When You Can’t Name What You Feel: An Indianapolis Therapist Explains
By Becky VanDenburgh, LCSW, LCAC | EMDR Certified Therapist | Think Well Live Well Counseling and Telepsychiatry, Indianapolis, Indiana. Alexithymia means having feelings without the words for them. Your body still reacts with a tight chest, a clenched jaw, or a knotted stomach, but those signals never turn into an emotion you can name. It affects about 1 in 10 adults, and it can be learned at any age.
Someone asks how you’re doing and all you’ve got is “fine.”
Your partner asks what’s wrong in the middle of an argument and your mind goes completely blank.
Your stomach has been in knots for three weeks. Your doctor can’t find anything. And it never once occurs to you that you might be grieving.
Then later you wonder, Why can’t I just say what I feel? What is wrong with me?
Nothing is wrong with you.
There’s a name for this. Once you understand it, a lot of things start to make sense. And once you know what helps, things start to change.
What is alexithymia?
The word comes from Greek and means “no words for feelings.” Psychiatrist Peter Sifneos came up with it in the 1970s after noticing that many of his patients with unexplained physical symptoms couldn’t describe their inner emotional lives at all.
It’s not a diagnosis. It’s a trait, and it lives on a spectrum. Some people have a little, some have a lot. According to a review published through the National Institutes of Health, about 10% of adults have it at a level that really affects their lives.
Therapists look at three pieces:
Trouble identifying feelings. You can’t tell whether that churning in your gut is anxiety, anger, or just hunger.
Trouble describing feelings. Even when you sense something is there, the words won’t come.
A mind that goes to facts. Your thinking naturally heads toward tasks, plans, and what happened, and steers away from what’s happening inside you.
You do have feelings. They just don’t come with labels.
This is the part people misunderstand most.
Alexithymia doesn’t mean you’re cold, and it doesn’t mean you don’t care. Your feelings are there. Often they’re louder in your body than they are for other people, because they never get named, worked through, and let go.
What’s missing is the bridge between the sensation and the thought I’m sad.
And it isn’t only the hard feelings. A lot of my clients tell me that joy, excitement, or tenderness shows up as a vague buzz or restlessness instead of something they can actually enjoy and share.
Why does this happen?
For most people, it starts in childhood.
Naming feelings is a learned skill. When a baby cries and a caregiver softens their face and says, “Oh, you’re so frustrated,” the baby’s brain starts connecting a body sensation to a word. Therapists call this mirroring. It happens thousands of times in a healthy childhood, and nobody even notices.
But if your parent was overwhelmed, depressed, checked out, or never learned to name their own feelings, that mirroring didn’t happen. You had a body full of sensations and no map for any of them.
So you did something smart. You turned the volume down. If nobody was going to help you with the hurt, it was safer not to feel it.
That worked. It just followed you into adulthood.
The trauma of what didn’t happen
Here’s the research that surprises people.
A large analysis of 88 studies covering more than 43,000 people found that every kind of childhood mistreatment was linked to alexithymia. But the strongest link wasn’t abuse. It was emotional and physical neglect.
That’s why so many clients tell me, “Nothing bad really happened to me.” Neglect isn’t about what happened. It’s about what didn’t. Nobody yelled. But nobody asked how you felt, either. I’ve written more about this in Normal Habits That Are Actually Signs of Childhood Neglect.
Genes play a part too. A twin study estimated that about 42% of the differences between people are inherited. So it can run in families both ways: through biology, and through how feelings were (or weren’t) talked about at home.
It can also show up later in life. Ongoing trauma, a brutal job, or years of chronic stress can teach an adult nervous system to shut feelings off just to get through the day.
And if you’re thinking your childhood wasn’t “bad enough” to count, you’re in good company. Indiana Department of Health data found that more than 61% of Hoosier adults report at least one adverse childhood experience.
What’s happening in your brain and body
You don’t need to be a scientist to get this. Here’s the simple version.
Your brain has a translator. Deep inside, a region called the insula reads what’s going on in your body, like your heartbeat, your breathing, and the tension in your gut. Then it passes that information to the part of your brain that turns it into meaning: Oh, I’m nervous.
In alexithymia, the line between those two areas is weaker. The signal goes out, but the message doesn’t fully get through. One study of people with damage to the insula found that the injury alone could cause alexithymia, which tells us how important that translator is.
Your alarm doesn’t turn off. When a feeling gets named, your stress system can calm back down. When it doesn’t, your body stays on high alert. Research links alexithymia to stress hormones that don’t settle the way they should, which is exhausting to live with.
It’s not just emotions. Your ability to read signals from inside your body is called interoception. Researchers Rebecca Brewer, Jennifer Murphy, and Geoffrey Bird found that alexithymia is a broad difficulty with reading the body, not only feelings. That’s why so many of my clients also forget to eat, don’t notice they’re exhausted, or can’t tell whether they’re cold.
Here’s the twist. Many people with alexithymia are actually hyper aware of their bodies. They just can’t read what the signals mean.
What researchers measure | What it means | What it often looks like with alexithymia |
Accuracy | How correctly you pick up body signals | Lower. You miss or misread what’s going on inside. |
Attention | How much you focus on your body | Often higher. Every little sensation feels loud. |
The match between them | Whether what you notice lines up with what it means | Poor. You notice a lot but can’t tell what it is. |
That mismatch explains a lot. A small jump in your heart rate from ordinary worry gets noticed loudly, but with no emotional label attached. So your brain fills in the blank with something is physically wrong with me. That’s how alexithymia can feed health anxiety and panic attacks.
It’s the same nervous system story I talk about in Why Do I Overreact to Small Things? and Your Nervous System Isn’t Broken. Your body isn’t failing you. It learned to survive, and it’s still running that program.
How alexithymia shows up in real life
Feelings that don’t get words don’t disappear. They find another way out.
In your relationships. Your partner wants to talk about feelings and you have nothing to say, so you shut down. Relationship researcher John Gottman calls this stonewalling, and it’s one of the biggest predictors of divorce. A study on alexithymia and marriage found it was linked to more loneliness, more fear of intimacy, and less satisfaction. Your partner reads it as not caring. You’re actually drawing a blank.
At work. Finland’s Health 2000 Study found that alexithymia is strongly tied to burnout, even after accounting for depression. You keep pushing because you can’t feel the warning signs until you hit the wall.
In your body. Headaches, stomach problems, chronic pain, and doctor visits that never find a clear cause. This isn’t “all in your head.” Your body is carrying what your mind hasn’t been able to name.
In how you cope. When you can’t name what you feel, you reach for whatever makes it stop. A drink. Food. Scrolling. Staying busy. Psychiatrist Edward Khantzian called this the self medication hypothesis, and I’ve written about why trauma rewires the brain for addiction. It isn’t a willpower problem. It’s a nervous system looking for relief.
Alexithymia is also much more common in some groups:
Group | How common it is | Source |
Adults in general | About 10% | |
Adults after a traumatic brain injury | 30% to 60% | |
Autistic adults | About 50% to 60% |
Recognizing yourself in any of this? You don’t have to figure it out on your own. I’d love to invite you to a complimentary consultation. It’s a relaxed conversation where you can share what’s been going on, ask me anything, and see whether working together feels right. No pressure and no commitment.
What helps you name what you feel
Here’s the good news. You don’t have to start with the feeling. Start with your body. It’s already telling you everything. Here’s what helps you listen.
Do a 30 second body check in
When something feels “off,” pause and ask yourself three questions:
Where do I feel something? Chest, stomach, throat, jaw, shoulders?
What is it like? Tight, heavy, hot, buzzy, hollow, shaky?
Is it pleasant, unpleasant, or neutral?
That’s it. You don’t have to name the feeling yet. Just noticing “my chest is tight and it’s unpleasant” is a real first step.
Start with just four words
Forget the giant list of emotions for now. Most feelings fit into one of four buckets:
Mad. Sad. Scared. Glad.
Ask yourself, “Which one is closest?” You can get more specific later. “Annoyed” and “furious” both live under mad. “Lonely” and “disappointed” both live under sad. Close enough counts.
Use a body clues cheat sheet
Your body gives clues. Here’s what they often point to. Everyone is a little different, so treat these as guesses, not rules.
What you notice in your body | What it might be |
Tight jaw, hot face, clenched fists, wanting to snap | Mad: annoyed, frustrated, angry |
Heavy chest, lump in your throat, tired, wanting to be alone | Sad: disappointed, hurt, lonely |
Racing heart, knot in your stomach, shallow breathing, can’t sit still | Scared: nervous, worried, overwhelmed |
Loose shoulders, easy breathing, warm chest, wanting to be close to someone | Glad: calm, safe, happy, grateful |
Numb, foggy, blank, far away | Often too much at once. Your system hit pause. |
Screenshot this. Keep it on your phone.
Keep a feelings wheel handy
A feelings wheel starts with a few basic emotions in the middle and gets more specific as you move outward. Some versions even show where each feeling tends to show up in the body. Psychology Tools has free emotion worksheets you can print. Stick one on the fridge and glance at it when you’re stuck.
Notice your urges
Sometimes it’s easier to notice what you want to do than what you feel. Your urges are clues too.
Want to hide or cancel plans? Maybe sad, or scared.
Want to yell, slam a door, or send a sharp text? Probably mad.
Want to call someone and tell them something? Maybe glad, or excited.
Write a 2 minute evening note
Once a day, write three lines. The notes app on your phone is fine.
What happened: “Boss moved my deadline up.”
What my body did: “Stomach dropped. Jaw tight.”
My best guess: “Scared? Maybe mad too.”
Guessing wrong is totally fine. The point is practice. Over time, this kind of repetition builds new connections between body and brain, and the words start coming a little sooner and a little easier.
What to say when your mind goes blank
This is where alexithymia hurts the most: in the middle of a hard conversation with someone you love.
You don’t have to have the answer on the spot. You just need a way to buy yourself time without shutting the door. Try one of these:
“I can tell I’m feeling something. I just don’t have the words yet.”
“Give me 20 minutes. I want to figure out what’s going on and come back to this.”
“My chest is really tight right now. I think I’m upset, but I’m still sorting out why.”
“I’m not ignoring you. This is just hard for me to put into words.”
Then actually come back. Do a quick body check in, pick one of the four words, and try again. Your partner will feel the difference, even if the words are still clumsy.
Why “How does that make you feel?” doesn’t work
If you’ve tried therapy before and felt stuck, this might be why.
The classic therapy question assumes you already have the words. For someone with alexithymia, it feels like a test you keep failing. A lot of people leave feeling worse, or decide therapy just isn’t for them.
That’s not you being bad at therapy. The approach started in the wrong place.
What healing actually looks like
Good therapy for alexithymia starts with the body, not the feeling. Here’s what that looks like, in order:
Step | What happens | Why it matters |
1. Notice | We get curious about one sensation. Where is it? Warm or cold? Tight or heavy? | Builds your body awareness without any pressure to name a feeling. |
2. Describe | You put it into plain physical words. “My jaw is clenched and my face is hot.” | Gives your brain a first bridge between body and language. |
3. Connect | We explore what feeling might live there. | A clenched jaw plus a hot face often points to anger. Now it has a name. |
4. Practice | Short daily notes between sessions. | Repetition strengthens the new pathway until naming starts to happen on its own. |
This body first approach draws on somatic trauma therapy, EMDR therapy, and polyvagal informed therapy. If you’re curious how EMDR compares to regular talk therapy, I’ve written about the benefits of EMDR. And it happens inside a safe, steady relationship, which gives you the mirroring that was missing the first time around.
I say a version of this to almost everyone who sits down with me: you didn’t miss the lesson because you weren’t smart enough. You missed it because nobody was there to teach it. Your brain can still learn this, at any age.
Does it actually work? A systematic review of treatments for alexithymia found real improvement with approaches like emotion focused therapy, acceptance and commitment therapy, and adapted CBT. Being straight with you: most of those studies are small, and the research is still growing. What I can tell you is what I see in my office. People who arrive saying “I don’t even know what I feel” slowly start finding the words, and their relationships and their bodies both feel the difference.
Ready to find the words?
If you’ve read this far and kept thinking that’s me, I want you to know something.
The part of you that learned to go quiet was protecting you. It was smart, and it worked. You don’t have to push past it or force feelings to show up.
In my practice we go slowly. We start with what your body already knows, and we build the language together at a pace that feels safe.
You don’t need to arrive with a clear memory, a diagnosis, or the right words. Honestly, not having the words is exactly why you’d come. Bringing the question is enough.
I’d love to meet you
I’d like to personally invite you to a complimentary consultation. It’s a relaxed, no pressure conversation where you can tell me what’s been going on, ask any questions you have, and get a feel for whether we’re a good fit. You don’t need to prepare anything or know exactly what to say. Figuring that out is what we’ll do together. Sessions are by secure telehealth, available anywhere in Indiana, so you can join from a space where you already feel comfortable.
Questions people ask
Is alexithymia a mental illness? No. It isn’t a diagnosis. It’s a trait that raises the risk for things like depression, anxiety, PTSD, eating disorders, and addiction. Knowing about it can explain why other treatment has felt stuck.
Am I just emotionally unavailable? No. Emotionally unavailable usually means someone doesn’t want closeness. With alexithymia, you often want closeness very much. You just can’t find the words to get there.
Is it the same as depression? No. Depression is about mood: sadness, emptiness, losing interest. Alexithymia is about naming and understanding feelings. You can feel happy and still not be able to describe it. The two often overlap, which is why treating only the depression sometimes falls short.
Does having alexithymia mean I’m autistic? No. Many autistic people have it, but so do plenty of people who aren’t autistic. Researchers Geoffrey Bird and Richard Cook found that many emotional difficulties once blamed on autism are better explained by alexithymia.
How do I know if I have it? Therapists often use the Toronto Alexithymia Scale or the newer Perth Alexithymia Questionnaire, which also looks at trouble with positive feelings. An online version is a fine starting point. A conversation with a trauma informed therapist gives you the full picture.
What if I pick the wrong word? That’s completely fine. “I think I’m mad, but maybe it’s hurt” is a great sentence. Feelings are often mixed anyway.
Do I have to talk about my childhood in therapy? Not right away, and not in detail. Body based work starts with what’s happening now, which makes it useful even when you don’t remember much or don’t have the words yet.
About the author
Becky VanDenburgh, LCSW, LCAC is the founder of Think Well Live Well Counseling and Telepsychiatry, based in Indianapolis, Indiana and serving clients across the state by telehealth. She is an EMDR Certified Therapist with more than two decades of clinical experience, working with adults on trauma and PTSD, anxiety and depression, addiction, and complex developmental trauma. Her approach draws on EMDR, somatic therapy, polyvagal informed therapy, Internal Family Systems, CBT, and ACT, and DBT.
Educational only, not individual clinical advice. If you’re in crisis, call or text 988, the Suicide and Crisis Lifeline.
Comments