Psikiyatrik Bozukluklarda Aleksitimi

Öz

Aleksitimi, duyguları tanımlama ve ifade etmede güçlüklerle karakterize bir fenomendir. Bu anlatısal derlemenin amacı, aleksitiminin kavramsal, nörobiyolojik ve klinik boyutlarını başlıca psikiyatrik tanılar çerçevesinde bütüncül biçimde sentezlemektir. Aleksitimi, güncel literatürde depresyon, anksiyete bozuklukları, bipolar bozukluk, şizofreni, obsesif-kompulsif bozukluk, travma ve ilişkili bozukluklar, somatik belirti bozuklukları, yeme bozuklukları, kişilik bozuklukları, uyku bozuklukları, dikkat eksikliği/hiperaktivite bozukluğu ve alkol ve madde kullanım bozuklukları dahil olmak üzere çeşitli psikiyatrik bozukluklarla ilişkilendirmiştir. Tanılar arasında bildirilen prevalans oranları geniş bir aralık göstermekte olup, çalışılan popülasyona göre yaklaşık %13 ile %70’in üzerine kadar değişmektedir ve özellikle somatik belirti bozukluklarında oranların %40–60 düzeylerine ulaştığı bildirilmektedir. Klinik açıdan aleksitimi, artmış belirti yükü, işlevsellikte bozulma, yaşam kalitesinde düşüş, intihar düşüncelerinde artış ve tedavi yanıtındaki kötüleşme ile ilişkilidir. Nörobiyolojik bulgular, anterior insula, anterior singulat korteks, amigdala ve prefrontal bölgelerdeki değişikliklere işaret ederek, aleksitiminin interoseptif farkındalık ve duygu düzenleme ağlarındaki bozulmalarla ilişkili tanılar arası bir yatkınlık faktörü olduğunu desteklemektedir. Aleksitiminin psikiyatrik değerlendirmeye rutin bir biçimde dâhil edilmesi, tanısal değerlendirme ve tedavi planlamasına önemli katkı sağlayabilir. Duygusal farkındalığı artırmayı, bedensel duyumlar ile duygular arasındaki bağı güçlendirmeyi ve duygu düzenleme becerilerini geliştirmeyi hedefleyen tedavi yaklaşımlarının, aleksitimik özellikler gösteren psikiyatrik bozukluğa sahip bireylerde klinik sonuçları iyileştirebileceği düşünülmektedir.

Anahtar Kelimeler

• Aleksitimi
• Duygu Düzenleme
• Psikiyatrik Bozukluklar

Alexithymia Across Psychiatric Disorders

Abstract

Alexithymia is a condition characterized by difficulty in identifying and expressing emotions. This narrative review aimed to provide an integrative synthesis of the conceptual, neurobiological, and clinical dimensions of alexithymia across major psychiatric diagnoses. Recent research has connected alexithymia with various psychiatric disorders, including depression, anxiety disorders, bipolar disorder, schizophrenia, obsessive-compulsive disorder, trauma and related disorders, somatic symptom disorders, eating disorders, personality disorders, sleep disorders, attention-deficit/hyperactivity disorder, and alcohol and substance use disorders. Across diagnostic categories, reported prevalence rates vary considerably, ranging from approximately 13% to over 70% depending on the disorder and population studied, with rates exceeding 40–60% in somatic symptom disorders. Clinically, alexithymia is linked to higher symptom burden, reduced functioning, lower quality of life, increased suicidal thoughts, and poorer response to treatment. Neurobiological findings consistently implicate alterations within the anterior insula, anterior cingulate cortex, amygdala, and prefrontal regions, supporting the conceptualization of alexithymia as a transdiagnostic vulnerability factor associated with disrupted interoceptive awareness and emotion regulation networks. Including alexithymia routinely in psychiatric assessments could greatly enhance diagnosis and treatment planning. It is thought that treatment approaches that aim to increase emotional awareness, strengthen the link between bodily sensations and emotions, and improve emotion regulation skills may improve clinical outcomes in individuals with psychiatric disorders who exhibit alexithymic features.

Keywords

• Alexithymia
• Emotion Regulation
• Psychiatric Disorders

Kaynakça

1. Abd-Elhamed MME, Hady RFA, Mahmoud SF, Mohamed BES (2023) Alexithymia, resilience and suicidal ideation among patients with obsessive–compulsive disorder. Middle East Curr Psychiatry, 30:86.
2. Alimoradi Z, Majd NR, Broström A, Tsang HWH, Singh P, Ohayon MM et al. (2022) Is alexithymia associated with sleep problems? A systematic review and meta-analysis. Neurosci Biobehav Rev, 133:104513.
3. Bagby RM, Zito L, Lau SCL, Mortezaei A, Porcelli P, Taylor GJ (2025) Alexithymia and impaired mentalization: Evidence from self-, informant-, and meta-perception ratings on the 20-item Toronto Alexithymia Scale. J Intell, 13:89.
4. Bauermann TM, Parker JDA, Taylor GJ (2008) Sleep problems and sleep hygiene in young adults with alexithymia. Pers Individ Dif, 45:318-322.
5. Berthoz S, Artiges E, Van de Moortele PF, Poline JB, Rouquette S, Consoli SM et al. (2002) Effect of impaired recognition and expression of emotions on frontocingulate cortices: an fMRI study of men with alexithymia. Am J Psychiatry, 159:961-967.
6. Cai F, Jiang H, Tong S, Zhou S, Wang M, Sun S et al. (2023) Alexithymia is associated with insomnia in Chinese patients with schizophrenia. Front Psychiatry, 14:1252763.
7. Cameron K, Ogrodniczuk J, Hadjipavlou G (2014) Changes in alexithymia following psychological intervention: A review. Harv Rev Psychiatry, 22:162-178.
8. Chaim CH, Almeida TM, de Vries Albertin P, Santana GL, Siu ER, Andrade LH (2024) The implication of alexithymia in personality disorders: A systematic review. BMC Psychiatry, 24:647.

9. Craparo G, Faraci P, Gori A (2015) Psychometric properties of the 20-Item Toronto Alexithymia Scale in a group of Italian younger adolescents. Psychiatry Investig, 12:500-507.
10. Cruise KE, Becerra R (2018) Alexithymia and problematic alcohol use: A critical update. Addict Behav, 77:232-246.
11. D’Agata F, Caroppo P, Amianto F, Spalatro A, Caglio MM, Bergui M et al. (2015) Brain correlates of alexithymia in eating disorders: A voxel-based morphometry study. Psychiatry Clin Neurosci, 69:708-716.
12. Demers LA, Olson EA, Crowley DJ, Rauch SL, Rosso IM (2015) Dorsal anterior cingulate thickness is related to alexithymia in childhood trauma-related PTSD. PLoS One, 10:e0139807.
13. Demirkol ME, Tamam L, Namli Z, Karaytug MO, Ugur K (2019) Association of psychache and alexithymia with suicide in patients with schizophrenia. J Nerv Ment Dis, 207:668-674.
14. Ditzer J, Wong EY, Modi RN, Behnke M, Gross JJ, Talmon A (2023) Child maltreatment and alexithymia: A meta-analytic review. Psychol Bull, 149:311-329.
15. Donfrancesco R, Di Trani M, Gregori P, Auguanno G, Melegari MG, Zaninotto S et al. (2013) Attention-deficit/hyperactivity disorder and alexithymia: A pilot study. Atten Defic Hyperact Disord, 5:361-367.
16. Durukan İ, Kara K, Almbaideen M, Karaman D, Gül H (2018) Alexithymia, depression and anxiety in parents of children with neurodevelopmental disorders. Pediatr Int, 60:247-253.
17. Edwards ER (2022) Posttraumatic stress and alexithymia: A meta-analysis of presentation and severity. Psychol Trauma, 14:1192-1200.
18. Eichhorn S, Brähler E, Franz M, Friedrich M, Glaesmer H (2014) Traumatic experiences, alexithymia, and posttraumatic symptomatology: a cross-sectional population-based study in Germany. Eur J Psychotraumatol, 5:23870.
19. Enea V (2025) Alexithymia and eating disorders. In Handbook of the Behavior and Psychology of Disease (Eds CR Martin, VR Preedy, VB Patel, R Rajendram):1893-1914. Cham, Springer.
20. Fabris MA, Longobardi C, Zdankiewicz-Ścigala E, Ścigała DK (2025) Parental rejection and generalized anxiety disorder in early adolescents: the mediating role of alexithymia. Front Psychol, 16:1511983.
21. Frewen PA, Dozois DJA, Neufeld RWJ, Lanius RA (2008) Meta-analysis of alexithymia in posttraumatic stress disorder. J Trauma Stress, 21:243-246.
22. Goerlich KS (2018) The multifaceted nature of alexithymia: A neuroscientific perspective. Front Psychol, 9:1614.
23. Goerlich KS, Votinov M (2023) Hormonal abnormalities in alexithymia. Front Psychiatry, 13:1070066.
24. Güleç H, Köse S, Güleç MY, Çitak S, Evren C, Borckardt J et al. (2009) Reliability and factorial validity of the Turkish version of the 20-item Toronto alexithymia scale (TAS-20). Klinik Psikofarmakol Bulteni, 19:214-220.
25. Hammer LA, Bonfils KA (2024) The roles of emotion regulation and alexithymia in the relationship between sleep and social functioning. Psychol Rep, doi: 10.1177/00332941241269472.
26. Hastürk DN, Bingöl FB (2025) The effect of alexithymia on functioning and perceived social support after a manic episode. J Psychiatr Nurs, 16:107-115.
27. Ho NSP, Wong MMC, Lee TMC (2016) Neural connectivity of alexithymia: Specific association with major depressive disorder. J Affect Disord, 193:362-372.
28. Hogeveen J, Bird G, Chau A, Krueger F, Grafman J (2016) Acquired alexithymia following damage to the anterior insula. Neuropsychologia, 82:142-148.
29. Kalmbach DA, Cuamatzi-Castelan AS, Tonnu CV, Tran KM, Anderson JR, Roth T et al. (2018) Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep, 10:193-201.
30. Kang S, Park CI, Kim SJ, Kang JI (2025) Associations between emotional awareness deficits and somatic symptoms in community and clinical populations: a cross-sectional study. BMC Psychol, 13:804.
31. Kang Y, Kim A, Kang W, Han KM, Ham B (2022) The association of white matter tracts with alexithymia among individuals with major depressive disorder. Exp Neurobiol, 31:343-352.
32. Kano M, Fukudo S (2013) The alexithymic brain: Neural pathways linking alexithymia to physical disorders. BioPsychoSocial Med, 7:1.
33. Karayağız Ş, Baştürk M (2016) Alexithymia levels in patients with unipolar and bipolar depression and the effect of alexithymia on both severity of depression symptoms and quality of life. Anadolu Psikiyatri Derg, 17:362-368.
34. Khosravani V, Samimi Ardestani M, Sharifi Bastan F, Kamali Z (2017) The relationship between alexithymia and symptom dimensions in patients with obsessive-compulsive disorder. J Obsessive-Compulsive Relat Disord, 14:127-133.
35. Kim N, Park I, Lee YJ, Jeon S, Kim S, Lee KH et al. (2020) Alexithymia and frontal–amygdala functional connectivity in North Korean refugees. Psychol Med, 50:334-341.
36. Kiraz S, Sertcelik S, Taycan SE (2021) The relationship between alexithymia and impulsiveness in adult attention deficit and hyperactivity disorder. Turk Psikiyatri Derg, 32:109-117.
37. Kılıç F, Demirdaş A, Işık Ü, Akkuş M, Atay İM, Kuzugüdenlioğlu D (2020) Empathy, alexithymia, and theory of mind in borderline personality disorder. J Nerv Ment Dis, 208:736-741.
38. Koppelberg P, Kersting A, Suslow T (2023) Alexithymia and interpersonal problems in healthy young individuals. BMC Psychiatry, 23:688.
39. Kumar V, Avasthi A, Grover S (2018) Somatosensory amplification, health anxiety, and alexithymia in generalized anxiety disorder. Ind Psychiatry J, 27:47-52.
40. Kun B, Alpay P, Bodó V, Molnár Á, Horváth A, Karsai S et al. (2023) Differences in the associations between psychoactive substance use and alexithymia: A series of meta-analyses. Clin Psychol Rev, 103:102297.
41. Lanzara R, Conti C, Camelio M, Cannizzaro P, Lalli V, Bellomo RG et al. (2020) Alexithymia and somatization in chronic pain patients: A sequential mediation model. Front Psychol, 11:545881.
42. Larionow P, Mudło-Głagolska K, Preece DA (2025) Is alexithymia a trait or a state? temporal stability in a three-wave longitudinal study. J Clin Med, 14:2628.
43. Li S, Zhang B, Guo Y, Zhang J (2015) The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry Res, 227:1-9.
44. Liao Y, Zhong Y, Yang K, Zhang XY (2025) Effects of comorbid alexithymia on cognitive impairment in chronic schizophrenia: A large-sample study on the Han Chinese population. Front Psychiatry, 16:1517540.
45. Liu Z, He S, Hou C (2025) The effect of alexithymia on depression: Evidence from meta-analysis. Front Psychol, 16:1465286.
46. López-Muñoz F, Pérez-Fernández F (2020) A history of the alexithymia concept and its explanatory models: An epistemological perspective. Front Psychiatry, 10:1026.
47. López-Peláez MM, Castañeda-González HO, Zenteno-Aguayo RA, Cabello-Rangel H (2025) Prevalence of alexithymia in patients with post-traumatic stress disorder: A cross-sectional study in Mexican outpatients. Journal of Global Health Neurology and Psychiatry, doi:10.52872/001c.138201.
48. Luminet O, Nielson KA (2025) Alexithymia: Toward an experimental, processual affective science. Annu Rev Psychol, 76:741-769.
49. Marchetti D, Di Nardo M, Di Benedetto S, Porcelli P (2025) Prevalence of somatic symptom disorder and influence of alexithymia in women with thyroid diseases. J Psychiatr Res, 189:231-235.
50. Modasi J, New AS, McClure MM, Koenigsberg HW, Rosell D, Hazlett EA et al. (2026) Associations between alexithymia and borderline personality criteria in personality disorders. Personal Disord, 17:73-82.
51. Motomura Y, Fukuzaki A, Eto S, Hirabayashi N, Gondo M, Izuno S et al. (2023) Alexithymia characteristics are associated with salience network activity in healthy participants: an arterial spin labeling study. J Physiol Anthropol, 42:18.
52. Nemiah JC, Freyberger H, Sifneos PE (1976) Alexithymia: A view of the psychosomatic process. Modern Trends in Psychosomatic Medicine, 3:430-439.
53. Nowakowski ME, McFarlane T, Cassin S (2013) Alexithymia and eating disorders: A critical review of the literature. J Eat Disord, 1:21.
54. Ogłodek EA (2022) Alexithymia and emotional deficits related to posttraumatic stress disorder: an investigation of content and process disturbances. Case Rep Psychiatry, 2022:7760988.
55. Onat M, Ünver ABN, Avcı H, Dinç GŞ, Çöp E, Akay AP (2025) The relationship between depressive symptoms, alexithymia, emotion regulation and empathy in adolescents with social anxiety disorder. Turk Psikiyatri Derg, 36:493-501.
56. Orsolini L (2020) Unable to describe my feelings without an addiction: the interdependency between alexithymia and addictions. Front Psychiatry, 11:543346.
57. Ospina LH, Shanahan M, Perez-Rodriguez MM, Chan CC, Clari R, Burdick KE (2019) Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder. Psychiatry Res, 273:218-226.
58. Ozdemir E, Xiao Z, Griffiths H, MacBeth A (2025) Alexithymia in schizophrenia and psychosis vulnerability: a systematic review and meta-analysis. J Clin Psychol, 81:410-424.
59. Pace CS, Muzi S, Morganti W (2023) Alexithymia in eating disorders: a narrative review. In Eating Disorders (Eds VB Patel, VR Preedy):313-352. Cham, Springer.
60. Palma-Álvarez RF, Ros-Cucurull E, Daigre C, Perea-Ortueta M, Serrano-Pérez P, Martínez-Luna N et al. (2021) Alexithymia in patients with substance use disorders and its relationship with psychiatric comorbidities and health-related quality of life. Front Psychiatry, 12:659063.
61. Panayiotou G, Panteli M, Vlemincx E (2018) Processing emotions in alexithymia: A systematic review of physiological markers.. In Alexithymia: Advances in Research, Theory, and Clinical Practice (Eds O Luminet, RM Bagby, GJ Taylor):291-320. Cambridge, Cambridge University Press.
62. Pinna F, Manchia M, Paribello P, Carpiniello B (2020) The impact of alexithymia on treatment response in psychiatric disorders: a systematic review. Front Psychiatry, 11:311.
63. Pozza A, Giaquinta N, Dèttore D (2015) The contribution of alexithymia to obsessive-compulsive disorder symptoms dimensions: an investigation in a large community sample in Italy. Psychiatry J, 2015:707850.
64. Preece DA, Mehta A, Becerra R, Chen W, Allan A, Robinson K et al. (2022) Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation. J Affect Disord, 296:337-341.
65. Putica A, Van Dam NT, Steward T, Agathos J, Felmingham K, O’Donnell M (2021) Alexithymia in post-traumatic stress disorder is not just emotion numbing: Systematic review of neural evidence and clinical implications. J Affect Disord, 278:519-527.
66. Rady A, Alamrawy RG, Ramadan I, Abd El Raouf M (2021) Prevalence of alexithymia in patients with medically unexplained physical symptoms: a cross-sectional study in Egypt. Clin Pract Epidemiol Ment Health, 17:136-145.
67. Roh D, Kim WJ, Kim CH (2011) Alexithymia in obsessive-compulsive disorder: clinical correlates and symptom dimensions. J Nerv Ment Dis, 199:690-695.
68. Šago D, Babić G, Bajić Ž, Filipčić I (2020) Panic disorder as unthinkable emotions: alexithymia in panic disorder, a Croatian cross-sectional study. Front Psychiatry, 11:466.
69. Sancassiani F, Perra A, Galetti A, Di Natale L, De Lorenzo V, Lorrai S et al. (2024) Alexithymia and bipolar disorder: virtual reality could be a useful tool for the treatment and prevention of these conditions in people with a physical comorbidity. J Clin Med, 13:6206.
70. Schroeders U, Kubera F, Gnambs T (2022) The Structure of the Toronto Alexithymia Scale (TAS-20): a meta-analytic confirmatory factor analysis. Assessment, 29:1806-1823.
71. Shen H, Li J, Zeng R, He Y, Dai J, Li Z et al. (2025) Depression may not be related to impaired interoceptive sensibility: the role of alexithymia. Behav Sci (Basel), 15:995.
72. Sifneos PE (1996) Alexithymia: Past and present. Am J Psychiatry, 153:137-142.
73. Speranza M, Loas G, Wallier J, Corcos M (2007) Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study. J Psychosom Res, 63:365-371.
74. Sun T, Karakuş G, Tamam L, Demirkol ME, Namlı Z, Yeşiloğlu C (2025) Association between alexithymia, sexual dysfunctions, and dyadic adjustment in obsessive-compulsive disorder.Medicina (Kaunas), 61:1802.
75. Takım U, Gokçay H, Sağlam T (2024) The relationship between early onset bipolar i disorder with clinical features and alexithymia. Van Medical Journal, 31:159-165.
76. Taylor GJ, Bagby RM, Parker JDA (1997) Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge, Cambridge University Press.
77. Taylor GJ, Porcelli P, Bagby RM (2024) A defense of the original conceptualization of the construct and a critique of the attention-appraisal model. Clin Neuropsychiatry, 21:329-357.
78. Thorberg FA, Young RM, Sullivan KA, Lyvers M (2009) Alexithymia and alcohol use disorders: a critical review. Addict Behav, 34:237-245.
79. Tsubaki K, Shimizu E (2024) Psychological treatments for alexithymia: a systematic review. Behav Sci (Basel), 14:1173.
80. van der Velde J, Servaas MN, Goerlich KS, Bruggeman R, Horton P, Costafreda SG et al. (2013) Neural correlates of alexithymia: a meta-analysis of emotion processing studies. Neurosci Biobehav Rev, 37:1774-1785.
81. Wallis DJ, Ridout N (2022) Direct and indirect effects of alexithymia on disordered eating in a non-clinical female sample: Determining the role of negative affect. Front Psychiatry, 13:994024.
82. Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K (2017) Alexithymia in eating disorders: systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res, 99:66-81.
83. Wiśniewski P, Jakubczyk A, Trucco EM, Kobyliński P, Suszek H, Zaorska J et al. (2023) Interoception, alexithymia, and anxiety among individuals with alcohol use disorder. Front Psychiatry, 14:1229985.
84. Xiao Y, Tian J, Pan YF, Dai Y, Sun YJ, Zhou Y et al. (2024) The prevalence of alexithymia in schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr, 102:104280.
85. Xu P, Opmeer EM, van Tol MJ, Goerlich KS, Aleman A (2018) Structure of the alexithymic brain: A parametric coordinate-based meta-analysis. Neurosci Biobehav Rev, 87:50-55.
86. Yang X, Liu L, Tian Y, Yang C, Ling C, Liu H (2024) Insomnia and alexithymia in Chinese adolescents with major depressive disorder: a cross-sectional study of sex differences and associations. Psychol Res Behav Manag, 17:615-625.
87. Yang Z, Xiao S, Su T, Gong J, Qi Z, Chen G et al. (2024) A multimodal meta-analysis of regional functional and structural brain abnormalities in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci, 274:165-180.
88. Zhang B, Zhang W, Sun L, Jiang C, Zhou Y, He K (2023) Relationship between alexithymia, loneliness, resilience and non-suicidal self-injury in adolescents with depression: a multi-center study. BMC Psychiatry, 23:445.