Conceptualizing alexithymia

Abstract

Since the 1970s, psychoanalytic conceptualizations of alexithymia have defined the trait as having four core facets: difficulties identifying feelings (DIF), difficulties describing feelings (DDF), externally orientated thinking (EOT), and constricted imaginal processes. However, there is ongoing controversy about whether constricted imaginal processes are actually a core facet of alexithymia, and which (if any) specific aspects of daydreaming/fantasizing activity might be impaired. In this study, we address this foundational issue by using factor analysis to establish the latent structure of the alexithymia construct. Participants (N = 554) completed a comprehensive battery of psychometric measures of alexithymia and imaginal processes, assessing the frequency, vividness, and content of daydreams or fantasies. None of the aspects of fantasizing loaded on the same factor (i.e., the latent alexithymia factor) as the established DIF, DDF, and EOT facets of alexithymia. Furthermore, patterns of Pearson correlations were inconsistent with psychoanalytic theory, as alexithymia was associated with more (not less) frequent daydreams, more daydreams characterized by negative emotions and wish-fulfillment fantasies, and more use of daydreaming to regulate emotions. Our findings are instead consistent with the attention-appraisal model of alexithymia, which holds that alexithymia is best understood as involving deficits in emotion processing.