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Alexithymia ~ "A condition where a person is unable to describe emotion in words. Frequently, alexithymic individuals are unaware of what their feelings are."

It is a disturbance in affective and cognitive function that overlaps diagnostic entities but is common is psychosomatic disorders, addictive disorders, and post traumatic stress disorder. The chief manifestations are difficulty in describing or recognizing ones own emotions, a limited fantasy life, and general constriction in the affective life.

Some people have little to say about their feelings. Asked to describe their emotions, they are stuck for words. Yet they are prone to isolated bouts of irritation, anxiety and rage. In casual conversation, they rarely mention dreams or desires - just a string of facts, observations, goals and practical demands. The term 'alexithymia' is used to denote this cluster of characteristics. The term literally means 'a lack of words for feelings'.

Loosely speaking, alexithymia is the inability to talk about feelings due to a lack of emotional awareness. Extreme cases are associated with a broad range of psychopathologies, including somaticization disorder, Asperger's syndrome, post-traumatic stress disorder, bulimia nervosa and narcotics dependency. However, the term is used principally when the emotional disorder occurs on its own.

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Feeling and Emotion - different?

"He had so much feeling, but there was no emotion." [from the novel 'Lies and truth']

[Excerpts]

Though there can be no consensus about the definition of emotion, there is a general agreement that emotional responding in humans involves three interrelated systems or sets of processes:

(1) the neurophysiological processes (largely autonomic nervous system and neuroendocrine activation);
(2) motor or behavioural-expressive processes (e.g. facial expressions, crying, changes in posture and tone of voice); and
(3) a cognitive-experiential system (subjective awareness and verbal reporting of feeling states).

While the word feeling refers to the subjective, cognitive-experiential domain of emotional response systems, the word emotion refers to the neurophysiological and motor-expressive domains. [From 'Disorders of Affect Regulation', Cambridge 1999]

A useful distinction when dealing with alexithymics is to know the difference between emotion and feeling. Emotion is something belonging to our most basic experience, whereas feeling is a cognitive function - ie. I get a 'feel' for a person and I size you up, make judgements, and evaluate on the basis of a feeling-rationale. Other criteria for differentiating feeling from emotion are: emotion is total, feelings not; emotion involves gross, perceptable physiological changes, feeling not; emotion involves drive activities, feeling not; emotion is symbolic, feeling rational; emotion transforms, feeling evaluates, etc [see 'Emotion: a comprehensive phenomenology of theories and thier meanings for therapy' by James Hillman].

"Regarding a person as being capable of love [emotional attachment] simply because he or she is a feeling type could have tragic consequences. Mistaking feeling for love is to overlook the fact that relationship is much more than perceiving on the basis of feeling, yet it is a mistake easily made." [Guggenbuhl-Craig, from 'The Emptied Soul']

As far back as 1915 Carl Gustav Jung was writing on the difference between feeling and emotion, in the same way as the modern writers above. He writes: "By the term affect I mean a state of feeling characterized by marked physical innervation on the one hand and a peculiar disturbance of the ideational process on the other. I use emotion as synonymous with affect. I distinguish feeling from affect, in spite of the fact that the dividing line is fluid, since every feeling, after attaining a certain strength, releases physical innervations, thus becoming an effect. For practical reasons, however, it is advisable to distinguish affect from feeling, since feeling can be a voluntarily disposable function, whereas affect is usually not. Similarly, affect is clearly distinguished from feeling by quite perceptable physical innervations, while feeling for the most part lacks them, or else their intensity is so slight that they can be demonstrated only by the most delicate instruments, as in the case of psychogalvanic phenomena. Affect becomes cumulative through sensation of the physical innervations released by it.

Feeling is distinguished from affect by the fact that it produces no perceptible physical innervations, i.e., neither more or less than ordinary thinking process." [From 'Psychological Types' by C. G. Jung]

Feeling - in C. G. Jung's 'typologies'

Feeling is a process "that imparts to the content a definite value in the sense of acceptance or rejection (what I "like" or "dislike"). The process can also appear isolated, as it were, in the form of a "mood," regardless of the momentary contents of consciousness or momentary sensations.... But even a mood, whether it be a general or only a partial feeling, implies valuation; not of one definite, individual conscious content, but of the whole conscious situation at the moment, and, once again, with special reference to the question of acceptance or rejection... Hence feeling is a kind of judgment, differing from intellectual judgement in that its aim is not to establish conceptual relations but to set up a subjective criterion of acceptance or rejection. Valuation by feeling extends to every content of consciousness, of whatever kind it may be. When the intensity of feeling increases, it [may] turn into an affect, i.e., a feeling-state accompanied by marked physical innervations.

It is important to distinguish abstract feeling from ordinary concrete feeling. Just as an abstract concept belonging to thinking abolishes the differences between things it apprehends, abstract feeling rises above the differences of the individual contents it evaluates, and produces a "mood" or feeling-state which embraces the different individual valuations and thereby abolishes them. In the same way that thinking organizes the contents of consciousness under concepts, feeling arranges them according to their value.... Feeling, like thinking, is a rational function, since values in general are assigned according to the laws of reason, just as intellectual concepts in general are formed according to these laws." [From 'Psychological Types' CW 6]

Book references:

Alexithymia is a set of cognitive-emotional deficits characterized by:

(a) difficulty in identifying and describing feelings in self or other,

(b) difficulty in distinguishing between feelings and the bodily sensations associated with emotional arousal,

(c) restricted imaginative processes (few dreams or fantasies), and

(d) thinking that is concrete and reality based

[Hendryx, Haviland, & Shaw, 1991; Taylor, Bagby, Ryan, & Parker, 1990]

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Alexithymia Provoked Response Questionnaire

INSTRUCTIONS: Please record the subject's response to the following questions. Please record the entire response. If you feel a response is amibuous in regard to its emotional content, use further questioning to decrease this ambiguity. Avoid introducing emotion-words into the interview. You may repeat the questions if necessary. The scale may be introduced as a measure of how people feel or act in a variety of situations. [adapted from J. Krystal's Integration & Self-Healing]

- 1. When you are upset, do you like to take action or do you prefer to think or daydream?

- 2. How would you feel if a policeman arrested you for a crime you did not commit?

- 3. How would you feel if someone insulted you?

- 4. How would you feel if you heard a suspicious noise while you were alone in your house at night?

- 5. How would you feel if you had an emergency and tried to make a telephone call but the line was continually busy?

- 6. How would you feel if someone cut you off in heavy traffic?

- 7. How would you feel if someone laughed at you?

- 8. How would you feel if you saw a truck coming at you at 160km per-hr?

- 9. How would you feel if someone called you a coward?

- 10. How would you feel if someone called you a thief?

- 11. How would you feel if someone complimented you?

- 12. How would you feel if someone said that you are the best?

- 13. How would you feel if someone you loved died suddenly?

- 14. How would you feel if someone tried to attack you with a knife?

- 15. How would you feel if someone pulled a gun on you?

- 16. How do you feel when you are hungry?

- 17. How do you feel when you are sick?

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Twelve-item modified version of the Beth Israel Questionnaire (for Alexithymia)

Based on your knowledge rank the person on each of the descriptions listed below using the scale provided.

Not true Somewhat true Very true

1 2 3 4 5 6 7

1. The person mostly describes physical details about health issues rather than feelings

2. The person has difficulty communicating feelings to you

3. The person is able to use appropriate words to describe emotions

4. The person describes circumstances and details surrounding events rather than expressing feelings about how he/she may have felt about the event

5. The person expresses emotions more in physical terms rather than in thoughts

6. The person's thought content is associated more with external events rather than with fantasy or feelings

7. The person has a rich vocabulary for emotions

8. The person can easily recall dreams

9. When talking about close friends or loved ones, the person shows a lack of emotional expressiveness

10. The content of the person's dreams closely resembles everyday thoughts or events rather than being more symbolic or abstract in nature

11. The person indicates that he/she does not daydream very much

12. The person indicates that he/she readily shares his/her feelings with others

Scoring: Items 3, 7, 8 and 12 are negatively keyed. In addition to a total BIQ score, there are two subscale scores - (a) Awareness of Emotions (items 2, 3, 5, 7, 9 and 12); (b) Operatory Thinking (items 1, 4, 6, 8, 10 and 11).

[From - 'Disorders of Affect Regulation' C.U.P.]

Clothing Adaptations/Games,Toys/Needs

Mindblindness/Theory of Mind

Noonan's Syndrome

Occupational Therapy

Sensory Integration

Fainting or Syncope

Definition: Fainting is a temporary loss of consciousness as a result of decreased blood flow to the brain. The occurrence is abrupt and is followed by rapid and complete recovery. People may complain of light-headedness or dizziness before fainting.

Alternative Names: Passed out; Light-headedness - fainting; Syncope

Considerations: The cause of fainting should be evaluated by a health care provider since more serious medical conditions such as heart attack, seizure disorder, and stroke need to be excluded.

Fainting or syncope is characterized by sudden pallor, loss of consciousness, and loss or muscle tone.

A "vasovagal" or "situational" fainting is a benign type of fainting. It may be associated with certain activities such as standing in one place too long, urination, defecation, coughing, or swallowing. This type of fainting can also be caused by fear, severe pain, or emotional distress. It can be preceded by weakness, nausea, dizziness, and a sense that the surrounding noise or light is growing fainter.

Orthostatic hypotension (low blood pressure) can also be a cause of fainting. This may occur if someone is losing significant blood or is severely dehydrated. Certain medications can also cause orthostatic hypotension and fainting.

Pathologic fainting or syncope may also be associated with heart conditions, most often abnormal heart rhythms (arrhythmias).

Common Causes: Fainting can be caused by any condition restricting blood flow to the brain. The more common causes include:

rigid standing at attention
arising quickly from a lying position
pressure on the neck (tight collar)
low blood pressure (hypotension)
severe pain, injury or fright
alcohol or drugs including anxiolytics, antihistamines, antihypertensives, vasodilators, decongestants, central nervous system depressants
strenuous coughing, straining during a bowel movement or any other Valsalva maneuver (forced exhalation with closure of mouth and nose)
hyperventilation

Heart conditions also can cause fainting or syncope and require immediate attention by a health care provider. Heart conditions include:

Ischemic heart disease
History of heart attacks
Abnormal heart rhythms
Family history of sudden death (such as Long QT syndrome and hypertrophic cardiomyopathy)

Home Care:
Follow your health care provider's recommendations.

Susceptible individuals should avoid situations known to cause fainting. Avoid sudden changes in posture. A person who becomes light-headed when they stand up should do so slowly and in a graded fashion.

Immediate treatment for fainting includes:

Keep the affected person lying flat
Move person to cool and quiet room
Seek medical attention immediately.

Call your health care provider if:

there has been a complete loss of consciousness, especially if it occurs after a head injury or if there is no readily identifiable cause (such as a susceptible individual who faints when they have blood drawn)
fainting is accompanied by a feeling that the room is spinning (vertigo) or any other symptoms
fainting occurs in a susceptible person more often than rarely
this is the first time a person has ever fainted
medication or alcohol is suspected as the cause.

What to expect at your health care provider's office: Your health care provider will perform a physical examination and ask questions such as:

Position :
Does fainting occur with upright posture?
Does fainting occur with a change in body position?