Alexithymia’s Effects on People with Eating Disorders
People with alexithymia typically have certain specific problems that indicate an unusual inability to pinpoint their own emotions or speak clearly in emotional terms. Examples of these problems commonly include difficulty telling the difference between emotions that other people view as quite distinct, difficulty labeling emotions for others, an unusually shallow emotional range, difficulty creating hypothetical “what-if” scenarios and difficulty thinking in terms of larger concepts. Alexithymic people also frequently stay away from emotion-based discussions whenever possible and stick to lighter subject matter. To estimate any given person’s alexithymic tendencies, mental health professionals can use a questionnaire known as the Toronto Alexithymia Scale (TAS-20). The results of this questionnaire may indicate anything from a complete lack of the personality trait to high degrees of alexithymia that can damage the ability to function normally in everyday life.
Eating Disorder Basics
The classic eating disorders designated by the American Psychiatric Association (APA) are bulimia nervosa and anorexia nervosa. Another condition—called binge-eating disorder—was first identified by mental health researchers years ago, but only received full status as an eating disorder in 2013. A fourth eating-related condition, called avoidant/restrictive food intake disorder (ARFID), also received official recognition in 2013. People with ARFID restrict their food intake like people with anorexia, but don’t have anorexics’ characteristic fixations with thinness and weight control. People with binge-eating disorder participate in bouts of extreme calorie intake like people with bulimia, but don’t have bulimics’ fixation with purging those calories from their systems. Some people affected by disordered eating don’t meet the criteria for a diagnosis of any of these four disorders; doctors refer to these cases as unspecified eating disorders or “other” specified eating disorders.
Impact of Alexithymia
In the study published in the Journal of Eating Disorders, a team of Canadian researchers used a large-scale review of previous studies to examine the impact of alexithymia on the development, symptoms and treatment of anorexia, bulimia and binge-eating disorder, as well as other eating disorders not included under these headings. (Because of its newness as a concept, avoidant/restrictive food intake disorder was not specifically singled out for examination). The authors of this study made several important findings. First, 24 separate earlier studies indicate that, taken as a whole, people with eating disorders have higher scores on alexithymia tests than people unaffected by eating disorders. People with isolated eating disorder-related symptoms also have unusually high alexithymia scores, even when they don’t have enough symptoms to qualify for any kind of eating disorder diagnosis.
Several studies indicate that individuals diagnosed with anorexia have bigger problems with alexithymia than individuals diagnosed with bulimia. While not all of analyzed studies support this point of view, the authors of the review believe that alexithymia does indeed play a larger role in anorexia than it does it bulimia. They also believe that alexithymia significantly contributes to a worsening of the symptoms associated with binge-eating disorder. No one knows for sure if the presence of alexithymia actually increases the chances that a person unaffected by an eating disorder will develop such a disorder at a later point in time.
Three well-designed studies have examined the impact of alexithymia on the treatment of anorexia, bulimia and/or binge-eating disorder. These studies concluded that the presence of alexithymia can potentially slow down or reduce the effectiveness of treatment; however, alexithymia levels tend to decrease as eating disorder treatments run their course. This decrease is especially apparent in eating disorder programs that take issues of emotion recognition and expression into account, and therefore intentionally or inadvertently address participants’ alexithymic personality traits.
The authors of the review in the Journal of Eating Disorders point out several deficiencies in the existing studies on the connections between eating disorders and alexithymia. First, the vast majority of the analyzed studies relied entirely on questionnaires from their participants and didn’t include objective observations made by the researchers themselves. The existing studies also generally focused only on negative emotional expressions in people with alexithymia, didn’t draw any conclusions about the gender-based effects of alexithymia, and also didn’t draw any conclusions about the ethnic- or culture-based effects of the personality trait. The authors recommend that future researchers take the steps needed to correct these deficiencies.