Alexithymia in Personality Disorders: New Insights for Diagnosis and Treatment
Struggling to understand or express your emotions isn’t just frustrating—it can deeply impact your relationships, mental health, and overall quality of life. At Philadelphia Integrative Psychiatry, Dr. Danish and his team often see this emotional blind spot, known as alexithymia, in patients dealing with complex psychiatric conditions. Whether it's Borderline Personality Disorder, Avoidant Personality Disorder, or another diagnostic picture, patients frequently express a common concern: “I just don’t know how I feel.” Recognizing and addressing this trait can dramatically improve treatment outcomes.
A recently published systematic review titled "The Implication of Alexithymia in Personality Disorders" offers valuable insight into how alexithymia plays a significant role in various personality disorders (PDs), especially those in Clusters B and C. This blog explores highlights from that review—and importantly, connects the dots between alexithymia, PDs, and conditions like autism spectrum disorder, where these overlaps are becoming increasingly recognized in clinical practice.
What Is Alexithymia—and Why It Matters
Alexithymia isn’t a diagnosis itself—it’s a trait. But it’s a powerful one. People with alexithymia often:
Struggle to identify their own emotions (DIF – Difficulty Identifying Feelings)
Find it hard to describe those emotions to others (DDF – Difficulty Describing Feelings)
Tend to think more about concrete facts than inner experiences (EOT – Externally Oriented Thinking)
These traits interfere with emotional regulation and connection—two core areas affected in many personality disorders. Importantly, alexithymia is also highly prevalent in individuals with autism spectrum disorder, which adds another layer of diagnostic complexity. Emerging literature has begun to show significant clinical and neurobiological overlap between autism and various PDs, particularly borderline and schizoid personality traits.
Alexithymia Across Personality Disorder Clusters
Cluster B: Emotional Dysregulation and Impulsivity
In patients with Borderline Personality Disorder (BPD), alexithymia levels are significantly higher than in healthy controls (TAS-20 scores; t = 8.711, p < 0.001) [1].
Up to 71.3% of BPD patients meet the threshold for alexithymia [49].
These individuals often show impaired emotional recognition (e.g., on tasks like the Reading the Mind in the Eyes Test) [48], making it harder to connect with others or respond flexibly in relationships.
Interestingly, this difficulty with emotion recognition also mirrors what we often see in individuals with autism, reinforcing the clinical observation that some patients may meet partial criteria for both BPD and ASD—or shift between provisional diagnoses over time.
Cluster C: Emotional Avoidance and Social Dependency
Avoidant Personality Disorder (AVPD) and Dependent Personality Disorder (DPD) also show strong ties to alexithymia.
For example, people with AVPD show elevated EOT scores, often avoiding introspection and leaning heavily on external validation—behavior patterns that are also widely documented in certain autistic presentations [27].
Though DPD and alexithymia are considered distinct constructs, they share moderate correlations, especially when depression is accounted for [28].
Trauma, Autism, and the Roots of Alexithymia
The review emphasizes that alexithymia is strongly associated with early emotional neglect, physical neglect, and abuse [5]. These experiences shape not only PD development but are also common in individuals later diagnosed with autism spectrum disorder—especially in those who grow up undiagnosed and misunderstood, often internalizing their struggles.
This overlap matters. As clinicians, we’re increasingly seeing patients with a mix of personality disorder traits, autistic features, and high alexithymia—leading to complex diagnostic pictures that benefit from a trauma-informed and neurodivergence-informed lens.
Clinical Implications: Rethinking Diagnosis and Treatment
The Toronto Alexithymia Scale (TAS-20) was used in 95% of the studies reviewed and remains the gold standard in both research and clinical screening.
These findings reinforce the importance of structured, active therapies like Dialectical Behavior Therapy (DBT) or Cognitive Behavioral Therapy (CBT). These modalities teach emotional recognition and regulation—critical skills for patients with alexithymia.
Traditional insight-oriented therapy may fall flat when patients can’t articulate their inner world. Instead, treatment should be highly structured, emotionally explicit, and paced according to each patient's processing style—something that benefits both PD and autistic populations.
Getting in Touch with Dr. Danish and His Team
If you or someone you care about struggles with emotional regulation, difficulty understanding their feelings, or has been diagnosed with a personality disorder—or even suspects an autism spectrum condition—you’re not alone, and we can help. At Philadelphia Integrative Psychiatry, our clinicians are trained to spot these overlaps and provide care that’s personalized, trauma-informed, and neurodivergence-aware.
Whether you’re navigating a new diagnosis or searching for answers after years of misdiagnosis, reach out to us. We specialize in complex cases—and we take the time to listen.
For More on This Topic and Related Subjects, Check Out These Blogs by Dr. Danish:
https://phillyintegrative.com/blog/personality-and-coping-styles-in-depression
Sources
Back to Blog
Disclaimer: This guide is for informational purposes only and not a substitute for medical advice. Any treatment—whether a supplement, medication, procedure, injection, therapy, or device—carries potential risks, especially when used in excess or by individuals with certain medical conditions or genetic predispositions. Always consult a qualified healthcare provider before starting any treatment.
