Childhood maltreatment predicts adult emotional difficulties

Have you ever wanted to convey a feeling but just couldn’t find the right words? Millions of people struggle with a personality trait known as alexithymia, which means “no words for feelings.” Individuals with alexithymia have difficulty identifying and describing their emotions. This trait can harm their social and intimate relationships. They are likely to miss social cues and thus fail to recognize or understand the feelings of others. Past research has suggested that a history of child maltreatment could play a role in developing adult alexithymia.

A new meta-analysis published this month in Psychological Bulletin, led by Stanford University researchers, is the first study to synthesize empirical evidence in global literature on links between adult alexithymia and all forms of child maltreatment.

“We can say now with more confidence that these phenomena – child maltreatment and alexithymia – are related to each other to a great extent,” said senior co-author Anat Talmon, who supervised the study as a postdoctoral research fellow at Stanford University and currently serves as an assistant professor with the Paul Baerwald School of Social Work and Social Welfare at the Hebrew University of Jerusalem.

The researchers examined 78 published sources that reported details of potential child maltreatment and levels of alexithymia in adulthood. In total, 36,141 participants were included in the study conducted by the Stanford Psychophysiology Laboratory with collaborators at the Hebrew University and Adam Mickiewicz University.

“One in four children worldwide is maltreated, but it often goes unrecognized,” said Julia Ditzer, lead author of the study, a graduate researcher at Stanford University, and a PhD student in psychology at the Technical University of Dresden.

Types of child maltreatment

Three child maltreatment types – emotional neglect, emotional abuse, and physical neglect – were particularly strong predictors of alexithymia. Emotional neglect and physical neglect commonly occur together. Two other types – sexual abuse and physical abuse – were related to alexithymia but were less strongly predictive.

Emotional neglect occurs when caregivers fail to provide for a child’s emotional needs, including security and comfort. Emotional abuse happens when caregivers ridicule, belittle, or blame children, making them responsible for household or caregiver problems. Physical neglect involves caregivers who fail to provide adequate food, clothing, or a safe environment.

“When someone is sexually or physically abused, he or she often knows, to a certain extent, that something is wrong,” said Talmon. Emotional neglect and emotional abuse, however, are often more difficult to identify by the victim or other family members or neighbors. Victims may be less likely to seek help. “Emotional neglect and emotional abuse are extremely devastating experiences for a child,” said Talmon. “No one is fulfilling your emotional needs, but you lack the ability to identify and recognize your emotions on your own, which increases the likelihood of developing alexithymia.”

About 10% of the general population have clinically relevant levels of alexithymia. For women, it’s about 7%. For men, it’s almost double that, about 13%. High levels of alexithymia are associated with psychological disorders, including autism, depression, and schizophrenia. According to James Gross, who is the Ernest R. Hilgard Professor of Psychology in the School of Humanities and Sciences, “It is increasingly clear that both alexithymia and child maltreatment are transdiagnostic risk factors, meaning that their presence puts a person at higher risk for developing a wide range of mental disorders. However, what is not yet clear is how these two risk factors are related to one another, and why they often co-occur.”

To understand the links between alexithymia and child maltreatment, it is helpful to consider the crucial role played by caregivers. Caregivers are typically the most important model for children in their emotional development. Yet caregivers are also the most common perpetrators of child maltreatment. Maltreated children grow up with fewer examples of positive coping strategies under stress and less opportunity to express emotions appropriately.

In response to negative events, some maltreated children can behave aggressively or violently, while others shut down with a flat emotional affect or dissociation. Past research has shown that childhood dissociation – detachment from feeling – is strongly related to emotional abuse or the unavailability of caregivers.

“These children might say, ‘I don’t care. I’m just surviving,’ ” said Talmon. “They don’t know what they want because they don’t know what their inside voice is, and what their true will is.”

But some forms of maltreatment can be subtle. Well-meaning caregivers could be chronically ill, clinically depressed, or unable to support children emotionally for other reasons. “No one living in that environment might see what’s happening as maltreatment,” said Talmon.

Alexithymia therapy could help

Improved therapeutic interventions for adults with alexithymia are needed, the authors note. People in treatment for depression or PTSD might score high on alexithymia, making it more difficult for them to be introspective and successful in therapy.

Therapists assess patients’ difficulty in expressing and identifying emotions. Treatment for adults with alexithymia often involves helping them develop an ability to be in touch with their emotions, understand them, and explain them in an embodied way. “Before you can work on regulating your feeling, you first need to understand and recognize your feeling,” said Talmon.

Family members and friends should try to understand that people with alexithymia often do not identify and express their feelings as readily as others do or understand the feelings of others. “They are not trying to be difficult,” said Ditzer. “They just really struggle with this.”

Additional Stanford co-authors are Eileen Wong and Rhea Modi, research assistants at the Trauma Research group led by Talmon. Maciej Behnke, of Adam Mickiewicz University in Poland is also a co-author. Gross is also a member of Stanford Bio-X, the Wu Tsai Human Performance Alliance, the Maternal & Child Health Research Institute (MCHRI), and the Wu Tsai Neurosciences Institute.