The Role of Early Emotional Neglect in Alexithymia

Sabine Aust & Malek Bajbouj
Department of Psychiatry and Psychotherapy
Charité University Medicine Berlin


doi: 10.12744/tnpt(4)096-097

Alexithymia (derived from Greek, literally “no words for feelings”) is characterized by difficulties in identifying, decoding and communicating one’s own emotional state.  It is related to increased individual and interpersonal distress and seems to be a risk factor for various psychological disorders.  There is wide agreement on the conceptualization of alexithymia as a personality trait showing a high degree of relative stability over the lifespan.  However, there is considerable debate about the etiology of alexithymia.

Besides biological models, which associate alexithymia with alterations of specific brain structures or with genetic factors, previous research suggests that alexithymia can develop as a reaction to an acute and severe traumatic event or in the presence of early life stress.  Extending these findings, recent studies have illustrated that alexithymia in adults is a predictor for the development of posttraumatic stress disorder (PTSD) after exposure to psychological or physical trauma.  Moreover, early life stress has often been described as a risk factor for emotional dysregulation.  Accordingly, previous studies have demonstrated a co-occurrence of early life stress and alexithymia in patients with affective disorders or disorders with prominent affective symptoms such as PTSD and borderline personality disorder.  However it remains unclear whether alexithymia and early life stress are still associated in the absence of psychological disorders, i.e., in healthy individuals, and if so, whether the experience of early life stress is related to specific emotional disturbances in alexithymia.

Therefore, a recent study addressed the association between early childhood adversities and alexithymia in 90 psychologically and somatically healthy individuals with an age range between 20 and 65 years.  Questionnaires and face-to-face interviews were used to assess early life stress and alexithymia.  Perceived emotional functioning was also measured, via self-report.  Participants with any current or lifetime psychological disorder and chronic or severe physical diseases or complaints were excluded from the study.

The study made an interesting discovery: there was a significant association between the degree of alexithymia and the experience of emotional neglect during childhood; however, other childhood trauma dimensions such as physical or sexual abuse were not related to alexithymia.  Within the group of high alexithymic participants, the degree of emotional neglect experienced was related to a reduced acceptance of one’s own emotions, to a stronger physical symbolization of emotions as well as to subjectively perceived deficits in emotion regulation.  In short, the study showed a meaningful relationship between the experience of early emotional neglect and both adult alexithymia and additional difficulties in experiencing emotions in healthy individuals.

It has previously been shown that the development of emotional abilities during childhood is mediated by close relationships between the child and his or her primary caregiver.  From a theoretical perspective, the development of these relationships is best described in terms of John Bowlby’s construct of attachment.  Bowlby’s influential theory proposes that emotional maltreatment by the caregiver can impede a secure attachment between caregiver and child.  Insecure attachment might then be related to a child’s mental health problems in adulthood.  Carrying this thought through, the experience of emotional neglect during childhood might play a part in the development of alexithymia. However, despite this line of argument, it is important to note that alexithymia may also develop without any influence of early stress experiences.  In the study presented here, 26% of the high alexithymic participants reported minimal or even no emotional neglect.  This implies that the developmental model of alexithymia may only be true for a certain percentage of individuals, and that additional factors, such as the influence of gene x environment interactions, need to be considered in future studies to better understand the complex etiology of alexithymia.

To go one step further in the etiological debates, the authors of the present study suggest the existence of two types of alexithymia: a “neglect type” and a “non neglect type”.  The idea of subtypes is an important element of ongoing discussions about alexithymia, but approaches as yet have not stood up to empirical examination.  Taking into account longitudinal data such as information on early emotional neglect seems a promising approach to explain the development of individual patterns of emotional abilities.  There is considerable brain imaging research investigating the effects of early adverse experiences on neural correlates of affective functioning in clinical and community-dwelling populations.  There are also a variety of results from emotion processing studies involving high alexithymic individuals; however, none of these studies has ever considered either the influence of early emotional neglect on the “alexithymic brain” and its structural, functional and neuroendocrine aspects or even the interaction of early emotional neglect and alexithymia with respect to neural correlates of affective functioning.

Besides these clear implications for future research on alexithymia and emotional functioning, the present study reveals another important point: despite a history of early emotional neglect and high degrees of alexithymia, the participants had a relatively high socioeconomic status and were psychologically and physically healthy.  It is essential to note that experiences of early life stress do not necessarily lead to psychological disorders.  To fully understand the mechanisms and factors of risk and resilience is probably the most important mission to be completed by future researchers.

Original Article:

Aust, S., Alkan Härtwig, E., Heuser, I., & Bajbouj, M. (2013). The role of early emotional neglect in alexithymia. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 225–232.

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