Alexithymia in Neurological Disease: A Review

Objective: Alexithymia has been considered a personality trait characterized by difficulties identifying and describing feelings and an externally oriented thinking style. A high rate of alexithymia is reported among patients with psychiatric and psychosomatic disorders. In this review, the authors examined the literature regarding the prevalence and importance of alexithymia in patients with neurological disorders. Methods: A systematic search of the computerized databases MEDLINE and PubMed was conducted in order to identify papers on alexithymia in neurological disease. Key search terms used included "traumatic brain injury," "head trauma," "head injury," "stroke," "epilepsy," "brain tumor," "multiple sclerosis," "Alzheimer's disease," "Parkinson's disease," "Huntington's disease," "Gilles de la Tourette syndrome," "dystonia," "psychogenic movement disorders," "functional movement disorders," "nonepileptic attacks," and "nonepileptic seizures." These search terms were paired with "alexithymia." Results: Alexithymia seems to be a common feature of neurological disease, with most evidence available for patients with traumatic brain injury, stroke, and epilepsy. However, it is not clear how independent it is from affective disorders such as depression and anxiety, which are themselves very common in neurological conditions. Conclusions: Identification of alexithymia could be relevant for prognosis and therapeutic decisions in patients with neurological disease and is certainly worthy of further study. Tools with which to measure alexithymia and delineation from affective disorders and apathy are important methodological issues for future work.