CHAPTER
9
Measures of Alexithymia
Bob Bermond1, Paul Oosterveld2and Harrie C.M. Vorst1
1University of Amsterdam, Amsterdam, The Netherlands
2Leiden University, Leiden, The Netherlands
Based on 20 psychiatric interviews with psychosomatic disordered patients, Nemiah and Sifneos (1970a)
observed that they:
‘manifested either a total unawareness of feelings or an almost complete incapacity to put into words what they were experiencing.
The associations of the majority of the patients were characterized by a nearly total absence of fantasy or other material related to their
inner, private mental life of thoughts, attitudes and feelings, and a recounting, often in almost infinite detail, of circumstances and
events in their environment, including their own actions. Their thoughts, that is, were stimulus-bound rather than drive-directed.’
Later Sifneos, (1973) coined the term alexithymia for this complex of features. Ten years earlier, Marty and de
M’Uzan (1963) had described many of the above-presented features and introduced the term ‘ pense ´ope´ratoire ’.
(Nowadays pense ´ope´ratoire refers to externally oriented thinking.) Although several slightly different descriptions
exist, most authors take those of Marty and M’Uzan (1963) , and Nemiah and Sifneos (1970a) as the definition of
alexithymia. Indeed, alexithymia has been conceptualized as one of several possible personal risk factors for a
variety of medical and psychiatric disorders ( Taylor, Bagby, & Parker 1997 ). The results, however, are not consis-
tent; others suggested that alexithymia is not specifically related to psychosomatic complaints ( Lesser, Ford, &
Friedmann 1979 ), while Lumley, Stettner, and Wehmer (1996) , and Kojima (2012) came to the conclusion that
there is little support for the hypothesis that alexithymia leads to organic disease. There is, however, general
agreement that alexithymic patients do poorly in psychotherapy focusing on insight and emotional awareness
(Lumley, Neely, & Burger 2007 ).
The ideas presented in the research literature as to what causes alexithymia vary from (1) neurological
(Bermond, Moormann, & Vorst 2006 ); (2) disturbances during childhood (childhood stress/abuse, being raised in
an emotionally cold family, disturbances or deficiencies in early family and social environment), or severe stress
during adulthood (Krystal, 1988); to (3) genetic influences ( Picardi et al., 2011 ). Thus, the general idea is that the
etiology of alexithymia involves multiple factors.
Most authors regard alexithymia as a relatively stable and dimensional personality trait ( Salminen, Saarija ¨rvi,
A¨a¨irela, & Tamminen 1994; Taylor et al, 1997; Taylor, Bagby, & Luminet 2000; De Gucht, 2003; Picardi, Toni, &
Caroppo 2005; Mikolajczak & Luminet, 2006; Parker, Keefer, Taylor, & Bagby 2008 ). Although alexithymia scores
change over time or due to treatment, the correlations between initial measurement and follow-up remain high
(Rufer et al., 2006; de Haan et al., 2012 ). This has led some authors to conceptualize alexithymia as a complex of
both state and trait elements ( Lumley et al., 2007 ), while others differentiate between primary and secondary alex-
ithymia, in which secondary alexithymia is seen as a reaction to severe stress or illness ( Bretagne, Pedinielli, &
Marliere 1992 ).
Alexithymia is a popular research field. PubMed presents more than 18,000 hits (as at November 2013), and
the construct has not only been correlated with classical psychosomatic complaints, but also with a wide array of
other phenomena. Just to give an impression: self-depreciation, introversion, persecutory ideation, impulse
expression, poor intentional control, guilt, fear, depression, rumination, non-cardiac chest pain, breast cancer, dia-
betes, chronic pain, eating disorders, substance dependence, pathological gambling, kidney failure, stroke, HIV
227Measures of Personality and Social Psychological Constructs.
DOI: http://dx.doi.org/10.1016/B978-0-12-386915-9.00009-7 ©2015 Elsevier Inc. All rights reserved.