Summary: New research highlights a strong connection between alexithymia — the difficulty in identifying and describing emotions — and multiple forms of child maltreatment.
By pooling evidence from 78 studies and 36,141 participants, the meta-analysis identifies emotional neglect, emotional abuse, and physical neglect as especially powerful predictors of adult alexithymia.
This work underscores the importance of early detection and development of targeted therapies to support millions who struggle with emotional awareness and interpersonal relationships.
Key Facts:
- Emotional neglect, emotional abuse, and physical neglect in childhood are among the strongest predictors of alexithymia in adulthood.
- Roughly 10% of the general population shows clinically relevant levels of alexithymia; prevalence is higher in men (about 13%) than in women (about 7%).
- Both alexithymia and child maltreatment act as transdiagnostic risk factors, increasing the likelihood of various mental health disorders.
Source: Stanford University
Have you ever struggled to put a feeling into words? Millions of people experience alexithymia — literally “no words for feelings” — a trait characterized by difficulty identifying and describing emotions.
Alexithymia can undermine social and intimate relationships by reducing awareness of one’s own emotions and diminishing sensitivity to others’ emotional cues.
Previous studies suggested a link between childhood maltreatment and adult alexithymia. A new meta-analysis published in Psychological Bulletin, led by researchers at Stanford University, is the first comprehensive synthesis of global empirical evidence examining the relationship between all forms of child maltreatment and adult alexithymia.
“We can say now with more confidence that these phenomena — child maltreatment and alexithymia — are strongly related,” said senior co-author Anat Talmon, who supervised the study as a postdoctoral fellow at Stanford and is now an assistant professor at the Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem.
The team reviewed 78 published sources reporting measures of childhood maltreatment and adult alexithymia, totaling 36,141 participants. The research was led by the Stanford Psychophysiology Laboratory with collaborators at the Hebrew University and Adam Mickiewicz University.
“One in four children worldwide experiences some form of maltreatment, yet many cases go unnoticed,” said lead author Julia Ditzer, a graduate researcher at Stanford and a PhD student in psychology at the Technical University of Dresden.
Types of child maltreatment
The meta-analysis found that emotional neglect, emotional abuse, and physical neglect were especially strong predictors of adult alexithymia. Emotional neglect and physical neglect frequently co-occur. Sexual abuse and physical abuse were also associated with alexithymia but showed weaker effects compared with the emotional and neglect-related forms.
Emotional neglect refers to caregivers’ failure to meet a child’s emotional needs for security, warmth, and validation. Emotional abuse includes behaviors that belittle, blame, or shame a child, or compel the child to shoulder inappropriate responsibilities. Physical neglect describes situations where caregivers do not provide adequate food, clothing, supervision, or a safe living environment.
Talmon noted that while victims of sexual or physical abuse may often recognize that something is wrong, emotional neglect and emotional abuse can be more subtle and harder for victims or outsiders to identify. As a result, those children may be less likely to receive help.
“When emotional needs are consistently unmet, a child may never learn to identify or name inner feelings, increasing the risk of alexithymia,” Talmon said.
About 10% of people in the general population reach clinically relevant levels of alexithymia. Rates differ by sex: approximately 7% for women and nearly 13% for men. High alexithymia is linked to a range of psychological conditions, including autism, depression, and schizophrenia.
James Gross, Ernest R. Hilgard Professor of Psychology, observed that both alexithymia and child maltreatment function as transdiagnostic risk factors, elevating the chance of developing diverse mental disorders. What remains less clear is exactly how these two risk factors are interrelated and why they frequently co-occur.
Caregivers play a central role in a child’s emotional development, serving as primary models for how to express and regulate feelings. Yet caregivers are also most often the source of maltreatment. Children raised without healthy emotional modeling have fewer adaptive coping strategies and limited opportunities to learn how to express emotions appropriately.
Responses to maltreatment vary: some children act out with aggression, others withdraw or show a flattened affect, and some dissociate. Previous research links childhood dissociation closely to emotional abuse and caregiver unavailability.
Talmon described the experience of emotionally neglected children as survival-focused: “They may say, ‘I don’t care; I’m just surviving.’ They don’t know what they want because they lack access to their inner voice.”
Maltreatment can also be subtle. Caregivers struggling with chronic illness, depression, or other challenges may be unable to provide emotional support. In such households, neglect can go unnoticed by family members and neighbors.
Alexithymia therapy could help
The authors emphasize the need for improved therapeutic approaches tailored to adults with alexithymia. High alexithymia can make it difficult for people in treatment for depression, PTSD, or other conditions to engage in introspective work and benefit from therapy.
Clinicians typically assess a person’s difficulty in recognizing and expressing emotions and then work to cultivate emotional awareness, naming sensations, and linking bodily experiences to feelings. “Before you can work on regulating your emotions, you need to recognize and understand them,” Talmon said.
Friends and family can support people with alexithymia by recognizing that difficulty expressing emotions is not intentional resistance but a genuine struggle. “They are not trying to be difficult,” Ditzer said. “They truly find this challenging.”
Additional Stanford co-authors include Eileen Wong and Rhea Modi from the Trauma Research group led by Talmon. Maciej Behnke of Adam Mickiewicz University is also a co-author. James Gross is affiliated with Stanford Bio-X, the Wu Tsai Human Performance Alliance, the Maternal & Child Health Research Institute (MCHRI), and the Wu Tsai Neurosciences Institute.
About this mental health and neurodevelopment research news
Author: Taylor Kubota
Source: Stanford University
Contact: Taylor Kubota – Stanford University
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Child Maltreatment and Alexithymia: A Meta-Analytic Review” by Anat Talmon et al. Psychological Bulletin
Abstract
Child Maltreatment and Alexithymia: A Meta-Analytic Review
Alexithymia involves difficulties in identifying and describing one’s emotions and is increasingly recognized as a transdiagnostic risk factor for mental illness. Its developmental origins are not well understood.
This meta-analysis summarizes evidence on one proposed antecedent of adult alexithymia: child maltreatment. The review extracted effect-size estimates from 99 independent samples across 78 unique sources that measured both childhood maltreatment and adult alexithymia, comprising 36,141 participants in total.
Using correlation coefficients as the effect-size metric, the analysis found a positive association between child maltreatment and overall adult alexithymia (r = .23 [.19, .27]). Emotional abuse (r = .18 [.13, .23]), emotional neglect (r = .21 [.16, .26]), and physical neglect (r = .18 [.15, .22]) emerged as the strongest predictors. Effects varied by gender, clinical versus nonclinical samples, and publication status. Results proved robust against publication bias and outliers.
These findings refine our understanding of how specific forms of early maltreatment relate to later emotional processing difficulties, offering insight into environmental influences on alexithymia and informing prevention and treatment efforts.