Imagine feeling a knot in your stomach, or your heart racing, and being unable to tell whether you are feeling anger, anxiety, or excitement.
For millions of people around the globe, this is a daily experience.
It's called alexithymia, a word derived from ancient Greek that means "no words for emotions".
Contrary to some simplifications, it does not mean an inability to feel emotions. Rather, it describes a struggle to identify and understand one's own emotional states.
That might sound like a minor inconvenience. But emotions do much more than tell us how we feel.
They help us interpret our experiences, communicate with other people, navigate relationships, and make decisions. When emotional signals are difficult to recognize, the effects can ripple through many areas of life.
The term alexithymia was coined by psychotherapists in the 1970s to describe a pattern of difficulties.
This typically includes struggling to identify one's emotions and to describe them to others; getting confused between emotional states and physical sensations; and a tendency towards fact-focused external thinking rather than emotional introspection.
It's difficult to know how many people live with alexithymia, since people may not know that they have it, but according to current estimates, it may affect around 5 to 10 percent of the general population.
But what does alexithymia actually feel like?
One of the most common features of alexithymia is an inability to distinguish an emotional state from a physical one. That knot in the stomach may just register as nausea, the racing heart as exertion. You know that something is happening, but its emotional root is out of reach.
Another common feature is what psychologists call externally oriented thinking. People with alexithymia often focus on the observable details of a situation – what happened, what was said, what needs to be done.
The implications of this extend beyond the moment, however.
Emotions are one of the ways humans communicate with each other. They help us explain our needs, build connections, and understand how other people are feeling.
When a person struggles to identify and describe their own emotions, this can become much more difficult. Others may interpret the emotional reserve demonstrated by people with alexithymia as disinterest or detachment, even when they care deeply.
Research has linked alexithymia to a range of interpersonal difficulties, including problems with emotional intimacy and relationship satisfaction.
Someone may know they are upset with a partner without being able to explain why, for example, or care deeply about a friend while struggling to express that feeling.
In addition, people with alexithymia often struggle to regulate their emotions, which can contribute to maladaptive coping strategies.
Research has linked alexithymia to behaviors such as social withdrawal, emotional suppression, and avoidance, all of which can further complicate relationships and communication.
The effects may also extend to decision-making.
Our emotions provide information that helps us assess risks and navigate uncertainty. Several studies have linked alexithymia to differences in decision-making, particularly in situations where there is no obvious right answer and emotional cues help guide choices.
If a person cannot easily tell whether a feeling is fear, excitement, apprehension, or intuition, they may lose one of the signals many people unconsciously rely on when weighing difficult decisions.
Alexithymia is not classified as a mental health disorder in its own right. However, it does appear more frequently in people with a number of conditions.
Perhaps its best-known association is with autism. Around 50 percent of people with autism are estimated to also have alexithymia.
However, it has also been linked to conditions such as post-traumatic stress disorder, obsessive-compulsive disorder, schizophrenia, anxiety and depression, premenstrual dysphoric disorder, and a range of chronic illnesses, such as cancer.
Not everyone with these conditions has alexithymia, and many people with alexithymia have none of them. Nevertheless, the overlap has led researchers to investigate whether difficulties identifying emotions may contribute to some of the challenges experienced across these very different conditions.
Related: One Complex Emotion May Have a Powerful Effect on Your Mental Health
The overlap can also make alexithymia difficult to spot. Patients may seek treatment for a condition without realizing that failing to recognize their emotions may be part of the puzzle.
While alexithymia can be challenging, it doesn't have to be set in stone.
The knot in the stomach, the racing heart, the tension in the shoulders – all may be carrying information. The task is learning how to read it.
Tools such as improving emotional literacy, meditation, and various types of therapy can help people living with alexithymia to connect with their emotions and learn to interpret what their body is trying to tell them.