Alexithymia Across Psychiatric Disorders

Alexithymia is a condition characterized by difficulty in identifying and expressing emotions. This narrative review aimed to provide an integrative synthesis of the conceptual, neurobiological, and clinical dimensions of alexithymia across major psychiatric diagnoses. Recent research has connected alexithymia with various psychiatric disorders, including depression, anxiety disorders, bipolar disorder, schizophrenia, obsessive-compulsive disorder, trauma and related disorders, somatic symptom disorders, eating disorders, personality disorders, sleep disorders, attention-deficit/hyperactivity disorder, and alcohol and substance use disorders. Across diagnostic categories, reported prevalence rates vary considerably, ranging from approximately 13% to over 70% depending on the disorder and population studied, with rates exceeding 40–60% in somatic symptom disorders. Clinically, alexithymia is linked to higher symptom burden, reduced functioning, lower quality of life, increased suicidal thoughts, and poorer response to treatment. Neurobiological findings consistently implicate alterations within the anterior insula, anterior cingulate cortex, amygdala, and prefrontal regions, supporting the conceptualization of alexithymia as a transdiagnostic vulnerability factor associated with disrupted interoceptive awareness and emotion regulation networks. Including alexithymia routinely in psychiatric assessments could greatly enhance diagnosis and treatment planning. It is thought that treatment approaches that aim to increase emotional awareness, strengthen the link between bodily sensations and emotions, and improve emotion regulation skills may improve clinical outcomes in individuals with psychiatric disorders who exhibit alexithymic features.