Why Some People Struggle to Identify Their Feelings (Alexithymia Explained)

Introduction

Have you ever asked someone how they feel and received the answer, “I don’t know”? Perhaps you’ve experienced it yourself. You know something is wrong, but putting emotions into words feels almost impossible. For some people, this difficulty goes beyond occasional uncertainty. They consistently struggle to identify, understand and describe their emotions. In psychology, this trait is known as alexithymia. Although alexithymia is not a mental health diagnosis, research suggests it is closely linked to emotional wellbeing, relationships, trauma, anxiety, depression and physical health. Understanding alexithymia can help people make sense of emotional difficulties that may have existed for years. More importantly, it can offer hope that emotional awareness is a skill that can be strengthened over time.

What Is Alexithymia?

The term alexithymia comes from Greek words meaning “no words for emotions.” It was first introduced by psychiatrist Peter Sifneos in the 1970s to describe people who struggled to recognise and express their feelings.

Today, psychology defines alexithymia as a pattern involving:

1. Difficulty identifying emotions.
2. Difficulty describing emotions to others.
3. Confusion between emotions and physical sensations.
4. A tendency to focus on external events rather than internal experiences.

People with alexithymia do experience emotions. The problem is not a lack of feelings. Rather, it is difficulty recognising, interpreting and communicating what those feelings mean. For example, someone may notice a racing heart, tight chest, or stomach discomfort without realising they are feeling anxious. Another person may become irritable without recognising underlying sadness or disappointment. Research estimates that alexithymia affects approximately 10% of the general population, although levels vary significantly across individuals and groups (Luminet et al., 2021).

Why Identifying Feelings Matters for Mental Health

Emotions serve an important purpose. They provide information about our needs, goals, relationships and environment. Fear alerts us to danger. Sadness signals loss. Anger highlights perceived injustice. Joy reinforces experiences that support wellbeing. When people struggle to identify emotions, they may miss important psychological signals. This can make emotional regulation more difficult and increase vulnerability to mental health difficulties. Recent research has linked alexithymia with higher levels of anxiety, depression, psychological distress, eating disorders, substance misuse and reduced wellbeing (Preece et al., 2022). Simply put, understanding our emotions helps us respond to them effectively.

What Causes Alexithymia?

Researchers believe alexithymia develops through a combination of biological, developmental and environmental factors. There is rarely one single cause.

Childhood Emotional Experiences

Children learn emotional awareness through interactions with caregivers. When parents consistently acknowledge emotions, children gradually learn to identify and label their internal experiences. For example, a parent might say:

“You seem disappointed that the game ended.”

“It looks like you’re feeling nervous about school.”

Over time, children develop an emotional vocabulary. However, some children grow up in environments where emotions are ignored, criticised, or dismissed. They may hear messages such as:

“Stop crying.”

“You’re overreacting.”

“There’s nothing to be upset about.”

As a result, emotional awareness may not fully develop. Research suggests that childhood emotional neglect is associated with higher levels of alexithymia in adulthood (Aust et al., 2019).

Trauma and Chronic Stress

Trauma can also affect emotional awareness. When people experience overwhelming stress, the brain often prioritises survival over emotional processing. This protective response may help during threatening situations but can create difficulties later. Some individuals learn to disconnect from emotions because feelings are associated with pain, fear, or vulnerability. Studies have consistently found elevated rates of alexithymia among individuals with histories of childhood trauma and post-traumatic stress symptoms (Berenbaum et al., 2023).

Neurobiological Factors

Research also suggests that brain functioning plays a role. Alexithymia has been associated with differences in brain regions involved in emotional awareness, emotional regulation, and interoception—the ability to notice internal bodily sensations. Neuroscientific studies indicate that difficulties in communication between emotional and language-processing regions may contribute to challenges in identifying and describing feelings (Goerlich, 2018). This helps explain why some individuals genuinely struggle to find words for their emotional experiences.

Common Signs of Alexithymia

Alexithymia can look different from person to person. However, several patterns commonly appear. A person may:

1. Frequently say “I don’t know how I feel.”
2. Have difficulty talking about emotions.
3. Focus more on facts than feelings during conversations.
4. Struggle to recognise emotional needs.
5. Feel disconnected from emotional experiences.
6. Experience physical symptoms without understanding their emotional triggers.
7. Find emotionally focused therapy challenging initially.
8. Have difficulty understanding other people’s emotions.

These challenges can affect both mental health and relationships. Partners, friends and family members may mistakenly assume the person is emotionally distant or uncaring when they are actually struggling to identify what they feel.

Alexithymia and Relationships

Emotional awareness plays an important role in healthy relationships. When people can recognise and communicate emotions, they are more likely to seek support, resolve conflicts and build emotional intimacy. Alexithymia can create obstacles in these areas. For example, someone may become withdrawn during conflict because they cannot identify what they are experiencing. Another person may struggle to express affection verbally despite caring deeply about their partner. Research suggests that alexithymia is associated with lower relationship satisfaction and increased interpersonal difficulties (Preece et al., 2022). This does not mean healthy relationships are impossible. Rather, it highlights the importance of developing emotional awareness skills.

The Link Between Alexithymia, Anxiety, and Depression

One reason alexithymia receives increasing attention in psychology is its strong connection with common mental health difficulties. When emotions remain unclear, they can feel overwhelming. People may notice distress without understanding its source. For example, anxiety may be experienced primarily as physical symptoms such as tension, nausea, headaches, or a racing heart. Depression may appear as exhaustion, numbness, or irritability rather than sadness. Recent meta-analyses have found significant associations between alexithymia and symptoms of anxiety and depression across diverse populations (Honkalampi et al., 2022). Researchers increasingly view emotional awareness as a protective factor for psychological wellbeing. The better people understand their emotions, the better equipped they are to manage them.

Can Alexithymia Improve?

A common misconception is that alexithymia cannot change. Fortunately, research suggests emotional awareness can be developed. Like learning a new language, identifying emotions often becomes easier with practice. Several approaches have shown promise.

1. Expanding Emotional Vocabulary

Many people know only a handful of emotional labels, such as happy, sad, angry, or stressed. Learning more specific emotional language can improve emotional awareness. For example, anxiety may involve feeling:

• Apprehensive
• Uneasy
• Overwhelmed
• Insecure
• Worried

The more precise the language, the easier it becomes to understand emotional experiences.

2. Increasing Body Awareness

Because emotions often appear first in the body, paying attention to physical sensations can provide useful clues. Questions such as the following can help:

• What sensations do I notice right now?
• Where do I feel tension?
• What changed before this feeling appeared?

Research on interoception suggests that improving awareness of bodily sensations can enhance emotional understanding (Murphy et al., 2018).

3. Journaling

Writing about daily experiences can strengthen emotional awareness. Instead of focusing only on events, try exploring emotional reactions. Questions might include:

• What happened today?
• What emotions may have been present?
• What need or value was connected to those emotions?

Over time, patterns often emerge.

4. Therapy

Several therapeutic approaches can help individuals develop emotional awareness. These include:

1. Cognitive Behavioural Therapy (CBT).
2. Acceptance and Commitment Therapy (ACT).
3. Emotion-Focused Therapy (EFT).
4. Trauma-informed therapies.

Research suggests that interventions targeting emotional awareness can reduce alexithymia and improve mental health outcomes (Preece et al., 2022).

Conclusion

Alexithymia refers to difficulty identifying and describing emotions, but it does not mean a person lacks feelings. Instead, it reflects challenges in recognising and interpreting emotional experiences. Research shows that alexithymia is associated with anxiety, depression, trauma, relationship difficulties, and broader mental health concerns. Fortunately, emotional awareness is not fixed. Through self-reflection, emotional education, body awareness, and therapy, people can develop a stronger understanding of their inner world. Learning the language of emotions takes time, but it can significantly improve wellbeing, relationships, and psychological resilience. The ability to recognise feelings is not simply an emotional skill—it is an important foundation for mental health.

References

Aust, S., Alkan Härtwig, E., Heuser, I., & Bajbouj, M. (2019). The role of early emotional neglect in alexithymia and psychological functioning. Frontiers in Psychiatry, 10, 311.

Berenbaum, H., Shah, P., & Abramowitz, A. (2023). Trauma, emotional awareness, and alexithymia: A contemporary review. Current Opinion in Psychology, 54, 101696.

Goerlich, K. S. (2018). The multifaceted nature of alexithymia – A neuroscientific perspective. Frontiers in Psychology, 9, 1614.

Honkalampi, K., Hintikka, J., Lehtonen, J., & Viinamäki, H. (2022). Alexithymia and mental health: A systematic review of recent findings. Nordic Journal of Psychiatry, 76(6), 411–421.

Luminet, O., Nielson, K. A., & Ridout, N. (2021). Alexithymia: Advances in research, theory, and clinical practice. Cambridge University Press.

Murphy, J., Brewer, R., Plans, D., Khalsa, S. S., Catmur, C., & Bird, G. (2018). Testing the independence of self-reported interoceptive accuracy and attention. Quarterly Journal of Experimental Psychology, 73(1), 115–133.

Preece, D. A., Becerra, R., Robinson, K., Dandy, J., & Allan, A. (2022). Measuring alexithymia and emotional awareness: Recent advances and clinical implications. Current Psychology, 41, 5082–5096.