Why certain people cannot express emotions

A report in the 2008 Jan issue of Psychotherapy and Psychosomatics by a group of Dutch investigators explores the relationship between alexithymia (the inability to express emotions) and the tolerance of negative emotions.

According to the clinical literature alexithymia tends to evoke negative countertransference reactions in the therapist, such as boredom and dullness. However, hardly any empirical study has been done on the association of alexithymia and pejorative feelings in the therapist. In a cross-sectional study at three psychiatric outpatient departments, the associations of alexithymia with defense style and difficulties in tolerating negative feelings, and with pejorative feelings in the therapist was explored. All consecutive new patients aged between 18 and 65 years who gave their informed consent were included. Patients completed the Toronto Alexithymia Scale (TAS-20), the Emotional Tolerance Scale (ETS), the Defense Style Questionnaire (DSQ-40) and the Hospital Anxiety and Depression Scale (HADS). The clinicians completed the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10). Two hundred sixty-four (80.2%) of the 329 eligible patients agreed to participate. Main diagnoses: affective disorder (n = 51), anxiety disorder (n = 38), somatoform disorder (n = 35), adjustment disorder (n = 21), other mental disorders (n = 69) and no mental disorder (n = 40). All 35 clinicians agreed to participate in the study. Most clinicians treated 2-6 patients. At the end of the study, alexithymia was clearly associated with the defense styles: strongest with primitive defense style mechanisms, negatively with adaptive defense style mechanisms and moderately with the use of neurotic mechanisms. Alexithymia was also strongly associated with negative feelings such as anxiety and depression as well as with a low tolerance for negative feelings, especially for feelings of vulnerability. Alexithymia did not, however, correlate with the induction of pejorative feelings in the clinician.