Estimated reading time: 9 minutes
By Dr. Dennis London
I have seen many clients who struggle to express their emotions. If this is you, you are not alone. Everyone can struggle with this; but in my experience, I have observed one subsection of the population to struggle more than others.
Not only have I observed this anecdotally in my clinical work, but research suggests that difficulty to express emotions is more pronounced in men, and it is known as male normative alexithymia (MNA).
Let’s first review alexithymia.
Alexithymia means “without words for emotions.”
The term is used to describe difficulty in identifying, processing, and expressing emotions. We have all, at times, experienced difficulties putting our feelings into words.
Maybe we felt overwhelmed or did not have enough time to process the situation to be able to adequately describe how we felt about it. Often, once enough time passes, many of us are able to describe or express how we felt about a given situation.
For many, describing and expressing emotions comes naturally. However, there is a small percentage of the population (estimated to be around 10%) who have levels of alexithymia considered to be significant enough to cause difficulties in their lives.
This is not a diagnosable condition or disorder; rather, it is considered a subclinical phenomenon.
Alexithymia can be conceptualized as a personality trait with a dimensional nature that involves both cognitive and affective (i.e., emotional) deficits. It is a way of describing a part of who we are that can be measured on a scale, kind of like how we can measure how tall we are or how much we weigh. There is a range of the amount of alexithymia people can have – from just a little bit to a lot.
Some examples of cognitive deficits in alexithymia are:
- Difficulties in recognizing, describing, and distinguishing feelings from bodily sensations of emotional arousal
- Impaired processing of emotional language
- Problems in emotional language production and comprehension
Some examples of affective deficits in alexithymia are:
- Difficulties in emotionalizing and fantasizing
- Poorer recognition of emotional expressions in faces
- Lower recall for emotional material
One of the main characteristics of alexithymia is a difficulty identifying feelings and distinguishing those feelings from bodily sensations of emotional arousal. For example, an individual with high levels of alexithymia might struggle to distinguish between physical symptoms that mimic anxiety with actual anxiety. In fact, this is commonly seen in panic disorder, where benign physical sensations (e.g., a normal change in heart rate) are mistaken for anxiety and can trigger a panic attack.
This means alexithymia is not just observed in mental health disorders but in physical health disorders as well.
Alexithymia can be a common feature of the following disorders:
- Certain anxiety disorders, such as panic disorder or health anxiety
- Chronic pain
- Irritable bowel syndrome
Differences in alexithymia by gender
A major question among researchers who study alexithymia throughout the years has been the difference in prevalence rates by gender. In other words, do men or women tend to have higher rates of alexithymia?
There is in fact a difference between men and women; one study found a prevalence rate of alexithymia in men to be almost twice that of women.
Male normative alexithymia (MNA) was a term created by researcher and psychologist, Dr. Ronald Levant, in a 1992 scientific paper.
He proposed the NMA hypothesis to account for his observations of many men who learned to hide or not express their feelings because they believed it’s what they should do as a man.
Levant observed that men had great difficulty finding the words to describe their emotional states and required practice to do so. He theorized that those men had been discouraged as boys from expressing and talking about their emotions, or even punished for doing so.
Hence, these men did not develop an understanding of many of their emotions. In particular, these men showed the greatest deficits with ‘more vulnerable’ emotions (like sadness or fear).
MNA is more prevalent in men. Although it is considered normative, it is not normal. It is considered “normative” because it is rooted in a common cultural expectation that men should not express their emotions as much as women.
It is not normal, and not natural, because it is shaped and formed by society. Society has set this standard or norm, which in turn influences men’s behavior.
This socialization occurs from a young age, and it often involves messages such as:
“Boys don’t cry.”
“Rub some dirt on it.”
Parents will often discourage their sons from expressing certain ‘vulnerable’ or ‘soft’ emotions and be rewarded or reinforced for their “toughness.”
Unfortunately, as a result of these messages, men may have a harder time recognizing and expressing their feelings, because many did not learn how to do so.
Examples of normative masculine role requirements and behavior:
- Restriction of emotional expression
- Demonstration of “status” or “toughness”
- Sentiments of anti-femininity
- Presenting as in control and unburdened by vulnerability
Theories of MNA Origin
A variety of theories seek to explain the etiology of MNA. Two are social learning theory and the gender role strain paradigm.
Social learning theory is one explanation as a basis for gender differences in alexithymia.
Social learning theory is a psychological theory that explains how people learn from observing and imitating the behavior of others around them.
According to this theory, individuals learn new behaviors by watching the consequences that others experience after exhibiting those behaviors. In essence, social learning theory suggests that learning occurs through social interaction, observation, and imitation.
According to social learning theory, men may learn to suppress their emotions by observing other men in their lives, such as fathers, brothers, or peers, who model similar behavior.
For example, a boy growing up in a family or social environment where expressions of emotions are discouraged or viewed as a sign of weakness may learn to suppress his emotions to fit in and be accepted.
He may observe the men in his life who exhibit similar behaviors, such as not showing vulnerability, and imitate this behavior to be seen as “masculine” or “tough.”
As a result, he may struggle to recognize and express his emotions as an adult.
In addition, social learning theory can also explain how this pattern of behavior is perpetuated over time. As more men exhibit this behavior, it becomes more normalized and expected, and other men may feel pressure to conform to these norms to fit in and be accepted by their peers.
This can create a cycle where the pattern of suppressing emotions becomes deeply ingrained in the culture and society.
The gender role strain paradigm is one other dominant theoretical perspective to explain MNA.
This perspective posits society shapes boys into men who conform to traditional masculine gender roles by raising them under the influence of traditional masculine ideology.
In fact, research has shown the greater one endorses traditional masculinity, higher levels of alexithymia are observed in addition to interpersonal difficulties!
This theory directly confronts the popular opinion or stereotype in society that boys are “hardwired” to be less emotional and more logical than girls or women. This theory directly refutes that.
There is evidence to suggest boys actually start life with greater emotional reactivity and expressiveness than girls.
However, they become less verbally expressive than girls at about the age of 2 years and less facially expressive by 6 years.
This developmental change suggests that socialization shapes gender appropriate emotional behavior and may account for gender differences in emotional awareness and expressivity.
According to the research, men are socialized to be this way, and thus explains why MNA is not natural or normal.
Ways it might be adaptive or beneficial from an evolutionary perspective:
- Helps in highly competitive environments to not show “weakness”
- To hide vulnerability
- To establish and maintain power
Negative effects on men’s mental health:
Male normative alexithymia can have a significant impact on men’s mental health, something I have personally observed in my therapy work with male clients. It can lead to the following:
- Difficulty identifying and expressing emotions, which can lead to stress, anxiety, and depression.
- Problems in relationships. Partners may struggle to understand what their male partners are feeling.
- In some cases, men may turn to substance abuse or other unhealthy coping mechanisms to deal with their emotions, because they have not learned healthy or productive ways of coping.
Ways you can support someone with alexithymia:
If you are a partner of a man struggling with male normative alexithymia, it is essential to be patient and understanding.
- Recognize that this difficulty is not something that he can control, and he may need support to learn how to express his emotions.
- Encourage him to seek help, and offer your support and understanding along the way.
Ways you can begin to cope with MNA:
- Start to practice awareness of your feelings (or even physiological state) in situations
- Use an emotions wheel to help identify your feelings
- Download the How We Feel app to set alerts on your phone and check in with yourself about how you’re feeling throughout the day
- When a difficult memory or painful sensation shows up, pause and notice what else comes with it. What does your mind tell you to do next?
- Take 3 slow breaths, inhaling for 3 seconds, pausing, then exhaling for 3 seconds. Repeat. Observe what occurs to you, whether it’s thoughts, judgments, evaluations, or impulses. Simply notice and describe them.
- Take inventory. At any moment of your day, come back to here-and-now by asking yourself: Where am I? What do I see? What am I doing? What can I smell? Who am I with? What do I taste?
- When feeling upset and you’re not sure why, use the ABC model to describe the activating situation, identify your beliefs, and determine the consequences
- Seek out positive role models who exhibit emotionally expressive behavior
How can seeing a therapist help?
Working with a therapist can help you identify and understand your emotions better. By recognizing these patterns and understanding the role of social learning, you can begin to challenge these norms and learn healthier ways to express your emotions.
If you struggle to identify or express your emotions and are curious if you might be affected by MNA, schedule a callback with me here. No matter what others or society has told you, you don’t have to ‘grin and bear it’ or ‘suck it up.’ Continuing to do so is probably making your life and relationships more difficult.
By learning new coping mechanisms through therapy, you can break the cycle of male normative alexithymia and develop a more balanced and healthy relationship with your emotions and others. With time and effort, you can learn to express your emotions in a way that is healthy and effective.
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