What is Alexithymia?
Alexithymia is a personality trait characterized by difficulty identifying, distinguishing, and expressing emotions. It is best understood not as a disease, but as a delay or deficit in emotional processing. While many people can recognize a feeling (for example, "I am anxious") and separate it from a physical sensation (for example, "my heart is racing"), a person with alexithymia may struggle to make that distinction. Emotional distress is often experienced primarily as physical discomfort or confusion because the brain does not clearly label the internal state as emotion.
Is Alexithymia in the PDM?
Yes, but not as a formal diagnosis. In PDM (Psychodynamic Diagnostic Manual), alexithymia is mainly described in the Mental Functioning axis (called the M-Axis), where clinicians assess capacities like identifying and describing feelings.
PDM-2 can also connect alexithymia with somatizing personality patterns, where distress is communicated through body symptoms more than emotion language.
- It asks how well a person can recognize and communicate emotions.
- It helps explain why distress may show up as bodily discomfort or confusion rather than clear feeling words.
Is Alexithymia in the DSM?
Yes, but not as a formal diagnosis. In the DSM (Diagnostic and Statistical Manual), does not include "Alexithymia Disorder" as a billable category with its own criteria.
In DSM practice, alexithymia is usually treated as an associated feature within another diagnosis. Clinicians document the primary disorder, then note alexithymic features as part of the formulation and treatment focus.
- It often helps explain somatic presentations, where distress is experienced mostly in the body.
- It is also relevant in trauma, eating disorder, and autism-related assessments.
- The key point: DSM recognizes the pattern clinically, even without a standalone code.
Is Alexithymia in HiTOP?
Not as a formal diagnosis, but rather as a trait profile. HiTOP (Hierarchical Taxonomy of Psychopathology) treats alexithymia as a dimensional pattern that can cut across multiple spectra.
- It can show up as emotional blunting and low access to differentiated feeling states.
- It can also show up as somatic distress, where emotions are experienced mainly as physical symptoms.
- It may overlap with internalizing distress when the person feels bad but cannot clearly name why.
In plain terms, HiTOP says alexithymia is measurable and clinically meaningful even when it does not map to one category.
At-a-glance comparison
| Framework | Standalone diagnosis? | How it is usually used |
|---|---|---|
| DSM-5-TR | No | Usually treated as an associated feature or symptom pattern within another diagnosis. |
| PDM-2 | No | Placed in Mental Functioning (M-Axis) and often linked with somatizing personality patterns. |
| HiTOP | No | Treated as a dimensional trait profile across spectra, not a discrete category. |
Overall pattern across the three models
DSM, PDM, and HiTOP organize psychopathology differently, but they converge on the same clinical signal: alexithymia is usually best understood as a cross-cutting emotional processing difficulty, not its own disorder. That is why it appears across very different presentations, from depression and trauma to eating disorders and chronic somatic complaints—when someone cannot identify and differentiate what they feel, regulation skills are harder to use.
A helpful perspective shift is to move from a category question ("Is this a diagnosis?") to a function question ("Which emotion skills are offline?"). Across frameworks, the same capacities matter most: noticing internal signals, naming affective states, and linking feelings to context, needs, and choices. This is also why alexithymia is often framed through mentalization: difficulty representing one's own internal state clearly enough to work with it.
The clinical takeaway is practical: treat alexithymia as a measurable skill gap with developmental roots, then target those skills directly in therapy. Current evidence supports this approach, including findings that early language/mirroring environments relate to later alexithymic traits and that psychotherapy can reduce alexithymia over time, with medium effects in recent meta-analyses.
Further reading: A Clinician's Guide to Noticing Alexithymia, Helping Your Client Make Progress with Alexithymia, and How to Talk About Alexithymia with Clients.