The Prevalence of 'Alexithymic' Characteristics in Psychosomatic Patients
P.E. Sifneos, Department of Psychiatry, Beth Israel Hospital and Harvard Medical School, Boston, Mass.
Psychotherapy and Psychosomatics, 22, pp.255-262
This paper also appeared in the book Topics of Psychosomatic Research, (Basle: Karger, 1972) edited by H. Freyberger.
Abstract. An attempt is made in this paper to investigate the prevalence among patients who suffer from various psychosomatic diseases, of a relative constriction in emotional functioning, poverty of fantasy life, and inability to find appropriate words to describe their emotions. For the lack of a better term, I call these characteristics 'alexithymic'.
Twenty-five psychosomatic patients outnumbered 25 control patients by better than two to one as far as possession of these 'alexithymic' characteristics. The question is raised whether these defects are due to biological or developmental factors, and the conclusion is reached that patients with these characteristics may not be good candidates for dynamic psychotherapy.
p.255
The paragraph below introduces the term and the observations which motivated it. (Note once again the modest qualifier, "for lack of a better term".)
It is of interest to notice that many, but not all, of the patients who suffered from psychosomatic disorders and whom I had the opportunity to interview over several years (1954-1968) while directing the Psychiatric Clinic at the Massachusetts General Hospital, showed a marked difficulty to communicate with the interviewer, they gave the overall impression of being dull, and they used actions to avoid conflicting or frustrating situations. In addition to a relative constriction in emotional functioning, their most striking characteristic was the inability to find appropriate words to describe their feelings. For lack of a better term, I proposed the word 'alexithymic' (from the Greek a = lack, lexis = word, thymos = a mood or emotion) to describe this specific difficulty which appears more likely to be due to a combination of neurophysiological and psychological defects rather than to purely psychological ones.
pp.255-6
He concludes that dynamic psychotherapy is inappropriate for alexithymics because their inability to articulate their emotions prohibits the insights required for the healing process. He suggests alternatives that may be more beneficial.
The implication of the observations about 'alexithymic' patients presented in this paper points to the conclusion that these individuals are not good candidates for dynamic psychotherapy, because their defects, such as for example, their inability to express their emotions verbally, or their diminution of fantasy life would jeopardize a form of treatment which emphasizes verbal expression and requires a capacity for emotional interaction. On the contrary, for psychosomatic patients with alexithymic difficulties, different and less disturbing or intensive kinds of psychiatric treatments such as, supportive psychotherapy, behavior therapy, hypnosis, case work, and so on, may be much more appropriate.
p.261
In the final paragraph, Sifneos states that further investigation is required to ascertain the causes of the deficits for the sake of developing effective therapies.
In sum, then, these alexithymic characteristics not only seem to be present quite often in patients suffering from psychosomatic disorders, but also defy our usual psychodynamic ways of understanding psychological processes in general, and psychosomatic diseases in particular. Possibly because they may be due to neurophysiological, neuroanatomical, biochemical defects, or developmental difficulties involving the learning process, they require a systematic investigation. Only after the etiological factors which are responsible for these defects are clearly understood, shall we be able to develop appropriate treatment modalities to correct these broad emotional difficulties. I hope that this paper may stimulate some interest and lead to further investigation of this fascinating area of psychosomatic medicine.
p.262
Note that the definition of alexithymia is still, at this stage, firmly within the context of psychosomatic medicine. There are separate questions about whether alexithymia occurs in non-psychosomatic control groups, and whether it signals a predisposing factor for psychosomatic disease amongst psychosomatic patients.