Can’t Identify Your Feelings? You Might Have Alexithymia—The Unspeaking Heart

Some people have difficulty saying what they feel. It might seem like they have no feeling, but more often it’s that they aren’t aware of the feelings they do have and they can’t articulate them.

This condition is known clinically as alexithymia, meaning, no words for feelings. More literally and movingly translated it means, “unspeaking heart.” (a=not, lexi=speaking, thymia=heart.) And if you’re rolling your eyes right now, you’re the very person that needs to read this.

Today I want to discuss a topic that can sometimes stump therapists, frustrate partners, and leave you feeling at a loss for words and everything they can express. One study indicates that as many as 13% of the general population has alexithymia. That’s a lot of people walking around who don’t know what they want.

It’s not that people with alexithymia have no feelings, as if there is some huge empty cavern inside of them. In fact, we’ll find out that to some degree it’s the opposite; alexithymia is associated with higher intensity of feeling.

But it is certain that the path to feelings is blocked. They just aren’t accessible. People who have alexithymia can’t identify or describe them to themselves or others. The heart can’t speak.

While the heart has the right to remain silent, that silence results in not knowing what you want, and you may turn to other sources for guidance. We’ll get to that and other results of alexithymia soon.

This is not technically a diagnostic term, and the last thing I want for you is to have another label to demean yourself with. But the term may help you to see that it’s a thing. The research community is on it. You’re not the only one that can’t say whether you’re feeling infuriated or irritated, repugnance or revulsion, apoplectic or angry.

Alexithymia is the partly result of an emotional strategy that no longer works.  It’s an aspect of your personality that had had a purpose but now needs balancing. Because, while its original intent was to prevent suffering, it now causes suffering. Let’s not put salt on the wound.

If you’re curious about whether you have alexithymia and want to take the standard test for it, the Toronto Alexithymia Scale, you can do so here.

My goal in this post is not to be diagnostically precise or comprehensive. And I won’t be able to address autism spectrum disorders or trauma and disassociation. The content is complex enough as it is. We’ll proceed by exploring the causes, consequences and cures for alexithymia.

Causes

You may be wondering, “How did it come to this? Why is my heart not speaking to me? Was it something I said?” Not exactly.

It’s not simple, but I’ll try to make it clear. The causes are interrelated, and understanding the loops they get into will help you improve your connection to emotion if you decide you want to. I’ll describe the causes in brief first, then in more detail.

1. You’re born with a certain degree of emotionality, how much you react. Metaphorically, you come with an excitable heart or a calm heart already installed. This is temperament and it can be observed at birth.

2. You’re born with degrees of access to those emotions, higher or lower levels of connection to your heart (alexithymic or not).

3. Then you may suppress or repress your feelings, magnifying your degree of temperament or alexithymia. You train your heart to either remain silent or to speak.

Now let’s dig deeper.

Genetic and Neurological

Temperament: Inborn Degrees of Emotional Intensity

How intense our emotions are is determined to some extent by genes. Some people are just more emotional from the get-go. And some of us are less. Ask any parent. These differences are due to neurological factors that shape you even before the world gets its hands on you.

Inheriting Alexithymia—Inborn Censors

While there is some debate in the research community about whether alexithymia is a stable trait, or a reaction to circumstances, it does seem that there is a genetic/neurological component to it. Forty-two percent, to be precise.

But notice, this is not about the intensity of your feelings, this is about accessing them. It’s about how well your heart is connected to your head.

Alexithymia doesn’t mean an absence of emotion. Contrary to how it might look at first, people who are born with predispositions to alexithymia censor feeling because it’s too intense. They are more likely to have lost connection with the heart because the heart felt so badly that registering it became intolerable early on. This may happen without external distress, but, as we’ll find out, the external distress makes it worse.

Magnifying Alexithymia—How the Environment Rouses the Censors

Let’s think of alexithymia as a potential trait. Your environment can either magnify it and its capacity to silence the heart or not affect it.

And you might be naturally emotional but your environment could block those emotions by activating alexithymia.

Or you might not have a large genetic load of alexithymia, but need to activate every ounce of what you do have to cope with your environment.

Let’s look at the ways this can happen.

Emotions Dying on the Vine

Alexithymia may become your default early on if emotional signals are not named, mirrored, and supported by caregivers early in life. This could happen if caregivers are neglectful, absent, distracted or otherwise unable or unwilling to help the child understand and express their feelings.

It’s just like speech. If you don’t hear certain sounds when you’re young, like the “r” sound in fried, it will be difficult to use it when you’re older. You end up saying “flied” instead. The consequences of not hearing about emotions are much greater though.

Environments that Discourage the Heart

If emotions have been mainly negative or hurtful, it’s understandable you would want to turn down the volume. You may be gifted with the capacity to do this (through alexithymia) and take full advantage of it.

Or it may be a learned behavior, a strategy you adopted to get along in an inhospitable environment.

Let’s look at some ways you might have come to shut down your feelings:

• Your parents directly discouraged you from having feelings.

“Just because your best friend left doesn’t mean you have to be upset. It’s over. Quit crying over spilled milk!”

“Oh NO, I spilled my milk!” “It’s just milk. You shouldn’t get all upset about spilling it. You should be more reasonable.”

“But Mommy, I want chocolate milk.” “Quit complaining. Poor kids would kill to have that cup of milk.”

• Your parents indirectly discouraged you from having feelings.

“Mommy, Bertha ignored me at lunch yesterday.” “Drink your milk. We have to leave in 5 minutes.”

• Your parents indirectly discouraged you from having feelings by having out-of-control emotions themselves.

“Don’t you ever spill your milk again. What’s wrong with you?” (Note to self: “Don’t ever be like that.”

In each of these cases, your experiences confirmed what your alexithymic genes had been warning you about all along: “Whatever you feel, don’t feel it!”

Suppression, Repression, and the Unspeaking Heart

Our next question is, “What goes on inside when these things happen? Are we aware of doing this or not?”

We humans have craftily evolved many ways to ignore feelings. Luckily psychology has come up with names for the different strategies so that we can understand why we do what we do. These defense mechanisms help us to cope with painful emotions. Some of them conscious, and some of them unconscious.

• Suppression is largely conscious and intentional.

• Repression is unconscious and unintentional.

All of these protective strategies can be linked.

Suppression

Suppression intentionally inhibits emotion. You perceive the emotion but then decide, aware or maybe just half-aware, to ignore it because it doesn’t feel so good. For instance, you might try to stay calm when you’re incensed, tell yourself that something doesn’t matter, or distract yourself from heartbreak.

But the emotion usually doesn’t go away with suppression. You may still be tense as a high wire as you try to act cool as a cucumber. Physiological arousal can actually increase even if you don’t show it. Your heart pumps more blood and your brain pumps more hormones.

At times it’s adaptive not to focus on a feeling or express it. But doing so can also lead to problems, especially when suppression was learned early in life and then used habitually. It starts to feel as if it were as natural and necessary as exhaling. But it’s not.

Repression

When we unconsciously block feelings, we’re repressing. Emotional cues can trigger anxiety, shame, or danger that we don’t want to feel so we block these feelings before they rise into awareness.

So, for instance, you might feel attraction to someone you’re not supposed to be attracted to, so you simply dismiss the disturbing intruder before your heart even gets a whiff of it. You might feel vague arousal or bodily symptoms as this is happening, but you have no idea what they’re trying to tell you. The meaning of the emotions is lost.

In the same way that you don’t register thousands of bits of sensory data every second, you no longer think about shutting down feeling.

You may start to repress if you habitually suppress. After a while you forget that you’re forgetting. It becomes automatic to censor your anger at your parents, or your feelings of hurt, fear and sadness from your middle school classmates bullying you. So, the distinction between repression and suppression is not always clear.

“I won’t feel this” becomes “I no longer know what I feel.”

Desire does not escape the embargo on feeling, so you’re left directionless.

The Unnamed Defense Mechanisms

We could go on breathlessly naming the many other defense mechanisms that can activate alexithymia, but we’d run out of stootch before we got to the end of this post [episode]. Rest assured knowing that if suppression and repression fail you, there are lots of other ways to avoid emotion.

Examples

Let’s ground this by observing Tanya, Andy, Sam, Regina and as they participate in a breakout group at a workshop.

Oh dear.

• Tanya was never much of one for feeling. She’s indifferent to the whole operation and is checked out. She has had low-affect intensity temperament from day one.

• Andy is only vaguely aware that he’s uncomfortable, but he can’t say why. He looks for cues from others about what to do. He has alexithymia.

• Sam is annoyed that the others all took their sweet time getting to the room where they’re meeting, but he chooses not to say so. Still, he feels tight and finds it hard to engage in discussion. Other people sense it. He’s suppressing and may activate any alexithymia he was born with.

• Regina is not aware that she feels resentment toward the people running the workshop. She doesn’t like being told what to do since her parents were very authoritarian, but because any sort of questioning was forbidden her feelings had to be blocked before reaching consciousness. Similarly, she isn’t aware of being triggered now. She’s just wondering what they’re serving for lunch. She’s repressing and probably has activated any alexithymia she was born with.

They had a jolly good time together.

Perpetuation: Defense Mechanisms Become Traits

Over time, to add insult to injury, if the heart does dare to try to speak to us as we bring order to the universe, we say back to it, consciously or unconsciously, “Don’t bother me with that. I’m busy. I’ve got things to fix, to perfect and produce. Can’t you see there’s chaos out there? Come back in a couple of decades and maybe we’ll talk.” Heart looks down at the ground. Crestfallen. Dejected. Heartbroken.

These mechanisms of suppression and repression can eventually become traits—an aspect of your personality, and that’s more like alexithymia. Defense mechanisms habitually hardening into a trait is like water freezing to ice.

In actual life these tendencies run together. Suppression can start as a circumstantial strategy, but over time, the nervous system always reduces access.

Results of Living Alexithymically

Like the causes of alexithymia, the results of it are intertwined and create a self-reinforcing loop. It took me a long time to write this section because it was like untying a very complicated knot.

There is no single starting place, but I’ve narrowed it down to six tangled results. Here they are and how they snowball:

1.     We Become More Disengaged Because Feelings Are Unknowable

Alexithymia can lead to disengagement and more unidentifiable emotions. Because they’re unidentifiable, it’s understandable that they will feel negative, and best avoided like an unopened letter from the IRS. You’re at a great disadvantage if you can’t say what you’re feeling so you duck and dodge.

Think of it this way. If it’s hard to understand what a teacher, friend or therapist is saying and feeling, they may feel very foreign to you, and you slowly disengage from them.

Disengagement from other people doesn’t necessarily mean you trot off to live off the grid. It may just mean that you only relate superficially.

In the same way, if you don’t understand your own emotions, you’re more likely to disengage from your own heart. Or just relate to it superficially.

Disengagement from others and from your own heart creates a loop.

2.     Our Relationships Suffer

If you have alexithymia people may experience you as distant, flat, restrained, uninterested, controlled or emotionally unavailable. They may not know that you’re upset when you’re hurt, or when you’re lonely, or when you care about someone. It can make you difficult to read and confusing to others because your expressions are indirect, at best.

Not expressing yourself is an expression—whether you like it or not. It sends a message. It’s like a butt dial; you’re sending a message you don’t intend to.

And you may not understand the feelings of others if you don’t understand your own. For instance, you might be asking yourself, “He looked away after I said I didn’t care, but I don’t know how he felt about it.”

Further you may project your own disowned feelings onto others. For instance, you might conclude, “I’m not angry, sad or brimming with lust. They are.”

Perhaps one of the worst results is that it is harder to find empathy for others when we are out of touch with our own feelings.

3.     We Substitute External and Quantifiable Sources of Information and Direction

But we humans are an adaptable lot. We find other sources for knowing and direction. If we don’t know what we want or feel, we quantify and seek advice.

“How many likes did my post get? How much would that new job pay?”

We focus on external facts rather than internal experience.

Or, in order to find direction, we look to others. “Everyone on Instagram says St. Barts is a great place to go so that’s where I’ll go.”

I was struck by this when I saw a message from Rufus, Amazon’s AI shopping concierge. Concerned, as always, about my well-being, Amazon had Rufus, unprompted, make suggestions about what deals I would like and what I should treat myself to.

Apparently, a lot of people out there don’t know what they want and need a machine to tell them what to do.

4.     When the Heart is Silent You Try to Substitute Thinking for Feeling

Without the input of the heart, we try to think decisions through, decisions that are outside the scope of practice of the cerebral cortex. It’s like consulting an electrician about whether to get a beagle or a basset hound.

We like to think of ourselves as rational creatures, guided by enlightenment and motivated by the right and reasonable thing to do. But we’re really guided by emotion, not reason. We’re just very talented at justifying our behavior as if it were, of course, the most reasonable thing any prudent human would do.

So, when we can’t hear the heart, like AI that just hallucinates facts it doesn’t know, we rationalize what we end up doing.

Chocolate ice cream might keep me awake so I’ll eat vanilla instead. I really wanted vanilla but couldn’t access the preference so I found a “reason” to go one way or the other. (I’ve chosen my flavors advisedly here.)

Emotions provide direction because they lead to our values, what’s most important to us. They fuel our passions. Without them, we’re paralyzed, or, at best, wandering aimlessly.

For example, when people don’t have access or vocabulary for their feelings, they may go back and forth about commitment to a relationship. It’s a very painful struggle, sometimes referred to as R-OCD (relationship obsessive compulsive disorder), and it originates in a lack of connection with the heart and an overreliance on the mind.

5.    We Become Depressed

One surprising thing about alexithymia is that it’s associated with depression. Depression isn’t exactly sadness, though in our inexactitude we equate the two. We sometimes use the word depression as a stand in for sadness, grieving, disappointment or discouragement. When you’re in those emotional states you still care.

But when we’re depressed, we may not care. Emotions seem absent. As I wrote in a previous post about depression, the absence of energy can be a warning from your heart that you’ve been caring too much about the wrong things. The heart goes on strike until you get the point and change your ways.

But which causes which? It goes both ways: depression makes you more likely to be alexithymic and alexithymia makes it more likely that you’ll be depressed. It can also increase your odds of becoming suicidal or aggressive.

Rather than chase our tails with this, let’s just say that when alexithymia is not addressed we have less reason to be happy. If you don’t desire anything, there’s less to savor and less to look forward to.

6.     The Body Expresses What the Heart Cannot: We Somatize

If we are unaware of our feelings, and so cannot address those needs, our body may speak for the heart. When our body expresses what we don’t have words for we call it somatization (Soma means body).

This could mean you get physically exhausted when you’re really “tired of” something but can’t say it. It could mean you vomit when faced with something you can’t swallow. It could mean your skin breaks out to express your anxiety about getting close.

We need to be cautious about assuming that any of these symptoms are psychosomatic. You should always get cleared by a physician before you conclude that you are somatizing. Then, once Doc clears you, consider your symptoms a possible back channel for prohibited communication.

What You Can Do About It

You can get better at knowing what you’re feeling and at describing it, probably more than you had imagined you could. But remember that progress is usually gradual, uneven, and measurable over months or even years, not weeks.

Psychotherapy Helps.

Research indicates that psychotherapy can help us to connect or reconnect with our feelings. Think of it as going back to school to learn what no-one ever taught you about growing up. That is, feelings.

It would be unrealistic for us to imagine that even with optimal therapy and self-help we could all become fountains of emotional clarity. Some of us will always be  better at this than others. But that doesn’t mean those at the low or middle end of the scale can’t enjoy a better connection with their heart.

Therapy aims to understand how we lost connection with our heart and what we’re still doing to keep up the barriers. We also learn, through practice, to detect emotional signals that rarely reached consciousness before. We usually use a bottom-up approach, tuning in to the body.

We learn to be with feelings without thinking we are the feeling or identifying with feelings. Recall that one of the causes of alexithymia is that emotions were actually too intense and too negative.

We can’t separate treatment for suppression and repression from alexithymia. Wholistic treatment includes understanding both why we suppress and repress,  and how we can build awareness of feelings and a vocabulary for them.

Individual or group therapy can be helpful both in providing structure, and in providing opportunities to exercise connecting and labelling feelings.

It may be helpful to some by:

• Getting feedback:

“Jim you almost always look to me like you’re sad.”

• Practicing identifying a feeling in the moment and expressing it:

“It really pisses me off when you tell me what I’m feeling.”

• Developing insight about your story:

“I thought that as my therapist (or group leader) you’d affirm my feelings. You don’t. You’re worse than my parents!”

Mindfulness Meditation

Mindfulness meditation can be helpful in that it structures time for you to simply watch feelings as they come up—without judging them.

Try it right now. Slow down and pay attention to this moment. If you try to mediate and nothing comes up, observe what the emptiness is like. The ask whether it is pleasant or unpleasant.

If that’s hard, just note any judgement the exercise, my suggestion, or about yourself. Have some compassion and patience for yourself.

Here is a link to an excellent guided meditation by Bodhin Philip Woodward on Insight Timer to help you label emotions.

But be mindful about how you use mindfulness; some people think  the purpose of meditation is to help us bliss out. Wrong. It’s about tuning in.

Practice Makes Connection

Whether you use therapy or meditation, or work on your own, here are some of the most helpful approaches to reconnecting with your heart. There is no magic. There’s just practice. You either started with the volume turned down on feeling, or you had to turn it down when things got too loud. In either case, we need to practice tuning in and turning up the volume.

• Pay attention to your body. Learn to tune in to it. The six-step technique known as Focusing is a great tool for this.

• Consider that there may be deeper layers of feeling than the one you may be faintly aware of. Notice that you may have more than one feeling at once. You may only be aware of the feelings that are “on top,” missing the feelings underneath.

• • Anger under anxiety
  • Anxiety under anger
  • Anger under depression

• Whenever you’re waiting, in line at the grocery, on hold on the telephone, or when your computer is warming up, take just a moment to try tuning in to what’s happening inside. This may seem simple, but chances are you’ve avoided it for years. Just as suppression may have become a habit, tuning in can become a habit as well.

Tuning In: Start with the Basics and Branch Out

If you’re not sure what you’re feeling, start by asking yourself whether your experience is pleasant or unpleasant.

Then ask which of seven basic emotions you may be having. Imagine a radio signal from a distant planet that you have to concentrate on to tune into. The signal may be very faint at first, but tune into it by tuning into your body. Take the risk that you may not get it just right. Don’t let perfectionism get in your way. This is just beta, a work in progress that’s always subject to tweaking.

• Fear

• Sadness

• Anger

• Joy

• Disgust

• Shame

• Hurt

Once you can pick one of these, just as a ballpark emotion, branch out into more nuanced expressions. Use this chart to find other words that may more accurately describe what you’re experiencing—however subtly. Keep checking in with your body to see if the term resonates.

Fear	Sadness	Anger	Joy	Shame	Disgust	Hurt
Frightened	Despairing	Mad	Happy	Remorse	Hate	Violated
Anxious	Devastated	Frustrated	Ecstatic	Guilt	Loathing	Betrayed
Terrified	Hopeless	Hateful	Content	Embarrassed	Disappointment	Humiliated
Concerned	Lonely	Furious	Satisfied	Insecure	Aversion	Rejected
Worried	Empty	Explosive	Peaceful	Inferior	Judgmental	Vulnerable
Powerless	Apathetic	Enraged	Liberated	Worthless	Revulsion	Isolated
Threatened	Indifferent	Irritated	Proud	Inadequate	Horror	Tortured

Here is an image of a more detailed chart for recognizing feelings.

Finally, let go. In your effort to tune in, try to monitor if you get tense or work too hard. Just notice. The process is much more about letting go so you can hear what wants to be heard, allowing it to surface. If you notice yourself straining or forcing, that’s a good start to connecting with and naming feeling.

While some of your emotions have been painful, remember that there is an entire world of positive emotions in there as well. I hope that you can permit them safe passage. Your heart is waiting.

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The Healthy Compulsive Project Podcast is now available in video format on YouTube.