annual Convention of the American Psychological Association, Toronto, August 10, 2003.
100.
Lumley MA, Tojek TM, Macklem DJ: The effects of written emotional disclosure among repressive and alexithymic people; in Lepore SJ, Smyth JM (eds): The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-being. Washington, DC, American Psychological Association, 2002, pp 75–95.
101.
Páez D, Velasco C, González JL: Expressive writing, alexithymia as a dispositional deficit in self-disclosure, and psychological health. J Pers Soc Psychol 1999;77:630–641.
102.
Solano L, Donati V, Pecci F, Persichetti S, Colaci A: Postoperative course after papilloma resection: Effects of written disclosure of the experience in subjects with different alexithymia levels. Psychosom Med 2003;65:477–484.
103.
Snowden DA, Greiner LH, Kemper SJ, Nanayakkara N, Mortimer JA: Linguistic ability in early life and longevity: Findings from the Nun Study, in Robine J-M, Forette B, Francheschi C, Allard M (eds): The Paradoxes of Longevity. Berlin, Springer-Verlag, 1999, pp 103–113.
104.
Danner DD, Snowden DA, Friesen WV: Positive emotions in early life and longevity: Findings from the Nun Study. J Pers Soc Psychol 2001;80:804–813.
105.
Kauhanen J, Kaplan GA, Cohen RD, Julkunen J, Salonen JT: Alexithymia and risk of death in middle-aged men. J Psychosom Res 1996;41:541–549.
© 2004 S. Karger AG, Basel
2004
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.