Review paper Archives of Psychiatry Research 2019;55:71-84 DOI: 10.20471/may.2019.55.01.06 Received September 26, 2018, accepted after revision March 25, 2019

Roots of

Daniela Šago1, 2, Goran Babić3, 4 1 Psychiatric Hospital ‘Sveti Ivan’, Zagreb, Croatia, 2Faculty of Medicine, Josip Juraj Stross- mayer University of Osijek, Osijek, Croatia 3Croatian Psychoanalytic Society, Zagreb, Croatia,4 University of Zagreb, School of Medicine, Zagreb, Croatia

Abstract - This paper presents the historical background and theoretical framework of alexithymia and the development of the instruments that measure this theoretical construct more accurately. The alexithymia concept was derived from clinical observation, initially formulated without an underlying theoretical frame- work. Nowadays, alexithymia is a part of the theory of cognitive processing and regulation of emotions. The paper also reviews the interest alexithymia aroused in research and clinical work of various fields of psychol- ogy, particularly . The concept was developed from clinical experience with psychosomatic patients that responded poorly to psychotherapy. The development of the concept from categorical to di- mensional is highlighted. Alexithymia was conceptualised as a defense mechanism, but also as deficit pathol- ogy. It overlaps with the concept of mentalization and can be viewed both in terms of state and trait features. Finally, the measuring instruments for alexithymia are comprehensively listed. Keywords: alexithymia, psychoanalytic theory, psychosomatic disorder, the , mentalizing

Copyright © 2019 KBCSM, Zagreb e-mail: [email protected] • www.http://apr.kbcsm.hr

Historical background and theoretical Clinical observation of alexithymia date framework of the alexithymia concept back to the 1940s [2]. Alexithymic deficits The term alexithymia (Greek; a = lack, lex- were described in patients with classic psy- is = word, thymos = emotion, mood, or feel- chosomatic diseases as well as in general ing) was coined by Sifneos and introduced in psychiatric patients, particularly in those re- the early 1970s to denote a cluster of features sponding poorly to psychoanalytic therapy including difficulty identifying and describing [3–6]. Reusch described affective and cogni- subjective feelings, a restricted fantasy life, tive disturbance due to developmental arrest and preoccupation with trivial aspects of ex- in early childhood when emotions are not well ternal events’ characteristics [1]. connected with words and expressed through bodily channels [3], while Kelman associated externalized living as modus vivendi [6]. Mar- ty and de M’Uzan’s [7] introduce a concept Correspondence to: Daniela Šago Psychiatric Hospital ‘Sveti Ivan’, Jankomir 11, 10 090 Zagreb, of pensée opératoire (operative thinking), de- Croatia noting the absence of fantasy and other man- Phone: +385-91-3211500; E-mail: [email protected] ifestation of the depleted inner mental world 72 of feelings, ideas about intentions, needs, at- pean Conference on Psychosomatic Research titudes and focused on external events. They in Heidelberg, Germany. At the meeting, Sif- also suggested a vulnerability to somatic ill- neos told attendees that ‘The word was sim- ness. Marty [8, 9] attributed it to a deficien- ply used to describe certain clinical observa- cy in mentalization – a concept introduced tions that were made over very many years. I in the early 1960s. Almost simultaneously, tried appropriately to use a Greek word or a Krystal independently described similar ob- pseudo-Greek word for descriptive purposes’ servations among patients with substance use [21]. Alexithymia engulfs a disturbance in af- disorders and posttraumatic states [10, 11]. fective and cognitive functions and is char- Krystal first highlighted alexithymia as possi- acterized by a difficulty recognizing and ver- bly the most critical single factor diminishing balizing feelings, and a paucity of fantasy [1]. the success of psychoanalysis [12]. Rubins Nemiah and colleagues made the distinction emphasized that Horney was the first to label between emotions and feelings [21]. Emo- these patients as alexithymic [5, 13]. McDou- tions have the neurophysiological component gall referred to these individuals as normo- and the component of motor-expression of paths, dis-affected and anti-analysands, and affect. Both components must have mental she warned of prolonged periods of stag- representations before the conscious experi- nation in therapy [14–16]. In 1967 Sifneos ence of feelings [20]. More recently Damasio reported his preliminary observations on emphasized the same conceptual distinction some patients’ distress from psychosomatic and highlighted that emotions precede feel- illnesses [16]. He recognized that they have ings [22]. Sifneos and Nemiah pointed out no pathology of conflict as neurotic patients that alexithymia is not an absence of emo- have, but rather show deficits in the abil- tions, but rather a deficit in elaborating feel- ity to experience feelings. In the subsequent ings [16]. Nemiah, Freyberger and Sifneos three years, Nemiah and Sifneos conducted also reported that ‘Although many individuals a more systematic examination of previous- may initially speak of being nervous, or sad, ly tape-recorded interviews of patients with or angry, if they are pressed to describe their two of the following classic psychosomatic feelings further and to tell the examiner what diseases specified by Alexander (duodenal being sad or nervous or angry feels like, it rap- ulcer, bronchial asthma, rheumatoid arthri- idly becomes apparent that they are totally un- tis, ulcerative colitis, hypertension, hyperthy- able to do so’ [20]. Many psychoanalysts and roidism, and atopic dermatitis) [17–19]. Their psychotherapists observed that those patients conclusion was that these patients have diffi- are deficient in specific psychological capaci- culty in describing and identifying their feel- ties and do not respond well to traditional in- ings. Also, many of these patients showed a terpretative psychotherapies [5, 6, 23]. thought content consistent with the concept of pensée opératoire. In the seminal publica- Lack of love, joy, and happiness tion, Nemiah, Freyberger, and Sifneos fully We can imagine an alexithymic person as explicated core features of alexithymic indi- an individual who lacks psychological mind- viduals [20]. The year 1976 was defining for edness, demonstrates a minimal interest in the alexithymia construct, when it was se- play and has concreteness in dreaming and lected as the central theme of the 11th Euro- thinking; someone who has limited aware-

Archives of Psychiatry Research 2019;55:71-84 Šago, Babić 73 ness of emotions and drives, and a utilitarian psychosomatic illness, the French psycho- style of living, whose behavior is guided by somatic school introduced the concept of rules instead of inner feelings, fantasies, and mentalization [8, 9, 31]. During the 1990s, wishes. When attending psychoanalytic ther- Lecours and Bouchard extended the contri- apy, an alexithymic individual fills the session butions of Marty and other French analysts with a monotonous chronological recital of by proposing a hierarchical conceptual mod- external events and is unable to engage in psy- el with levels of mentalization which shows chotherapeutic therapy, provoking feelings of some similarities to Krystal’s theory of af- dullness and boredom in the therapist. Hence, fects and Lane and Schwartz’s hierarchical it is very likely that alexithymia will be associ- model of levels of emotional awareness [28, ated with less improvement in psychotherapy 32, 33]. It was around that time when Fonagy [24]. The alexithymic individual has a limited and Target adopted the concept of mental- ability to experience pleasurable emotions ization and defined it more broadly as the ca- such as joy, love, and happiness [25, 26]. Krys- pacity to think about one’s own and others’ tal conceptualized the course of maturation mental states regarding feelings, desires, and of emotions as a progressive desomatisation intentions [34, 35]. More recently, Fonagy, also linked to learning of words and subse- Bateman and Luyten described mentaliza- quently differentiated into different subjective tion as a multifaceted construct with cogni- feelings [27]. Furthermore, the failure to link tive and affective components and indicated feelings with fantasies and to reflect on inner that mentalizing is not granted and constant experience pushes the mind toward a preoc- capacity of the mind, but is in constant flux cupation with the details of external events, and dynamic and interplay context of specif- which is characteristic of pensée opératoire ic attachment relationships is also influenced [28]. With alexithymia, the emotions are still by the level of distress in specific moments felt, but the connections with words and im- [36]. According to Taylor and Bagby the way ages are interrupted, the emotions are poorly that Fonagy understands mentalization [36], represented at higher levels of consciousness, and the way Lane applies it, is very different resulting in a deficit of conscious feelings and from how it was conceptualized originally by difficulties in identifying and verbalizing feel- French psychoanalysts [8, 9, 23, 31, 36, 37]. ings. It is likely that individuals with difficulty Lane and colleagues argue that scientific de- identifying, verbalizing, and reflecting on feel- velopments since the 1970s, including the ings would be inclined to greater emotional concept of ‘theory of mind’ or mentaliza- arousal in response to emotional stimuli [29]. tion, make it essential to expand the alexi- Individuals with alexithymic deficits can have thymia concept [38]. He permits a shift to a outbursts of sadness or rage, which may seem perspective that difficulty in verbalizing is the to be at odds with the definition, but they indicator, not the cause of the problem. Van- have no understanding of these strong emo- heule and colleagues also have highlighted tional expressions [30]. that alexithymia is an indicator of an under- lying process [39, 40]. While Taylor, Bagby, Alexithymia and the concept of mentalization and Parker argue that alexithymia does not During the 1960s in an attempt to un- embrace the cognitive aspects of broad men- derstand the role of pensée opératoire in talization construct, the authors of this paper

Alexithymia Archives of Psychiatry Research 2019;55:71-84 74 see externally oriented thinking as a teleologi- and colleagues [37]. Following Krystal’s ideas cal stance which is a developmental stage in about the impact of trauma on affect devel- mentalization [41]. Teleological stance/mode opment and affect regression, the degree of is extreme exterior focused thinking in which alexithymia in a person is likely to reflect the only observable change or action is consid- extent of trauma experienced by the person ered to be a valid indicator of the intentions during childhood or as an adult, and whether of others [42]. Lane and colleagues report or not an attachment figure was available to that the Levels of Emotional Awareness contain and modulate the person’s distress Scale (LEAS) correlated positively with some [48]. Contemporary theory and research of measures of ‘theory of mind’, which is not alexithymia suggest continuous rather than the case with the Toronto Alexithymia Scale categorical approach, as it often includes trait [37]. Some individuals with a high degree of and state components alike [37, 47, 49–52]. alexithymia might be impaired in their ability The empirical results of different studies to read the intentions, desires, and emotional provided substantial finding for viewing alex- states of others, but measures of alexithymia ithymia as a dimensional construct, as well as were not designed to assess this ability [43]. findings from several different taxometric in- Several researchers have found associations vestigations [23, 50, 51]. between alexithymia and poor empathic abili- ties, which is consistent with clinical observa- Primary versus secondary alexithymia tions and suggests that impaired is a A distinction between primary and sec- correlate of alexithymia [28,44–46]. ondary alexithymia was made in the last cen- tury [53]. Primary alexithymia was thought to Dimensional or categorical construct? reflect ‘structural or neurobiological defects’ While Lane and colleagues proposed and secondary or acquired alexithymia was two subtypes of alexithymia anomia (lack seen as emerging from ‘developmental ar- of words for emotions) and agnosia (not rests or from a catastrophic environmental knowing one’s emotions), Primmer suggest- onslaught’, or a reaction to life-threatening ed various degrees of alexithymia [37, 47]. illness or medical treatment [25, 54]. Second- The concept of affective agnosia is a cue ary alexithymia is thus amenable to change that alexithymia is not merely a difficulty in when the medical illness or life setting im- finding words for feelings, but involves a de- proves [55–57]. Taylor, Bagby, and Parker ficiency in the mental representation of emo- have pointed out that alexithymia is the name tions [37]. Contrary to Nemiah and Sifneos, of the multifaceted construct, and regardless Krystal regarded alexithymia as a dimension- of etiology, is not only a difficulty in -find al construct and reported that ‘Most patients ing words for emotional feelings or emotion- are able to experience some feelings some of al non-expression in the face of situational the time’ and stated that alexithymia is not stressors that clears when stress decreases an ‘all or nothing’ manifestation [28]. It is [41]. possible that the same individuals with alexi- thymia might express fluctuations in their Defense mechanism level of emotional awareness and they shift Several psychoanalysts advocated that back and forth on the continuum between af- alexithymia is ego defense or immature de- fective agnosia and anomia proposed by Lane fense mechanism against anxiety and under-

Archives of Psychiatry Research 2019;55:71-84 Šago, Babić 75 lying neurotic conflicts [5, 6, 58–60]. On the searchers have attempted to develop reliable contrary, Krystal argued that alexithymia is a and valid instruments for its measuring. Many defense in a teleological sense only, as it is of observer-rated questionnaires, self-report an arrest in affective and cognitive develop- scales, and projective techniques are available, ment [61]. McDougall reconciled with the but most of these with poor psychometric proposed explanation that defense theory properties [70]. Haviland has given a detailed and the deficit/developmental arrest theory overview of the instruments for measure- are not mutually exclusive [62, 63]. Her the- ment of alexithymia by enlisting them as self- ory depicts alexithymia as a massive defense report, structured interview, semi-structured against primitive dreads and overwhelming interviews, observer reports, projective test, pain rather than neurotic anxieties. Other and self-report / rater scored [71]. authors perceive alexithymia as massive de- Most researchers agree that clinically ob- fense against intolerable emotions as well as a servable features of alexithymia consist of deficit in the mental representation of emo- four salient components (restricted imaginal tions, or as a diminished capacity for imagina- process included), even though the widely tion and mental representation of emotions used measurement of alexithymia, Toronto [23, 33 ,58, 64]. alexithymia scale (TAS-20), consists of three subscales [20]. Vorst and Bermond included State and trait features impaired capacity for experiencing feelings Empirical findings demonstrate that al- of emotion as the fifth component of the though alexithymia is a trait, it shows some alexithymia concept [72]. Some researchers state variation as a reaction to the presence of have suggested fantasizing and emotionaliz- illness [23, 49, 65]. Patients affected by panic ing as correlates rather than prominent con- disorder might resolve the alexithymic reaction stituents of the alexithymia construct, while only after remission when symptom severity others have proposed externally oriented returned to the premorbid level [66]. This sup- thinking (EOT) subscale substantially differ- ports the hypothesis of alexithymia as a per- ent than difficulty identifying feelings (DIF), sonality trait with state characteristics which and difficulty describing feeling (DDF) sub- wax and wane together [66]. Fonagy P., Bate- scales [73,74]. Some of these topics were man A., and Bateman A. emphasize that in explored recently, and it has been suggested contrast to alexithymia, mentalization is not a that restriction of imaginal capacity might be static and unitary skill or trait but a dynamic ca- a less salient component of the alexithymia pacity [67]. Several studies have shown lack of construct [75]. The same study supported absolute stability of alexithymia, although gen- pensée opératoire as a salient component erally speaking, an individual’s degree of alex- of the alexithymia construct which might ithymia is fairly constant in clinical situations be adequately assessed by the EOT subscale and other interpersonal contexts [65, 68, 69]. [75]. For decades, the concept of alexithymia has challenged discussion concerning facets Instruments developed to assess alexithymia that constitute this construct, which is re- flected in the subscales of different- instru Since the concept of alexithymia was in- ments for measuring alexithymia [29]. Nev- troduced as a coherent construct, several re- ertheless, empirical research is challenging to

Alexithymia Archives of Psychiatry Research 2019;55:71-84 76 address the complexity of the multifaceted The Amsterdam Alexithymia Scale (AAS) is a alexithymia construct. Measurement of alexi- self-report questionnaire covering five essen- thymia has been proven as problematic in the tial features of alexithymia and encompasses clinical and nonclinical sample [76]. fantasizing and analyzing emotions [88]. Sif- Some of the earlier instruments for mea- neos developed previously mentioned ob- suring alexithymia reflect the duality of theo- server-rated BIQ, but with lack of adequate retical perspectives and categorize individu- interrater reliability [41, 89]. Following sug- als into those with and without alexithymia, gestions of Sriram, Taylor and Bagby devel- such as the first instrument for measurement oped a modified version for measuring alexi- of alexithymia Beth Israel Hospital Psycho- thymia with six items that assess affect somatic Questionnaire (BIQ), or interview- awareness and six items that assess operative based Diagnostic Criteria for Psychosomat- thinking [30, 90]. The same authors gave the ic Research, Alexithymia (DCPR-A) [77]. most significant contribution to the develop- DCPR-A assesses 12 psychosocial syndromes ment of instruments for measuring alexi- clustered into five diagnostic areas, one of thymia. Nowadays, Modified-BIQ is used which is alexithymia with difficulties verbal- only occasionally. Later, they developed the izing and communicating emotional states, Toronto Structured Interview for Alexi- reduced fantasy, external thinking, physical thymia (TSIA) which is a more reliable meth- reactions to strong emotions; outburst of an- od then self-report question measurement ger, crying, or joy [78]. BIQ, as well as Alexi- [91]. Measuring alexithymia with structured thymia Provoked Response Questionnaire interview method assesses the imaginal pro- (APRQ) and Karolinska Psychodynamic cesses, although the items may not adequate- Profile (KAPP) are assessment scales to be ly capture wish fulfillment imaginations and used with an interview [79, 80]. fantasies, which was the content emphasized Some authors suggest that self-report by Krystal, and Nemiah, Freyberger and Sif- scales do not reliably assess individuals with a neos [20, 92]. The TSIA consists of 24 inter- high degree of alexithymia, who may lack the view questions distributed across four six- introspective capacity to accurately evaluate item subscales and includes a separate their difficulty in identifying and describing subscale for measuring the fantasizing facet subjective feelings [54, 81, 82]. The Shipko over the three facets also assessed by the and Noviello Alexithymia Scale (SNALEX) TAS-20 [50]. The TSIA correlates positively lacks construct validity as a measure of alexi- with the TAS-20 in a variety of samples [91]. thymia in psychiatric patients [83]. Twenty- Rorschach Reality-Fantasy Scale (RFS) or two item MMPI Alexithymia Scale was devel- Rorschach Alexithymia Scale (RAS) repre- oped in Denver from the first 556 items sent an alternative method for assessing the derived from Beth Israel Psychosomatic creation, imaginal capacity and potential Questionnaire (BIQ) and is supposed to have space between reality and fantasy [93–96]. more stability over time [84]. Unfortunately, The Scored Archetypal Test (SAT9), similarly MMPI Alexithymia Scale as well as the origi- to Rorschach, uses projective instruments to nal and revised versions of the Schalling-Sif- measure the degree of alexithymia [97]. The neos Personality Scale (SSPS)lack validity and California Q-set Alexithymia Prototype have poor internal reliabilities [74, 85–87]. (CAQ-AP), an observer- and a self-report

Archives of Psychiatry Research 2019;55:71-84 Šago, Babić 77 measure of the alexithymia construct, com- Scale (TAS) was developed with concern for pares to which extent the alexithymia is de- empirical and theoretical congruence with termined either by the patient or by an ob- the alexithymia construct. It encompasses server [98–100]. Nemiah, who actively five different features of alexithymia includ- participated in the construction of this in- ing lack of introspection, social over adapta- strument, stated that CAQ-AP seems to pro- tion, and limited fantasy life together with vide the most accurate and complete descrip- difficulties remembering dreams [104]. Ini- tion of alexithymia, as it was initially derived tially, it had 41 items. Half of these items from clinical observation [71]. Observer were phrased negatively, to compensate an- Alexithymia Scale (OAS) is a self-report ques- swering tendencies and at the end, only 26 tionnaire to be completed by a subject’s ac- were retained. Fifteen items had to be quaintance or a relative and has 33-items dropped due to low correlations [105]. The based on a five-factor structure: distant, un- resulting scale with 26 items comprising the insightful, somatizing, humorless, and rigid TAS was clustered into a four-factor struc- [101]. Lane and Schwartz proposed a com- ture and covered diminished daydreaming plex hierarchical model of cognitive-emo- (supposed to represent a limited fantasy life). tional development which can be assessed In the available literature, we have found it as with the self-report instrument Levels of the original 26-item TAS whichis still used Emotional Awareness Scale (LEAS) [33,102]. worldwide [104, 106]. In subsequent studies, Although the LEAS may adequately assess the TAS-26 was found to have some psycho- the levels of emotional awareness construct metric shortcomings such as social desirabil- and the continuum of increasing cognitive ity, a high number of items measuring dimin- complexity, and can also distinguish between ished daydreaming, and low item correlation, affective agnosia and anomia, it ‘was not cre- also the daydreaming factor correlated nega- ated as a measure of alexithymia per se’ [82], tively with the first factor and had little theo- and was recently described simply as ‘a per- retical coherency in the alexithymia construct. formance measure of the ability to put emo- The authors of the scale suggest that self-re- tions into words’ [38, 82, 102]. The recent port assessment of daydreaming activity is meta-analytic review has shown a small over- confounded by a social desirability response lap between LEAS and TAS-20 [103]. The bias and may not adequately capture the ca- self-report Bermond-Vorst Alexithymia pacity for imaginal activities [70]. They also Questionnaire (BVAQ) was developed to im- added that the compositional structure of prove assessment of the salient features of the TAS-26 does not represent the separate alexithymia as a diminution of fantasy [72]. domains equally. So they decided to develop Vorst and Bermond view emotionalizing as a an improved and revised version TAS-R fundamental personality dimension that falls where all items assessing daydreaming were outside of the alexithymia construct [72]. eliminated [26]. In the first revision, TAS-R However, recent network analysis of the had 23 items and a two-factor structure with BVAQ did not support emotionalizing as a DDF and DIF items tending to collapse into distinct component of the alexithymia con- one single component [70, 105]. In the sec- struct [29]. Recognizing the limitations of ex- ond revision they added 17 new items, and at isting measures, the Toronto Alexithymia the end, 20 items were included in TAS-20

Alexithymia Archives of Psychiatry Research 2019;55:71-84 78 consisting of three factors DIF, DDF, and ternal correlates [71]. Many studies found EOT. It was considered as being indepen- that the TAS-20 weakly correlated with older dent from the socially desirable answers. In age, male sex, lower socioeconomic status empirical studies, the TAS-20 is widely used and fewer years of education [82]. The com- as a measurement for alexithymia construct mon limitations of the self-report method because of its supposed good psychometric are poor self-insight as alexithymic patients properties [105,107]. TAS-20 provides a di- usually are not very self-reflective, dissem- mensional and categorical assessment of the blance and various response styles, as well as alexithymia features. It incorporates empiri- poor comprehension of some of the respon- cally derived cutoff scores as well as scores dents [105, 116–118]. One of the possible ranging from 20 to 100. The TAS-20 has TAS-20 limitations is that highly alexithymic been translated into more than twenty lan- individuals cannot accurately assess their def- guages and has been cross-validated by con- icits in affect awareness due to lack of insight firmatory factor analysis in Western, Eastern [23]. Lane and colleagues added an inherent European, East Asian, and Middle Eastern difficulty with the use of self-reports to mea- countries [108–112]. These findings support sure, and that is the reason why authors rec- the view of alexithymia as a universal trait ommend using more than one method when rather than a culture-bound construct. The assessing alexithymia [30, 43, 50]. Vanheule TAS-20 indirectly assesses imaginal process- noted that asking a person if he or she is un- ing of alexithymia by the EOT subscale, even aware of his or her feelings is to a certain ex- though this subscale correlates negatively tent paradoxical and therefore, measuring with measures of fantasy [113, 114]. The alexithymia by self-report is problematic omission of an explicit assessment of imagi- [119]. On the other hand, Taylor, Bagby, and native processes may produce issues of Parker yielded good results regarding con- ‘noise’ and unreliable responding that is as- struct validity and endorsed TAS-20 as a valid sumed to be associated with the self-report measure of the alexithymia construct method or the weakest point of a chain of [41,107]. TAS-20 measurement [50]. Kooiman, Spin- hoven, and Trijsburg highlight unsatisfactory Limitations low internal consistency of the EOT factor In this review we focused on the histori- and low test-retest reliability for DDF and cal background and theoretical framework EOT subscales [105]. They also noted that of the alexithymia construct and the instru- TAS-20 assesses some, but not the fantasy as- ments developed to assess alexithymia. Due pect of alexithymia. Their opinion is to use to the abundance of theoretical and empirical the TAS-20 in empirical research combined knowledge on the alexithymia construct, we with some other instruments for alexithymia could not encompass the genetic and envi- [105]. Similar viewpoint have Rokvić and ronmental/developmental factors in the eti- Jovanović who suggest a modification of the ology of alexithymia, as well as attachment EOT subscale [115]. Although TAS-20 au- theory, childhood trauma and all other fac- thors recommend using total TAS-20 scores, tors that distress the development and af- researchers often calculate total and subtotal fect regulation. We have to acknowledge the scores and evaluate all relationships with ex-

Archives of Psychiatry Research 2019;55:71-84 Šago, Babić 79 common limitations of narrative versus sys- connection with the alexithymia construct tematic literature review as a potentially bi- [120]. Alexithymia is an intriguing topic and ased source and selection of literature, less has generated a large body of research in the evidence-based inferences as well as qualita- past 40 years. Debates about the definition tive analysis instead of quantitative synthesis. and measurement of alexithymia continue even though its etiology has not been firmly Conclusion established [71]. Alexithymia is not classified as a mental disorder in DSM-5. Nevertheless, it is accept- Acknowledgements ed that alexithymia has a negative impact on None. a variety of somatic and mental health treat- ments. The recent review ‘The relationship Conflicts of interest between alexithymia and morbidity’ listed None to declare. many somatic and mental disorders and their

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Korijeni aleksitimije Sažetak - Ovaj pregledni rad predstavlja povijesnu pozadinu i teorijski okvir koncepta te razvoj instrumenata koji mjere aleksitimiju. Koncept aleksitimije proizašao je iz kliničkog promatranja, bez prethodno osmišljenog teorijskog okvira. Danas je aleksitimija dio kognitivne teorije i teorije regulacije afekta. Aleksitimija je pobudila veliko zanimanje psihoanalitičara, kao i kliničara drugih teorijskih usmjerenja. Koncept je nastao iz kliničkih iskustava sa psihosomatskim bolesnicima kod kojih je uočen nezadovoljavajući odgovor na psihoterapiju. U ovom radu opisujemo razvoj od kategorijskog do dimenzijskog koncepta aleksitimije. Aleksitimija se može razumjeti kao obrambeni mehanizam, ali i kao patologija deficita. Preklapa se s konceptom mentalizacije. Mogu se razlikovati njene state i trait karakteristike. U završnom dijelu članka navedeni su svi instrumenti za mjerenje aleksitimije. Ključne riječi: aleksitimija, psihoanalitička teorija, psihosomatske bolesti, teorija uma, mentalizacija

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