Alexithymia and Medically Unexplained Symptoms
Alexithymia is a risk factor for untreated medical illness and premature death.
Posted March 23, 2025 | Reviewed by Abigail Fagan
What if you were someone who could not identify or express your feelings? Now, suppose you were experiencing distressing physical symptoms. You call your medical provider and make an appointment, and during the assessment, you cannot explain how your symptoms feel or what may be contributing causes. This lack of ability to describe what you feel internally can be a risk factor for untreated illness, and you may be diagnosed with medically unexplained symptoms.
People with alexithymia experience this regularly. In addition, alexithymia makes it challenging to understand that physical symptoms can sometimes be the somatic equivalent of underlying emotional distress. As a result, those who experience this can erroneously attribute physical signs as an indication of an illness and may request a medical evaluation for which there is no underlying physical cause. For example, a 2021 study of 200 patients seen in an outpatient internal medicine office with complaints consistent with medically unexplained symptoms showed that almost half qualified for a diagnosis of alexithymia.
The term alexithymia is from Greek and means no emotions for words. People with alexithymia struggle to identify feelings, express emotions, and differentiate between emotions and bodily symptoms. This means they cannot accurately identify the physical signals their body is sending them and may misinterpret its cues. If you have alexithymia, you may be viewed as socially awkward or lacking in appropriate emotions for a given situation. If you try and see a therapist about this, you may have difficulty answering some basic questions such as “How are you feeling today?” because you don’t know. The estimate of people with this trait is about 13 percent of the population and is twice as likely in men. It can occur congenitally, from birth, or can be secondary as the result of a brain injury.
People with alexithymia who experience bodily cues such as a racing heart, difficulty breathing, or body pain often cannot identify where they come from. Some individuals with alexithymia misinterpret the physical components of feelings because they cannot recognize an emotional state and its physical accompaniments.
What Causes Alexithymia?
Most researchers believe that primary alexithymia is the product of genetics and environment. In one study published in 2018, investigators reported that participants with alexithymia had differences in an area of their left brain hemisphere compared with their unaffected counterparts. The affected participants had smaller amounts of grey matter in their insula. The insula is crucial in integrating sensory signals with emotional and cognitive processes, particularly those from your body.
In a different study, patients with alexithymia underwent brain imaging while being shown various facial images of angry, sad, and happy individuals and were asked to discriminate between them. The results showed that alexithymia correlates with decreased activation in brain areas associated with emotional awareness during viewing facial expressions.
Some authors suggest that alexithymia can develop as a reaction to an acute and severe traumatic event or in the presence of early life stress. A majority of studies demonstrate the co-existence of early life stress and alexithymia in patients with mood disorders. A survey completed in young adult German volunteers diagnosed with alexithymia found that early neglect rather than physical or emotional abuse was most highly correlated with severe forms of alexithymia. The authors defined early neglect as “the experience of a caretaker ‘s failure to provide adequate affection and emotional support for the child.”
According to a 2011 study, people who experience adversity in childhood tend to have difficulty identifying their emotions. A Portuguese study published in 2023 sought to identify and analyze the relationship between adverse childhood experiences and alexithymia in adulthood. In agreement with earlier work, the researchers reported that in their sample, there was a statistically significant positive correlation between childhood emotional neglect and difficulty in identifying feelings and distinguishing them from the bodily sensations of emotion .
How Does Alexithymia Lead to Amplification of Physical Symptoms?
Symptom magnification is the tendency to report physical symptoms in an intense and disturbing way. Research suggests that alexithymia can be associated with the amplification of physical symptoms like those reported by Alex. Because people like Alex struggle to identify and express emotions adequately, they can misinterpret bodily sensations related to emotion (like a rapid heart rate when you are scared or excited). Instead, they overemphasize the physical sensation and believe it is due to a medical disease or condition. Instead of identifying an emotion as the cause of the physical symptoms, they often focus on the symptoms themselves, which can heighten the perceived intensity and is one of the reasons they can frequently be diagnosed with a medically unexplained condition.
How Does Alexithymia Impact Medical Conditions?
An early theory suggested that people with alexithymia have difficulty regulating negative emotions (because they don’t recognize them), which leads to altered immune system activity. Studies that examined patients with alexithymia and their immune status reported that they generally have a worse immune status.
Another theory suggests that people with alexithymia have alterations in their autonomic nervous system , a part of the nervous system that is not under voluntary control. Support for this theory is from studies that show some people with alexithymia have increased resting cardiovascular activity, like increased blood pressure and heart rate.
Does alexithymia lead to unhealthy habits that impact medical illness? The inability to identify emotions or the difficulty with regulation can lead to poorer choices in nutrition , substance abuse or other behaviors that act to decrease the negative feelings. For example, alexithymia is elevated in people with eating disorders, excessive gambling, and alcohol abuse .
Additionally, some studies of alexithymia showed that these individuals have worse overall nutrition and lead a more sedentary lifestyle, which contributes to the onset of disease. Alexithymia is also associated with cardiovascular diseases and is a predictor of cardiovascular risk in healthy people. In addition, alexithymia is a risk factor for early death after a heart attack.
Unfortunately, because alexithymia patients have difficulty recognizing emotions and their link to physical symptoms, they may delay seeking help, leading to a worse prognosis. Traditional psychiatric interventions such as psychotherapy and medication are not usually successful. The best approach is cognitive behavioral therapy, which has succeeded in some research studies. However, because of their difficulties communicating their feelings, alexithymia patients find it challenging to build and maintain close relationships with others and to appropriately utilize social support to protect themselves from the potentially pathological influences of stressful events.
Aust, Sabine, and Malek Bajbouj. “The Role of Early Emotional Neglect in Alexithymia.” The Neuropsychotherapist , no. 4, International Association of Applied Neuroscience, Jan. 2014, pp. 96–97.
Kano, Michiko, and Shin Fukudo. “The Alexithymic Brain: The Neural Pathways Linking Alexithymia to Physical Disorders.” BioPsychoSocial Medicine , no. 1, Springer Science and Business Media LLC, 2013, p. 1.
Kojima, Masayo. “Alexithymia as a Prognostic Risk Factor for Health Problems: A Brief Review of Epidemiological Studies.” BioPsychoSocial Medicine , no. 1, Springer Science and Business Media LLC, 2012, p. 21.
Kooiman, Cornelis G., et al. “Is Alexithymia a Risk Factor for Unexplained Physical Symptoms in General Medical Outpatients?” Psychosomatic Medicine , no. 6, Ovid Technologies (Wolters Kluwer Health), Nov. 2000, pp. 768–78.
Lumley, Mark A., et al. “The Assessment of Alexithymia in Medical Settings: Implications for Understanding and Treating Health Problems.” Journal of Personality Assessment , no. 3, Informa UK Limited, Nov. 2007, pp. 230–46.
Nakao, Mutsuhiro, and Takeaki Takeuchi. “Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness.” Journal of Clinical Medicine , no. 5, MDPI AG, May 2018, p. 112.
Sancassiani, Federica, et al. “Why Is It Important to Assess and Treat Alexithymia in the Cardiologic Field? An Overview of the Literature.” Clinical Practice & Epidemiology in Mental Health , no. 1, Bentham Science Publishers Ltd., Aug. 2023.
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Susan Trachman, M.D., is an associate professor at George Washington University and assistant professor at Virginia Commonwealth. She is a board-certified psychiatrist in adult and forensic psychiatry.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.