Brain health · Sanctum

Not having the words for a feeling (alexithymia)

Someone asks how you feel and you genuinely do not know. You are not avoiding the question or hiding the answer. You reach for it and there is nothing there. You might notice you are tense, or tearful, or snapping, long before you can say that it is sadness, or anger, or fear.

This is alexithymia, difficulty identifying and putting words to your own emotions. The feelings are there, and often large, but the link between the bodily sense of them and the name for them is thin. So emotion tends to arrive as a physical state or a behaviour first, and the word comes late, if it comes at all.

It is easily mistaken for being cold, blunt or out of touch with yourself, and it makes talking therapies harder, because they ask you to begin with a feeling you cannot locate. It also means distress can build unseen, by you as much as by anyone, until it spills over. It often travels with the interoception difficulty, and it is rarely asked about.

We do not assume that being unable to name a feeling means it is not there. We look at how emotion actually reaches you, because that changes what helps. None of this is a diagnosis. It is what we explore with you. If that unspoken distress ever feels like too much to hold, you do not have to hold it alone. Your GP can help, and the Samaritans are on 116 123.

Written by Dr Asad RaffiConsultant Psychiatrist · Founder & Medical Director