Alexithymia Illustrated: 4 Comics about Alexithymia Origins and Treatment
Alexithymia is when a person is not able to understand, express, or name their emotions. It’s not a disorder in itself; rather, it’s a symptom that appears as part of other disorders.
In this article, I share some illustrations I made to explain alexithymia and how therapy can help us reorient to our own emotional life.
How We (Typically) Learn to Express Emotion
Most of us learn as infants – before we even learn language – how to express and tell the difference between emotions.
Babies orient to their own emotions when they see their emotions amplified on the face of a caring parent or caregiver.
Most caregivers naturally pick up on a baby’s emotions and reflect them back. It’s something we tend to do without thinking. (You might have even noticed your own face amplifying an infant’s expression in a casual encounter!)
But not every parent is able to do this work. Something therapists call “mirroring”.
Some caregivers can’t be physically present to do this because of work, health issues, or separation. Others may struggle emotionally or with postpartum depression. A parent’s own experiences with trauma, abuse, or neglect can make it too painful – or too unfamiliar – to emotionally connect and reflect their child’s feelings.
This mirroring-in-the-face-of-a-parent helps a child’s brain begin to know and recognize their emotions, eventually helping babies grow into adults able to feel their feelings openly, name those feelings, and describe their feelings with words.
So, what happens when we don’t get that mirroring as infants?
Some children, through luck or perhaps having genes a bit more adept at navigating emotion and language, gain these skills through a relationship with an attuned adult as they grow up.
Many children without mirroring, however, grow into rational, functional, good people who have a strange sense that something is missing or blunted- this is Alexithymia. Alexithymia may not itself create suffering in the way a depression or trauma diagnosis might. Instead, it’s the absence of something that should be.
Thankfully, our incredible brains remain open to creating new neural pathways1 and new neurons2 throughout our lifetime. Mirroring can transform our brains and our emotional experience at any age.
How Psychodynamic Therapy Treats Alexithymia
People with Alexithymia might feel like they have no emotion, but it’s more accurate to say that they don’t have awareness or words to express their emotions. Even if emotions can’t be recognized or named, emotional currents still run under the surface – impacting our thoughts, behaviors, and relationships.
Therapy typically approaches Alexithymia in 2 ways:
Attuned Caregiving:
In psychodynamic therapy, a therapist might treat alexithymia by fostering the formation of new neural pathways through attuned, empathic mirroring of what the therapist senses might be the underlying, unrecognized emotion that a client brings into session. It might sound something like:
Psychoeducation:
Psychoeducation is, essentially, education about psychology. It’s a big part of counseling (and the bulk of my work on Patreon!)
Psychoeducation plays a roll in the treatment of alexithymia because even though we might have a great grasp of language, we might not have made connections between how emotions feel when they are in our bodies and an emotional vocabulary.
It might sound something like:
These processes, repeated countless times, build an ability to recognize and express emotion, while also helping to build satisfying relationships that support good mental health.
Psychodynamic therapy, like the work I did in my clinical practice, addresses alexithymia by offering to clients the attunement and mirroring of emotion that may have been missing in childhood. Over time, this type of therapy can strengthen the neural pathways in the brain that make it possible to notice, name, express, and get care for the emotions they experience. Though this process, a wider emotional range can be developed, leading to more satisfying relationships outside of therapy and richer life experiences.
Learning to Name Emotions
Our ability to name our own emotions begins through an emotional connection with other people. These connections help our brains learn to notice body sensations, match them with feeling words, share those feelings with someone else, and then take in the support and response that comes back.
When we show up in relationships able to express emotion, we create deeper, more satisfying relationships.
Where We Start: Emotions in the Body
Emotions are experienced throughout the body.
For many of us, learning to notice our emotions—especially how they show up in our bodies – can be a powerful part of healing from alexithymia.
When we pause and gently check in with what our body might be telling us (e.g., tight shoulders, a pit in our stomach, a racing heart), we’re actually helping our brain grow new connections that support emotional awareness.
Think of it like physical therapy: Just like we might work a weak muscle to help it get stronger and more supportive, we can “work” these brain pathways by practicing mindfulness and tuning into body-based feelings. Over time, that practice can help us feel and name emotions with more clarity and confidence.
We can learn to recognize a particular emotion by learning to recognize and name the associated body sensations. A skilled therapist can provide the essential one-on-one care to recover from Alexithymia. In support of that recovery, you may find my printable emotion sensation wheel, which takes a traditional feeling wheel and modifies it to include the physical sensations that often accompany emotions, a helpful resource.
Alexithymia and Trauma
While it is not unusual for alexithymia to be diagnosed as part of an autism, major depression, or even a personality disorder diagnosis, Many individuals without these diagnoses experience the symptoms of alexithymia to some degree.
Struggling to notice, name, or express emotions is common to many individuals who have survived trauma or emotional neglect – even those who may have had attuned mirroring as a child and who may otherwise be thriving.
Trauma survivors may develop alexithymia as a way to cope with overwhelmingly negative emotions. For these individuals, blocking emotions may have been adaptive for much of their life. However, not being able to feel and express their emotions may eventually leave them feeling isolated and lonely. Over time, they may feel cut-off from relationships with others and even from themselves.
For trauma survivors who experience alexithymia, treatment from an experienced trauma-informed counselor or therapist may provide containment for the overwhelming emotions associated with the trauma while the person grows a greater capacity to experience and express them.
Why Seek Treatment?
Treating alexithymia can improve our overall well-being and life satisfaction. It can also deepen our relationships – strengthening connection in friendships, partnerships, and marriages. For many people, it even leads to more satisfying sexual experiences, as emotional awareness grows and we become more present in both our bodies and our connection with a partner.
In Summary
Ideally, each of use has our emotions noticed, responded to, and integrated back into our own awareness in early childhood. In normal development, through mirroring a child becomes increasingly capable of automatically intuiting the physical, emotional, and social experiences within their body and connecting them with an emotion.
Historically, researchers believed this naturally happened in childhood – with emotional development occurring as automatically as a child growing in height or progressing through puberty. We now know that developing awareness and language to describe the emotions we experience is a learned skill that requires some basic support for people to develop. Social emotional learning curriculum in schools is beginning to address these deficits in school-age children, but how to help the millions who didn’t get early emotional needs met or early intervention? Psychotherapy, counseling, and meaningful relationships.
Image Description for Screen Readers:
There are four illustrations for this article.
The first illustration is of two people looking at one another. They have thought bubbles coming out of their heads that connect, which look like scribble lines coming from the person on the left (the client) and is more of a straight line from the person on the right (the therapist). Below them is written: “In Psychodynamic therapy, the therapist notices the feelings stirred in themselves and begins to put words to these emotions for the client.”
The second illustration is the same two people, both wearing matching sad expressions. Text below them reads, “Simply seeing our emotions mirrored on the face of an attentive listener can grow the capacity to recognize our own emotions.”
The third illustration is of the same two people, but the person on the left is holding their stomach. They have speech bubbles above their head. The person on the left is saying, “My stomach feels funny…” The person on the right is responding, “I wonder what that’s trying to tell you? Could it be…” Below them is text that reads, “Emotion is experienced throughout the body. We can learn to recognize emotion by learning to recognize and name body sensations.”
The fourth illustration is just the person who has been on the left (the client). They are speaking, “I feel…um…” The speech bubble is filled with scribbles. Text below this reads, “Alexithymia is when a person is not able to express, tell the difference between, and name emotions.”
Illustrations created by @LindsayBraman.
- Kolb, B., & Gibb, R. (2011). Brain plasticity and behaviour in the developing brain.
Journal: Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20(4), 265–276. https://pmc.ncbi.nlm.nih.gov/articles/PMC3222570/ [↩] - Boldrini, M., Fulmore, C. A., Tartt, A. N., et al. (2018). Human Hippocampal Neurogenesis Persists Throughout Aging. Journal: Cell Stem Cell, 22(4), 589–599.e5. https://www.cell.com/cell-stem-cell/fulltext/S1934-5909(18)30121-8 [↩]
This has been super helpful and informative as a therapist – thank you for sharing this information.