This is a part of podcast series from the Model Systems Knowledge Translation Center discussing emotional challenges after a traumatic burn injury (TBI). In this segment, Dr. Dawn Neumann discusses alexithymia.

There's different aspects of alexithymia and not everybody has all of those aspects. You can have one and not the other. So it comes out differently in people. So I kind of think about three main ways that I see it most often. You have your guy who basically has completely flat affect that blunted affect, and that typical person that says, I don't feel emotions anymore, and they describe themselves as very emotionally disconnected. That is interesting because most people take that for face value, that there's no emotions there. They assume it's not there. But the issue is that there's a disconnect between the emotion and the experience. And we know this. So it's interesting because, and one of our, what we were able to do one time, we had a guy come to us who was describing exactly this, and the wife was absolutely distraught because there was no kind of affection in their relationship anymore.

And so we wound up having him bring in items, personal items like pictures of the wet, their wedding and pictures of their children, and even a piece of cloth with the wife's perfume on it. And we did an interview process. And while we were interviewing this guy, we actually hooked him up where we were able to see physiological responses to find out what was going on inside him. And as I'm interviewing him and showing him these really personal items, he had no outward response whatsoever, but internally, physiologically, his body was responding. So this was an indicator that something is going on, that there's just a disconnect between his brain and what's going on internally. So that's one way it can manifest itself. The other way, or one of the other ways it can manifest is I like to give this example of a guy who was in one of our support group meetings and something clearly agitated him.

And the next thing you know, he's yelling, clenching fists, veins are popping. He jumps out of his chair and everybody in the room is frightened. And we say, relax. Why are you so angry? And he yells, I'm not angry. Why do you think I'm angry? Well, again, so there's this clear disconnect where it's affecting his behavior, and he has this complete lack of awareness of that experience and how it is affecting his behavior and how he's coming across. So I think it's important, the message to communicate with that is that these people are having emotions. It is going to impact how they behave and less likely to control it. And then the last way that we often see is somebody could be well aware that they're having an emotional response, but they'll describe that emotional response as being flooded with their emotions. So too much is coming in at once, and it's just a whole bunch of unpleasant noise that they're experiencing.  

But they don't know exactly what it is. They don't know what they're feeling. They can't tell the difference between angry and sad and afraid, and it's just this jumbled mess that they don't know how to deal with. And so they might not be able to put labels or describe them. And so this type of person tends to just be angry. Anger is one of the most commonly expressed emotions in Alexithymia. We will typically see, or you'll hear reports of people, he has two emotions, nothing or anger. And this is really, really common in alexithymia. People with alexithymia, they tend to know they're angry, but that's about the extent of it. All of the other emotions are just overshadowed, and that's all they know how to express, and they don't know how to control it.

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