Do alexithymic individuals avoid their feelings? Experiential avoidance mediates the association between alexithymia, psychosomatic, and depressive symptoms in a community and a clinical sample

Objective Alexithymia is defined as the trait associated with difficulty in identifying and describing feelings as well as poor fantasy and imagery. While alexithymia is related to psychopathology in general, it has been associated with increased reporting of medically unexplained symptoms and depression in particular. This study attempts to assess the extent to which alexithymia represents a learned, avoidant coping strategy against unwanted emotions. In this way the study aims to identify a potential mechanism that may elucidate the relationship between alexithymia and psychological symptoms. Method Alexithymia is examined in two different samples, students from two universities in Cyprus and intensive outpatients/residents in an American anxiety disorder treatment program. We examine whether alexithymia predicts psychosomatic and depressive symptoms respectively through the mediating role of experiential avoidance, a coping mechanism believed to be reinforced because of the immediate relief it provides. Results Experiential avoidance was found to correlate strongly with alexithymia, especially its difficulty in identifying feelings factor, while the mediation hypothesis was supported in all models tested. Furthermore, results from the clinical sample suggest that clinical improvement in depression was associated with a decrease in alexithymia, especially difficulty in identifying feelings, mediated by decreased experiential avoidance. Conclusions Alexithymia, and more specifically its difficulty in identifying feelings aspect, may be a learned behavior used to avoid unwanted emotions. This avoidant behavior may form the link between alexithymia and psychopathology. Implications for alexithymia theory and treatment are discussed.