Published: October 2026 | Last updated: October 2026
Alexithymia means you have trouble noticing, naming, and describing your own emotions. For recovery, this matters because if you can’t tell anxiety from anger from loneliness, a drink or a pill becomes the one tool that fixes “feeling bad” in general. The good news: emotional awareness can be learned. I’ve written for treatment centers for eight years, and “I don’t know what I feel” is the sentence counselors tell me they hear most in week one.
What is alexithymia, and is it a mental illness?
Alexithymia is a personality trait, not a diagnosis. It describes difficulty identifying feelings, difficulty describing them to others, and a habit of focusing on external facts instead of inner experience. The word comes from Greek: roughly “no words for emotions.”
How common is it?
More common than people expect. According to a general population study in Finland published in the Journal of Psychosomatic Research, 13% of adults scored as alexithymic, with men (17%) almost twice as likely as women (10%).
It runs on a spectrum. Most people sit somewhere in the middle; some have a little trouble putting feelings into words, and some genuinely can’t tell whether a tight chest means fear, excitement, or a coming panic attack.
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Primary vs secondary alexithymia
Researchers split it into two broad types. Primary alexithymia is a stable trait, often present since childhood and linked to temperament or neurodivergence, including autism. Secondary alexithymia develops as a response to something: trauma, chronic stress, depression, or long-term substance use that numbs emotional signals.
The distinction matters because secondary alexithymia often eases as the underlying cause is treated. I’ve seen clients six months sober describe feelings with a precision they simply didn’t have at intake.
So how do you actually spot it in yourself or someone you love?
What are the signs of alexithymia?
The core sign is answering “How do you feel?” with “fine,” “bad,” or a description of your body or your day rather than an emotion. People with alexithymia do have feelings. They just arrive as vague physical noise instead of something with a name.
Common signs
- Describing emotions as body sensations: a headache, stomach knots, “feeling off”
- Sudden outbursts that seem to come from nowhere, even to the person having them
- Struggling to answer therapy questions like “What came up for you?”
- Being told by partners that you seem distant or hard to read
- A practical, fact-focused way of talking and thinking, with little interest in inner life
- Trouble reading other people’s emotions, not just your own
The standard screening tool is the Toronto Alexithymia Scale (TAS-20), a 20-item questionnaire most clinicians can give in ten minutes. It measures three things: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. According to a 2022 meta-analysis of 52 studies, difficulty identifying feelings had the strongest link to substance use of the three.
Alexithymia or something else?
| Alexithymia | Depression | Autism | Private personality | |
|---|---|---|---|---|
| Feels emotions? | Yes, but unclear | Yes, mostly low or numb | Yes; may process differently | Yes, clearly |
| Can name them? | Struggles | Usually | Varies; overlap is common | Yes, chooses not to share |
| Main feature | Emotional confusion | Persistent low mood | Social and sensory differences | Preference for privacy |
| Is it a diagnosis? | No, a trait | Yes | Yes | No |
The last column matters. Plenty of people get labeled “emotionally unavailable” when they’re just private. The difference is whether you know what you feel.
That confusion is exactly where substances tend to slip in.
Why do people who can’t name their feelings turn to drugs or alcohol?
Because substances work on feelings you don’t have to identify first. Alcohol, opioids, and benzodiazepines quiet emotional discomfort across the board, so for someone who only knows “I feel bad,” they become a universal fix.
How strong is the link?
Strong enough that treatment centers should screen for it. According to a critical review in Addictive Behaviors (Thorberg et al., 2009), between 45% and 67% of people with alcohol use disorders meet the criteria for alexithymia. A 2018 update by Cruise and Becerra put the figure lower, at 30% to 49% among alcohol-dependent samples. Even the conservative number is two to three times the general-population rate.
The link works in both directions. Alexithymia can make someone reach for substances, and years of heavy use can blunt emotional signals until they’re almost impossible to read.
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What it looks like day to day
Picture a 34-year-old warehouse supervisor. After a shift where his manager embarrassed him in front of the crew, he doesn’t think “I’m humiliated and angry.” He thinks “rough day,” notices his jaw is tight, and opens a beer. Then three more. Ask him the next morning why he drank and he’ll say, truthfully, “I don’t know. I just wanted to.”
That “I don’t know” isn’t evasion. It’s the problem. And it’s why recovery plans built only around willpower or avoiding triggers often fall apart for this group.
What does alexithymia mean for recovery and relapse?
It means standard talk-based recovery can feel like it’s built for someone else. Most programs assume you can spot a craving, trace it to an emotion, and respond differently. If step two is the hard part, the whole chain breaks.
Why it complicates treatment
According to the same 2022 meta-analysis, the link between alexithymia and substance use was considerably stronger in clinical patient populations than in general or student samples. In plain terms: the people walking into treatment are the ones most likely to have it.
It also overlaps with trauma. According to a systematic review from the University of Edinburgh, roughly 33% to 50% of people attending treatment for substance or alcohol use disorders have a trauma history, and trauma is one of the main roads into secondary alexithymia. That same review found alexithymia didn’t by itself predict who stayed abstinent, which is encouraging. It’s an obstacle, not a sentence.
Where recovery usually stalls
If you’ve sat in a group circle, been asked how your week felt, and gone blank, then left feeling like you were failing at recovery, you’re not alone, and you weren’t failing. Relapse prevention worksheets ask you to list emotional triggers. That’s a hard assignment when the trigger registers only as restlessness.
I’ve reviewed a lot of treatment center content. Almost all of it promises clients will “process their emotions.” Very little of it admits some clients first need to learn what an emotion feels like from the inside.
The upside is that the skills involved are concrete and teachable, which brings us to treatment.
How is alexithymia treated, and can online therapy help?
Alexithymia is treated by building emotional awareness step by step: first noticing body signals, then attaching words to them, then linking them to situations and choices. Therapy that starts with the body tends to work better than therapy that starts with “tell me how you feel.”
It won’t fade on its own
Left alone, the trait is sticky. A Finnish study that followed more than 3,000 adults over 11 years found their alexithymia scores stayed largely stable. That’s the case for deliberate practice rather than waiting it out in early sobriety.
Approaches that help
| Approach | What it does | Good fit when |
|---|---|---|
| Dialectical Behavior Therapy (DBT) | Teaches emotion identification and regulation as explicit skills | Feelings show up as sudden, intense reactions |
| Somatic and mindfulness-based therapy | Trains attention to body signals (interoception) | Emotions register mainly as physical symptoms |
| Cognitive Behavioral Therapy (CBT) | Connects thoughts, feelings, and actions | You can name some feelings and want structure |
| Mentalization-based therapy | Builds understanding of your own and others’ mental states | Relationships keep breaking down |
| Movement and exercise therapy | Uses physical activity to regulate the nervous system | Sitting and talking feels pointless |
Small tools matter too. A printed feelings wheel on the fridge sounds basic, and it works. So does the free How We Feel app, built with researchers at the Yale Center for Emotional Intelligence, which asks you to log your mood several times a day and slowly expands your vocabulary past “fine.”
Online treatment
Virtual intensive outpatient programs and online DBT groups can work well here, partly because some people find it easier to describe feelings typing in a chat box than face to face. What online care can’t replace is a stable home environment while you practice these skills, which is where sober living comes in.
Frequently asked questions
Is alexithymia a symptom of addiction?
Not exactly. Alexithymia is a personality trait that can exist before substance use starts, but long-term drinking or drug use can also produce it or make it worse. Either way, it’s far more common in people with addiction than in the general population.
Can alexithymia go away in recovery?
It often improves, especially secondary alexithymia caused by trauma, depression, or substance use. Untreated, the trait tends to stay stable, so improvement usually comes from deliberate work like DBT, somatic therapy, or regular emotion-labeling practice.
How do I know if I have alexithymia?
The Toronto Alexithymia Scale (TAS-20) is the most widely used screening questionnaire, and a therapist or treatment program can give it to you. Online versions exist, but a clinician can tell whether depression, trauma, or neurodivergence is part of the picture.
Is alexithymia the same as being emotionally numb?
No. Emotional numbness means feeling less. Alexithymia means feelings are there but hard to identify or describe, so they often show up as physical sensations, irritability, or a vague urge to use.
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