Alexithymia and eating disorders: a critical review of the literature

Abstract

Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.

Facial expression of positive emotions in individuals with eating disorders

“…People with eating disorders exhibit high levels of comorbidity with disorders that have shown to be related to reduced facial expression, such as anxiety and depression . In addition, socio-emotional difficulties found in eating disorders include high levels of alexithymia (Nowakowski, et al, 2013), social anhedonia , self-silencing (i.e., the tendency to avoid expressing negative emotions) , and fear of the social consequences of expressing emotions . It has been…”

Modeling the cognitive mechanisms linking autism symptoms and anxiety in adults.

“…Indeed, there are elevated rates of alexithymia across a multitude of psychiatric disorders including depression (Kim et al, 2008), eating disorders (Nowakowski, McFarlane, & Cassin, 2013), alcohol use disorder (Evren et al, 2008), as well as neurological disorders (Ricciardi, Demartini, Fotopoulou, & Edwards, 2015) and personality disorders (New et al, 2012).…”

Medically Hospitalized Patients With Eating Disorders and Somatoform Disorders in Pediatrics: What Are Their Similarities and Differences and How Can We Improve Their Care?

“…1,8 Understanding the characteristics of patients with primary psychiatric disorders like ED and SFD, who are often medically hospitalized in pediatric settings, is the first step toward establishing foundational knowledge to guide future quality improvement and integrated care efforts. Although it is well documented that patients with ED and SFD have higher rates of health care use across multiple health care settings compared with the general population 5,9 and that psychological factors, such as denial, poor motivation, alexithymia (ie, difficulty identifying and verbally expressing feelings), and limited insight affect their health care use, [10][11][12][13] it is not known if they use services with the same rates and patterns. Furthermore, although other similarities can be gleaned from separate studies of patients with ED and patients with SFD (eg, female preponderance, 6,14 age of presentation in adolescence, 4,6 increased risk of ED and SFD in the offspring of parents with anxiety and depressive disorders 15,16 ), it remains unclear how much biopsychosocial characteristics overlap between these 2 patient groups.…”