Reprinted from Eating Disorders Review
November/December 2001 Volume 12, Number 6
©2001 Gürze Books
Q: I have been told that patients with anorexia nervosa often have alexithymia. Exactly what is alexithymia, how common is it in anorexia nervosa, and what does it signify? (M.N., Dallas)
A: Alexithymia refers to three specific characteristics of psychological functioning. Individuals with alexithymia usually have difficulty identifying and describing their own feelings, and they tend to be limited in their capacity to introspect. Instead, they mostly think in an externally oriented manner.
Community based studies have shown that, on average, individuals with anorexia nervosa do not show higher ratings on an alexithymia scale than controls. However, a sizeable minority, about 20%, of persons with teenage-onset anorexia nervosa actually do have very high alexithymia scores, even after recovering their normal weight. Careful examination of this subgroup suggests that these individuals may also be more likely to have some degree of obsessive-compulsive personality disorder (OCPD) and of “empathy disorder,” defined as impairment of the ability to understand the cognitive and emotional perspectives of other people, and histories of difficulties in social interactions throughout childhood and in the interview. But these associations are not very robust (Acta Psychiatrica Scandinavica 1997; 95:385). Although early observations relating alexithymia, OCPD and empathy disorders are intriguing and suggestive, they are inconclusive, and additional research is needed to sort out these relationships and their possible implications.
Other studies have shown that high alexithymia scores in patients with eating disorders correlate with their degree of clinical depression (Psychiatric Research 2000; 93:263). This finding suggests that alexithymia may partly reflect the mental state of the patient, and not merely reflect an enduring trait.