Alexithymics often have a range of canned responses to normal social situations in which empathy is required. They can mimic others' responses and assemble a repetoire of phrases like, "That must be so hard" and "Awww," with the correct, imitated, tone. Only an intimate partner will notice that the same responses recur over and over and the pseudo-emotion that is exhibited dissipates instantly. This is why other people often think that an alexithymic is normative, and that the partner is the one with the issue.

Alexithymia is really a disorder of imagination. In order to empathize, you need to imagine yourself in someone else's shoes. Alexithymics therefore seem to have no imagination, little spontaneity, and a constricted fantasy life. Their dreams are usually of everyday occurrences, and are boring for them to recount and for others to hear. They are not artistic or creative. They can succeed at work in occupations where order and predictability are prized, but they cannot think outside the box or predict others' social or political maneuvers, so they will only advance until a certain point before they plateau. (However, they are very stable and even keel, so they will never make impulsive decisions that jeopardize their jobs.)

Conversations with alexithymics can feel monotonous and frustrating. In the excellent (although jargon-heavy in the last chapters) book Emotionally Dumb: An Overview of Alexithymia, the author writes, "The alexithymic communication style is object-tied and logical, with a striking absence of poetic undertone which might reveal deeper resonances of psychic life." The alexithymic does not often lead with opinions or reflections. Rather, he discusses factual happenings in his day, or details about his activities, without offering observations or feelings about them that would draw others into his story. It seems to others that the alexithymic is intentionally shutting down deeper communication, but he just does not understand how or why people would continuously discuss feelings or hypotheticals. Alexithymics are very literal. They usually don't enjoy novels, or shows or movies that focus on emotions, but if they come into contact with them, they may learn ways of talking or relating from them, just as they mimic others in their social circle.

The imagination deficit in alexithymia impedes romantic and sexual functioning. Empathy and imagination are necessary for responsive sexual behavior. For fulfilling sex, people usually need to be able to pick up on non-verbal communication and to know what a partner is alluding to or hinting at. Sex with alexithymics can feel very mechanical and awkward. Alexithymics can learn sexual techniques, and will then repeat them by rote after they received a positive response once or twice, but there is limited variety or spontaneity during the act. Some alexithymics feel physically uncomfortable during sex and don't enjoy it, because sex arouses emotions that then make them feel overwhelmed or even physically sick. Others are addicted to sex as a rote way to feel physical pleasure. In neither case does sex feel like "lovemaking" to a partner.

Alexithymia does not only occur in people with Asperger's. It can also affect individuals with depression, PTSD, or those with emotionally neglectful childhoods (which you can read about in Running on Empty: Overcome Your Childhood Emotional Neglect, and probably means the person likely had an unempathic, narcissistic, or alexithymic parent himself). In the Asperger's case, though, it is more often trait (or innate, permanent) alexithymia, and in the other cases, it is more often state alexithymia, which can be helped with therapy.

State alexithymia is thought to develop from having your feelings constantly ignored and/or invalidated, or via observing parents who don't express emotions normally. When parents "mirror" a baby or child, they notice the child's emotion and label it and respond in kind, such as when a baby looks surprised, the mother says, "Oh! That was a surprise!" When parents are not capable of empathic responding, a child does not learn about his own emotions or what they mean. Therapy that is geared toward helping a client recognize and identify his emotions can therefore be helpful, and can change a relationship dynamic. Sometimes, insight oriented therapy can help a client uncover repressed anger and sadness about his childhood, and can be cathartic and lead to emotional change and the expression of dormant imagination and creativity.

Trait alexithymia may be more organic and biologically based, as is Asperger's and autism spectrum diorders as a whole. In therapy, clients can learn to express more empathy and possibly to identify their and others' emotions by rote. It is unlikely that this will lead dramatic change, and partners will find themselves in a marriage where people finish one another's sentences and call each other during the day just to tell each other something exciting or upsetting. However, just having a therapist explain to an alexithymic that a partner's emotions are not abnormal or irrational can be marriage-changing (if, of course, the alexithymic is open-minded enough to identify as alexithymic and own this aspect of his identity).

This post was originally published here on Dr. Psych Mom. Follow Dr. Rodman on Dr. Psych Mom, Facebook, Twitter, and Pinterest.

I AM A MUSLIM FOR 45 YEARS.

I MARRIED A MALAY FOR 33 YEARS.

I USED TO HAVE CHILDREN FROM AGES 25 TO 35 YEARS.

FROM MY EXPERIENCE, ALEXITHYMIA IS HEREDITARY.