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Panic Attacks And the Inability to Express Emotions: Are They Related?

by Mike on January 6, 2009 · 16 comments

unsmiley-face-smThe search for the causes of panic attacks and Panic Disorder continues to turn up new and surprising clues to the origins and contributors to the disorders.

A new vein of research has been trying to find out if panic attacks are related to personality traits that are not mental illnesses. Researchers in Italy and Denmark have published studies in the last few months that show a distinct relationship between alexithymia, the inability to talk about feelings, and Panic Disorder.

Alexithymia is a relatively new field of study. The personality trait was only named in 1972, and has received increasing attention in the past few years as a cause or contributor to a number of medical and psychological maladies.

This post discusses alexithymia and its relationship to panic attacks and Panic Disorder under these headings:

  • What is alexithymia?
  • How do I tell if I’m alexithymic?
  • What relationship do panic attacks and Panic Disorder have with alexithymia?
Check out the article What Panic Attacks Have Taught Me for more help on overcoming Panic Attacks.

What is alexithymia?

Inability to talk about feelings due to a lack of emotional awareness

Alexithymia is the inability to talk about feelings due to a lack of emotional awareness. Alexithymics are typically unable to identify, understand or describe their own emotions.{{1}} It is a personality trait that places people at risk for other medical and psychiatric disorders while reducing the likelihood that these people will respond to conventional treatments for other conditions. 

Alexithymia is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a mental disorder, since it is considered to be a personality trait at this time.{{2}} This Manual is the source used by most US psychiatrists and psychologists to make diagnoses. The new DSM-V, due to be released in 2012, may change this.

The term “alexithymia” was coined in 1972 by Peter Sifneos from the Greek a (prefix meaning “lack”), lexis (“word”), and thymos (“feelings”), and can be read literally as “a lack of words for feelings.”{{3}}The name actually is inaccurate, since the syndrome involves much more than a simple inability to express feelings.

Alexithymia is a relatively new diagnosis, so there have been no large-scale studies of the prevalence of the syndrome in the general population. Smaller-scale studies point to the prevalence as being from 5 to 9 percent.

The key features of alexithymia are:{{4}}

  • Difficulty identifying different types of feelings
  • Difficulty distinguishing between emotional feelings and bodily feelings
  • Limited understanding of what caused the feelings
  • Difficulty verbalising feelings
  • Limited emotional content in the imagination
  • Functional style of thinking
  • Lack of enjoyment and pleasure-seeking
  • Stiff, wooden posture

Genetics play a large role in alexithymia

A study by Michael Jørgensen and colleagues in Denmark shows that genetics play a large factor in all aspects of alexithymia, much greater than environmental influences. {{5}} They studied 8,785 twin pairs in Denmark and found that, while environmental factors do play a role in alexithymia, the genetic makeup of a person plays a greater part.{{6}} This points up that alexithymia is more of an inherited personality trait, rather than something that is learned, and therefore fully treatable.

Note that alexithymia should not be confused with:

  • Sociopathy – a lack of concern for others
  • Stoicism – a deliberate resistance of emotional impulses
  • Apathy – a lack of emotional reactivity or motivation
  • Emotional repression – subconscious but motivated denial of emotion

How do I tell if I’m alexithymic?

Deficiency in emotional understanding

If you have a marked deficiency in emotional understanding, there will be various clues evident in everyday life. For example, you might:{{7}}

  • Find it difficult to talk about your own emotions
  • Be perceived by others as excessively logical, or unsentimental without being unfriendly
  • Be perplexed by other people’s emotional reactions
  • Give pedantic and long-winded answers to practical questions
  • Rarely daydream or fantasize about personal prospects
  • Have a subdued reaction to art, literature or music
  • Make personal decisions according to principles rather than feelings
  • Suffer occasional inexplicable physiological disturbances such as palpitations, stomach ache, or hot flushes

What relationship do panic attacks and Panic Disorder have with alexithymia?

Same brain dysfunction in panic and alexithymia

A definite relationship has been found by Silvana Galderisi and her colleagues in Italy between dysfunction in certain parts of the brain (the fronto-temporo-limbic circuits) in both alexithymia and panic disorder.{{8}} These parts of the brain process emotional stimuli, among other things.{{9}} 

Galderisi found that alexithymia was more frequent in patients with Panic Disorder than in those without it. Those with Panic Disorder had lower verbal cognitive abilities and more difficulty in inhibiting interference from nonverbal stimuli and panic-related words. She notes that this reduction in verbal skills might suggest reduced abstraction and symbolization.{{10}}

Another study by Carlo Marchesi and colleagues showed that patients with Panic Disorder were more alexithymic than normal patients, even when their Panic Disorder was in complete remission.{{11}} Though the levels of alexithymia dropped after the remission of panic attacks, phobic avoidance and anticipatory anxiety, those with Panic Disorder were still more alexithymic and anxious than normal people.

What do you think?

I spent most of this post describing alexithymia, but it’s a syndrome that most people are unfamiliar with. We all know people that are not forthcoming with their emotions, particularly men, and particularly men in the southern and upper midwest US. But much of this is a learned cultural behavior. 

The unanswered question

The question unanswered by these studies is what kind of environment might foster alexithymic tendencies? There are many different kind of environmental influences that might come into play: cultural, religious, and family, to name but a few.

On reflection, I think that I have known several people who could be alexithymic. They were cold, unsentimental, and had no reaction to the arts. My wife even worked for one! 

  • Do you know someone who might be alexithymic? Why do you think so?
  • What part do you think cultural learning might have in alexithymia?
  • What do you think are some of the environmental influences that might bolster alexithymia?

As always, your comments are welcome!

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[[1]] Hal. (2003, July 28). The Alexithymia FAQ. Retrieved December 18, 2008 from “What is alexithymia? ¶1[[1]] 

[[2]]Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Arlington, VA: American Psychiatric Association. 1994.[[2]]

[[3]]Hein, Steven. (2007, July 27). Alexithymia. Retrieved January 3, 2009 from “The History of the Term” ¶1[[3]]

[[4]] Hal. (2003, July 28). “What are the key features of the alexithymia syndrome?”[[4]]

[[5]]Jørgensen, Michael; Zachariae, Robert; Skytthe, Axel; Kyvik, Kirsten. (2007, October). Genetic and Environmental Factors in Alexithymia: A Population-Based Study of 8,785 Danish Twin Pairs. Retrieved January 3, 2009 from Psychotherapy and Psychosomatics: [[5]]

[[6]]Science Daily. (2007, November 19). Is the Inability to Express Emotions Hereditary?. Retrieved January 3, 2009 from ¶3 ¶6 [[6]]

[[7]] Hal. (2003, July 28). “How do I tell if I’m alexithymic?”[[7]]

[[8]]Galderisi, Silvana; Mancuso, Francesco; Mucci, Armida; Garramone, Stefania; Zamboli, Rosita; Maj, Mario. (2008). Alexithymia and Cognitive Dysfunctions in Patients with Panic Disorder. Retrieved December 12, 2008 from Psychotherapy and Psychosomatics: [[8]]

[[9]]Science Daily. (2008, June 5). Are Panic and Inability to Express Emotions Related?. Retrieved July 1, 2008 from ¶2[[9]]

[[10]]Galderisi. (2008).[[10]]

[[11]]Marchesi, Carlo; Fontó, Stefania; Balista, Chiara; Cimmino, Carmen; Maggini, Carlo. (2005). Relationship between Alexithymia and Panic Disorder: A Longitudinal Study to Answer an Open Question. Retrieved December 18, 2008 from Psychotherapy and Psychosomatics:  [[11]]

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