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Lack of feeling emotion


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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated

Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).

Alcohol

Data:

  • Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
  • Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44. 4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily

Programs/Initiatives:

  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism

Tobacco

Data:

  • In 2020, 20.7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
  • Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3. 4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals

Resources:

  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program

Links:

  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes

Opioids

Data:

  • Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose

Resources:

  • Medications for Substance Use Disorders
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program

Links:

  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network

Marijuana

Data:

  • In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.

Resources:

  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.

Resources:

  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated

Last Updated: 03/22/2023

Alexithymia: an emotional gap hiding under the mask of normality

Alexithymia is a psychological state of a person in which a person, having lost the ability to determine and display his own emotions, is forced to try to look normal in the eyes of others. The psychiatrist Saito Satoru talks about this disorder using examples from his own practice, as well as the example of the heroes of the novel "Man of the convenience store" ( Kombini ningen , by Murata Sayaka), awarded the Akutagawa Prize for 2016.

In psychiatry there is a term "alexithymia". It consists of the negative prefix "ἀ" and two stems: "λέξις" (word) and "θυμός" (feelings, emotions). This term describes a psychological state where a person is unable to evaluate and describe their own emotions. In order to have a holistic view of one's own life, the individual must be aware of and distinguish what he feels. However, there are people who are incapable of this - they do not understand in what situations this or that emotion arises in them. Features of alexithymia appear in such people in those moments when they are overcome by anger, sadness, or any other strong feeling that they are not able to define and express.

In fact, with the exception of babies, there are practically no people in modern society who would cry or scream, completely without restraint. It is understood that an adult member of society should control himself and not show such primitive emotions outwardly. And if he is not able to restrain himself, then he needs treatment.

Young people striving to conform to the notions of "normality" learn from the older generation to suppress the expression of emotions. Over time, some of them lose the ability to recognize their own feelings. Suppressed anger, sadness become the cause of psychosomatic diseases and hypochondriacal disorder. Hypochondriacs are characterized by a clear manifestation of somatic symptoms in the absence of any significant pathological abnormalities. As a result of an anxious set and constant concern about health, the functions of the heart, gastrointestinal tract and other autonomically innervated systems can be disturbed. And this, in turn, leads to the development of arterial hypertension, peptic ulcer, etc. That is why hypochondria is considered a psychosomatic disease.

However, with alexithymia, not only negative emotions are blurred, but also positive ones - a person is not able to experience such feelings as joy or inspiration. The loss of the ability to experience pleasure is called anhedonia. This disorder is characterized by a loss of motivation for activities that the individual enjoyed in the past. The development of anhedonia is an important indicator in the diagnosis of pathological depression.

Under the guise of normality

I have my own psychiatric practice in Tokyo, and I encounter people suffering from depression and hypochondria on a daily basis at work. During the first meeting, most of them show no signs of suffering or despair. And I have to pull off their mask of normality, under which they hide their illness, which needs treatment.

Cover of "Convenience Store Man" (illustration courtesy of Bungei Shunju)

I thought about this when I read the novel "Convenience Store Man" for which Murata Sayaka recently won the Akutagawa Prize. Indeed, in this story we are talking about a person suffering from alexithymia. The heroine, a woman named Kokura Keiko, worked for 18 years as a saleswoman in the same minimarket ( combi) - it is on her behalf that the story is being told. She made it a rule never to show her feelings or express judgment. Instead, she has created a "patchwork personality" by copying the behavior and adopting the habits and mannerisms of the women around her (mostly work colleagues), whom she considers correct and admires for their style. This effective and convenient strategy allows it to adapt to its own environment. The moment she arrives at work shortly before the start of her shift and changes into her work uniform, Keiko becomes a function, a convenience store man. Now all that is required of her is to perform the prescribed duties for the appointed time, using the skills she has learned and the judgments she has borrowed appropriate to the occasion. The school years of the heroine passed under the endless complaints of parents who were dissatisfied with their individualistic daughter, and constant pressure from school teachers. As an adult, she is grateful for the opportunity to hide her identity under a faceless uniform.

However, when Keiko suddenly realizes that those around her feel sorry for her - a single woman who worked as a saleswoman in a minimarket for 18 consecutive years - she becomes extremely worried. At this moment, she meets a new minimarket employee, a man who is the complete opposite of her. He is convinced that society has turned its back on him and that everyone is hounding and persecuting him. So he doesn't even try to appear normal, and very soon he is fired from the convenience store. Keiko invites him to stay with her. At first glance, it seems that they are a very harmonious couple, but their relationship is built on a cold calculation. For a workaholic Keiko, this is an opportunity to create the appearance of a romantic relationship; for a lazy man, life with Keiko is an excellent hiding place from the injustice of a cruel world. But their life together upsets the fragile mental balance that Keiko has maintained and strengthened in herself throughout all these eighteen years.

The caustic remarks of her roommate expose her spiritual emptiness, the gaping emptiness of her personal space, which Keiko had refused to notice for so many years. Refusal, denial is a primitive psychological defense mechanism, a subconscious attempt to ignore the problem, the existence of which is obvious to any outside observer. And the one who denies the obvious looks infantile and eccentric in the eyes of others.

Realizing the hopelessness of his situation, Keiko quits his job and ceases to be a "man of the convenience store". She has no choice but to lie all day under the covers, on the futon, which she spread out inside the closet. I call this phase "bed addiction" and I believe that it is the starting point for the development of other types of addiction: from drug or alcohol addiction to sexual addiction. In fact, both addictive behavior and "show normality" are desperate attempts to get out of the quicksands of the emotional vacuum.

This story has a somewhat happy ending - Keiko starts working at the convenience store again. But I do not think that this will make many readers laugh too much, as they notice the connection between excessive obsession with work and the meaninglessness of the heroine's personal space.

Refusal to feel

"Bed addiction" is essentially a regression to the so-called "primal sleep" - a dream-like state characteristic of infants. This is exactly the state that heroin addicts so passionately desire to achieve. A similar process of regression is also experienced by recluses.0003 hikikomori . Every day this quagmire sucks in hikikomori more and more, and getting them out of it is not an easy task.

Here it is important to pay attention to one point. A baby who falls asleep while nursing and wakes up to find that he has been taken from his mother's breast will feel restless, angry, flushed and crying.

Older babies (between a year and a half) also live in a world of basic emotions such as anger, anxiety, depression, or sadness. But adults hikikomori are deaf to these emotions. At first they themselves refuse to feel anything, and then they simply lose this ability and fall into a state of alexithymia.

Break free from the spell of "normality"

Such people sometimes come to my clinic for help, mistaking their condition for depression. For example, a housewife came to me who told me that after graduating from university she got a job at a firm right away, but worked for only a year, because office work seemed boring to her. She then found a part-time job at a sadomasochistic (SM) club, a place she liked so much that she worked there for four years. Shortly before she turned thirty, she resigned from the club, judging that sooner or later she would have to do it anyway. Some time later, after an active search for a suitable party ( konkatsu ) she got married, had a baby, and began to lead a "normal" life as a housewife. And then she suddenly found that she spends most of the day in bed or in close proximity to it.

Her husband - a typical sissy, who also suffers from atopic dermatitis - quickly realized that his wife would not take care of him to the same extent as his mother did, and divorced her. At the time of her visit to me, about a month had passed since the divorce.

I think some of my colleagues would have diagnosed this patient with depression or adjustment disorder and would have given her antidepressants. But I noticed how strong her desire to be, or at least seem normal. It was it that made her suppress her individuality and doom herself to life in a world that causes nothing but boredom in her.

Everyday work in the SM club was fraught with danger, but at the same time excited her – the idea that she was working in a “non-standard”, “abnormal” job served as a strong source of emotional excitement. Thus, "normality" is just an illusion, an ideal that can be different for different people.

My patient says that she is already thirty-five, the figure is no longer the same, and that "what was in the past cannot be returned." I do not dispute this point of view. But whether she returns to work at the SM club or not, I think she needs to remember and rethink the strong, exciting feelings she experienced while working at a job she loved. My task is to return to this woman the ability to feel strong emotions, restoring her connection with her own eroticism. I have to convince her that she doesn't need to hide behind a mask of normality.

Title picture: Design Pics/AFLO

(Japanese article published November 18, 2016)

What is alexithymia and how to understand your feelings in which a person is not able to describe and understand his feelings and emotions.

It leads not only to problems in interpersonal relationships, but can also cause psychosomatic illnesses. We talked to people living with alexithymia and learned from experts how to deal with it.

"It's like not being able to taste and smell"

Tatyana, 21 years old

I have schizoaffective disorder, obsessive-compulsive disorder and Asperger's syndrome - the first signs were in adolescence, diagnosed several years ago. As a child, for the first time, I realized that it was difficult for me to define emotions and feelings. I could cry and didn't realize why. Because of the pain or because I'm sad.

When I realize that I feel something, I try to pay attention to the sensations in my body. If heaviness appears in the chest, most likely, these are negative emotions - sadness, sadness, resentment. If warmth is felt in the body and limbs, then it must be positive.

For a long time I did not understand what love and sympathy are and whether I can experience them. I was able to distinguish them from other feelings when I met my boyfriend at the age of eighteen. This is a completely different level of feelings that I felt physically : my heart beat faster when I thought about him, I wanted to be near him, when talking it became hot, my palms sweated, there was a feeling of intoxication in my head. And somehow I realized that this is something new and that I can love someone.

Fear also manifests itself more physically: lack of air, headache, severe tinnitus, spasm in the intestines, muscle stiffness, coldness in the body, trembling. It looks like the beginning of a cold - I would say so that it was more understandable.

The most difficult thing for me is to tell my relatives how I feel if they ask me about it or wait in a conversation for me to say something about emotions. I just feel like I can't find the words for this, it's like there aren't any, and I don't know what to say. At such moments, people think that I do not feel anything, and my silence confuses them.

Sometimes relatives get angry - apparently, they are waiting for an emotional return in the course of a conversation, and I often don’t know what to do, what emotion to show, squeeze out of myself. But I think that they are not angry on purpose. Once I talked with my mother about further education, I explained where and for whom I want to study, to which she replied that I was speaking without interest and emotions, as if I didn’t care.

You seem to be deprived of the opportunity to fully experience emotions. It’s like they don’t exist, and you don’t know what they are, because anger and joy feel equally insipid. For me, it's like living with a constant runny nose and not feeling the taste and smell.

I didn't tell my parents about alexithymia and Asperger's syndrome. They are of the old school, all people with autism for them are those who cannot speak and are kept in boarding schools. Also, we are not very close, and I don’t even know how to gently talk about my states. I tried to explain my mental disorder to my mother, but for her it’s “you can’t control yourself”, so all my stories and articles shown on this topic are useless. I have a physical disability - my parents treat me the way they treat people with disabilities in Russia: they consider me weak and unable to work. They are aware that I am mentally ill, but if you also tell them about problems with emotions and Asperger's syndrome, they will treat me with even more pity and think that I am not like normal children, and that this is their punishment from God. But my young man is aware of my problems, and after he found out about them, we began to understand each other better.

I am in therapy and it is very difficult for me to talk about how I feel, about my emotions. But the more time passes, the more I learn to describe my emotions in images. For example, sadness is a dark and cloudy cloud . It's a strange experience, but I like it.

"I was considered a callous and unsociable person"

White, 35 years old

I have bipolar II disorder. I am currently in remission and continue medication. I have long felt that it is difficult for me to describe emotions and feelings, but for the first time I realized this about ten years ago. Then we often played word games in the company, and several times I got questions of the format “what do you feel about ... (a person, phenomenon, event, and so on)?” Such questions plunged me into a stupor, and at the same time I noticed that other people had no problems with answers. I tried to understand how they find words so quickly, for a while I even suspected that they were making them up on the go. Later, I accidentally stumbled upon an article on alexithymia on the Internet and recognized the familiar symptoms.

In my case, alexithymia does not affect creativity and professional tasks: I love fiction based on the problems of human relationships, sometimes I write prose, poetry, songs myself. Feelings are easier to formulate on behalf of a lyrical hero, besides, this is verbalization training.

But in my personal life and communication with friends, alexithymia leads to problems: relatives often noticed that I had difficulty expressing emotions - before, they were mostly angry and took the position “why can’t I immediately say normal.” For a long time I was considered a callous and unsociable person, because I did not understand how to express various kinds of empathy. Several times I quarreled with my girlfriend almost to the point of breaking up, because my reaction was “wrong”: it did not correspond to the situation and incorrectly displayed my own emotions.

After I started to warn about my problem, there were fewer conflicts, we started talking more about feelings with loved ones.

I also have problems with decision-making because of the inability to understand what feeling guides the opinion, but this is rather good: you have to learn to look at things from a rational position, fixing the pros and cons, instead of succumbing to emotions.

“My feelings are a mystery to myself”

Anton, 30 years old

Until recently, I did not know about such a problem as alexithymia, but I began to notice that I did not understand my emotions and feelings in my youth. I could not understand how to react to the actions of classmates and friends - when to laugh, get angry and upset. I still can't tell a joke from an insult if it's not obvious. For example, I can be offended to tears if they say “fool” to me in a friendly way, and laugh when I hear a mate addressed to me.

Trying to socialize, I repeated after other people, but it looked awkward, I did not catch the norms. I was bullied at school, but I didn’t know how to react: I was silent on insults, and for a slight irony I could get into a fight, then I was ashamed and apologized.

When I started working, I could not settle down in the team, because I did not read other people's attitude towards me and, accordingly, did not know how I should treat people. Many said that I was being arrogant, which surprised and upset me, because I was just silent all the time. My unsociableness leads to the fact that, despite high professional performance, career growth and a leadership position do not shine for me. In the humanitarian field in which I work, relationships with people, the ability to understand and read the emotions of others, are extremely important, especially if you want to manage a team.

Relations with friends and close people do not develop for the same reason - mutual misunderstanding, which even strong romantic or friendly affection could not overcome. I felt the difference in the direction of these attachments only by the presence of sexual desire, which manifests itself in a standard human way. However, his absence did not stop me from rash acts: I confessed my romantic love to my girlfriends and even friends, although I did not think about sexual relations with them, I was simply drawn to them and in their presence it became physically warm and comfortable. People, to put it mildly, were surprised in response to my proposal to meet, and the guys expressed dislike. Relations with many wonderful people were ruined once and for all, even an apology did not help restore friendship.

And after the breakup, I didn't understand what I was feeling - sometimes I was sad, sometimes I was happy, and it drove me crazy. When the ex-girlfriend moved out from me, my breath often took hold in an empty apartment, my pulse quickened, especially when I recalled our life. The reasons are not clear, because there is nothing to be offended and angry at, because we parted on my initiative. And somehow a friend posted a photo from the party, and everything boiled inside me, my breath also caught (it seems that this is my standard reaction to anything), but I did not understand what was happening inside me. I called him and asked why he went there, which sounded very stupid - he did not understand this question, and I no longer understood why I was asking it, and even in a breaking voice. My friends know that I am not a party lover in principle, and I know this about myself, so I did not hold any claims in my mind, but some emotions were overwhelmed, judging by the physical manifestations. I would call them meaningless, phantom.

Trying to explain to people that I have problems with emotions does not help: even those closest to me are sure that this is a whim and I just don't want to control myself and "try to understand others."

When I first went to a psychiatrist, he said that problems with emotions are a neurosis. I was treated with various drugs for a long time, but the situation did not get better, until now my feelings are a mystery to myself. Psychotherapy is weak, but it helps: the doctor taught to determine how feelings differ from emotions, but it is still difficult to recognize them. I learned that emotion is a small, short-term acute sensation, like a flash, lightning, you don’t have time to think about anything. And a feeling is a long-term state accompanied by a bunch of thoughts. For example, I hit a chair and screamed, my hands clenched, instinctively hit the chair in response - it means that the emotion of anger arose. But I had a colleague at a former job who set me up, and if we went on the same shift, then I felt muscle tension, heart palpitations and often thought about how he could be such a lousy person.

The hardest thing for me is to tell the doctors what I'm experiencing: no matter what words I choose, everything seems like a lie or a fantasy. This applies to both mental and physical sensations. As soon as I go into the office of a gastroenterologist or a therapist and start complaining, I listen to myself more carefully and start thinking that I dreamed the sensations. It’s the same with a psychotherapist and a psychiatrist: it seems that I’m actually a healthy dreamer, because I can’t convey exactly how I feel, and specialists are not telepaths and cannot understand.

"I can't put my feelings into human language"

Kristina, 28 years old

I went to a psychologist with borderline and depression issues, one day he asked me to describe myself and I felt confused because I didn't know Who am I. I told him that I consist of layers: on the outside there is a polite shell, under it is an evil gopnik, and under it is a kind soul that saves everyone, and it is she who is protected by the gopnik. Then again something dark that I do not understand and am afraid to analyze, and so on ad infinitum. Later, these layers emerged into some subpersonalities, and their emotions were perceived as alien, which I cannot understand or control. I gave them names, and they speak in my head like separate parts of me: kind, aggressive, overly emotional, my ordinary.

I can describe my feelings with the help of a table of feelings, in psychotherapy pairs (I studied as a doctor) we were offered to use it to tell others about our feelings. But sometimes I experience things that are not in this table or there is no name for these feelings.

I have developed empathy, I easily understand others, but inside of me is either a mixture [of feelings], or nothing at all. This does not affect my hobby: I draw the necessary emotions for my characters, sometimes the drawing helps me figure out what I feel, or others begin to understand it - sometimes they are horrified. Due to alexithymia, I do not communicate with people much, because I cannot respond with the emotional reactions they need.

For example, if a person raised their voice at me, I may cry, even if I just feel like I'm being pressured, or I get too angry and yell. There is no average response to pressure. If they regret it, I roar.

The most difficult thing is to tell those who expect warmth from me that I experience this warmth, but do not show it, because I do not know how. This feeling is blurred, it is impossible to concretize it in words. Also, I can’t tell people what specifically offended me, because words get stuck or I can’t put feelings into human language. It's hard to be locked up and not understand how I really feel . I ignore my feelings more often than I track.

Alexithymia often leads to psychosomatic manifestations: when I am nervous, the temperature rises to 37–37.5 degrees, pains in the abdomen, heart, head, teeth ache, allergies begin (I itch, I break out in a rash), breathing problems (I can’t do breath or I don’t feel oxygen in the air), anything can hurt at all, regardless of the absence of physical pathology.

Why does alexithymia occur and how to deal with it?

Alexithymia is most characteristic of autism spectrum disorders, but can accompany any mental disorder (depression, personality disorders, etc.). It is associated with the mechanism of formation and maintenance of a psychosomatic symptom, but not the only reason for its occurrence. Clients with alexithymia, as a rule, first of all turn to somatic doctors with physical discomfort.

According to the results of some studies, difficulties with the expression of emotions are more common in men than in women, alexithymia is practically not studied in people of a different gender identity. However, the quality of most research on alexithymia is quite low.

The exact causes of this condition have not yet been identified. There is evidence that mirror neurons are involved in the occurrence of alexithymia, structures such as the amygdala, insula and cerebellum are involved. Violation of dopaminergic metabolism in these structures is associated with manifestations of alexithymia.

Nevertheless, the environment plays a significant role in the development of difficulties with understanding one's emotions: whether the child sees the expression of emotions, hears their names, whether they tell him what emotions are, how they manifest themselves.

Alexithymia can lead to difficulties in building or maintaining interpersonal relationships - in these cases, I would recommend contacting a specialist. If you notice that it is difficult for you to interact with people, there is a feeling that no one understands your goals, motives, and it is often difficult for you to understand people when they talk about their emotions, you can independently study materials about emotions, gradually learn to notice them from yourself and other people, observe them and express.

By itself, this problem does not require medical treatment. A psychotherapist works with alexithymia at the beginning of any psychotherapy, since it is important for a specialist to understand how the client feels in problem situations.

Relatives can help a person by talking about their emotions and thereby showing the experience of living them, and also by asking about the person's experiences, thereby drawing his attention to the emotional sphere.

Alexithymia is indeed common among my clients and makes interaction in the first meetings much more difficult. At the beginning of the work, the specialist collects information about what is happening with the client (about his behavior, thinking, emotions), of course, alexithymia hinders this process. In such cases, we dedicate several meetings to the client to find out what emotions are, how they manifest themselves, how they feel, learn to notice them in themselves, name them, observe them. The most difficult for me case of alexithymia in a client required eight meetings of work on the identification, observation, description and expression of emotions.

How does alexithymia affect physical health?

Alexithymia can lead to the occurrence of psychosomatic symptoms - pain, squeezing, bursting, tingling, and others, but at the same time, according to tests and studies, doctors do not find anything.

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