 One of the main characteristics of empathic people like me is the ability to recognize emotions in other people and to interpret them and label them correctly. If you are devoid of this capability, if you are incapable of recognizing emotions in yourself, in other people and identifying them for what they are, you are suffering from alexithymia, which is a topic of today's video. I'm going to propose a new way of looking at alexithymia based on the work of the French psychoanalyst Joyce McDougal, coupled with new insights in the 11th edition of the International Classification of Diseases. And why am I doing this to you on a beautiful weekend? It's because I'm Sam Baknin, the author of Malignant Self-Love, Nocissism Revisited, a former visiting professor of psychology and currently on the faculty of CIAP's Commonwealth Institute for Advanced Professional Studies. Alexithymia, it is. I want to link alexithymia to something known as anuncastia. Ununcastia is a fancy word for rule-based affectionism. It makes an appearance in the latest edition of the International Classification of Diseases as a trait domain, one of five. There's also dissociality, negative affectivity, etc. etc. Now, it is very reminiscent of Obsession Compulsion. In the fifth edition, text revision of the Diagnostic and Statistical Manual, we have Obsessive Compulsive Personality Disorder, which is the rough equivalent of Ununcastic Personality Disorder. So traits in this domain, ununcastia, include Perfectionism, Perseveration to Persevere, Emotional and Behavioral Constraint, Stubbornness, Deliberativeness, Orderliness and Concern with Following Rules and Meeting Obligations. This is the excellent definition proposed by Ottmann's and Wiediger in 2018. When you listen, when you put together these behaviors and traits and qualities and so on and so forth, you are reminded vaguely of Conscientiousness, one of the five factors in the famous Five-Factor Model of Personality. But this equivalence is superficial, because Ununcastia and Conscientiousness are not synonyms. Conscientiousness is an element in Ununcastia, and the motivation for Conscientiousness in the Five-Factor Model is pro-social, while the motivation for Conscientiousness within Ununcastia has nothing to do with society or with social functioning. It has to do with rigid internalized imperatives, catastrophizing and ritualizing against catastrophe. We'll come to it a bit later. And so, as the authors that I mentioned before say, that at its core, Ununcastia involves a narrow focus on the control of behavior to ensure that things conform to the individual's particularistic ideas. So it's about the individual, not about society, and that's why Ununcastia is not Conscientiousness. Ununcastia is often linked to other trait domains. For example, when Ununcastia is linked with dissociality and with negative affectivity, we get something that is roughly the equivalent of narcissistic personality disorder in the DSM. A person high on Ununcastia may have other adaptive qualities associated with extreme rigidity, with perfectionism, with a bit of sadism, with stubbornness, with insistence, with perseverance, and so you all know the type. Passive aggression is usually the outcome of Ununcastia. There are varying degrees of Ununcastia, of course. We'll not go into it right now. There's literature included in the description of this video, and you may wish to avail yourself of this literature. Why did I start a video about Alexithaimia with Ununcastia? Because I think there's a connection. Alexithaimia is a rejection of emotion, at least according to the psychoanalytic model, the advanced psychoanalytic model by Jones-Mendugo. There is an element of rejection of emotion, whether it is unconscious and whether it is conscious. Emotion is excluded, denied, repressed, ignored. There's a pretension, as if emotion does not exist. Why would you do that? Only if you believe that emotions are imperfect, that emotions are a weakness, a vulnerability, something that is dysregulated and disruptive and dangerous. People with Alexithaimia reject emotions because they consider emotions to be a kind of perturbation, a kind of imperfection, a kind of malfunction or dysfunction. In other words, people with Alexithaimia reject emotions because emotions render them imperfect. And of course Ununcastia is about the pursuit of perfection, and that's why I'm linking the two. I think people who reject emotions, generally speaking, Alexithaimia cannot, are people who are ununcastic, people who suffer from ununcastia, people who are perfectionistic. Very often we find perfectionistic people who are also emotionless, rigid, cold, detached, cruel even. There's a cruelty involved in the pursuit of perfectionism because you are setting yourself up for failure, it's self-destructive, but you're also setting up everyone else for failure. No one can measure up to your standards. Everyone keeps failing, everyone keeps disappointing you. You keep disappointing yourself, so it is a form of externalized and passive-aggressive aggression. Perfectionism is a way to render everyone miserable, yourself, your workers, employees, spouses, children, colleagues, neighbors, friends and so on. They all keep failing, they're all imperfect. And of course perfectionism sits ill, cannot occupy the same space as emotionality. Because if you're emotional, you're bound to tolerate inner perfection, you're bound to accept compromise standards in everyone around you, because you're emotional, you love them, for example. So emotions and perfectionism don't go together. If you're a perfectionist, you need to suppress your emotions or ignore them somehow. And if you are an emotional person, let alone a dysregulated person, like a borderline, you cannot be a perfectionist. Indeed, in borderline personality disorder, also known as Emotional Disregulation Disorder, there's not an encasture. There's no perfectionism. So I think calixithymia is a form of perfectionism, emotional blindness. Now, there's a huge debate whether there are some neurological foundation or genetic template which yield later on in life, alexithymia. No one knows and there's no proof to the contrary. And all the studies that have been published are, to put it charitably, less than rigorous, especially studies in neuroscience. But we do know that people with alexithymia fail to recognize, to express and to describe their own emotions and also emotions in other people. And it's extremely reminiscent of autism spectrum disorder. Indeed, something like three quarters of people with autism spectrum disorder have also been diagnosed with alexithymia. And we do know there's a connection between autism spectrum disorders and certain personality disorders, and especially narcissistic and antisocial personality disorders. We also know there's some connection between attention deficit hyperactivity disorder, ADHD, autism spectrum disorder and narcissistic and antisocial personality disorder. They all interconnected somehow and perhaps the underlying connection, perhaps the thing that generates this constant comorbidity is alexithymia. Problems with emotions, problems recognizing emotions, interacting with emotions, expressing emotions, accepting emotions, embracing emotions. All these create extreme issues with attachment and interpersonal relations, as I will discuss in a minute. Now, alexithymia sometimes goes hand in hand with alexisomia. Alexisomia is a new, relatively new clinical concept. It's the difficulty in the awareness and the expression of somatic or bodily sensation. It's like being divorced from the body. We have this in cerebral narcissism. There is alexisomia in cerebral narcissism. The cerebral narcissist is both alexisomic and alexithymic. He has both alexithymia and alexisomia. There is no scientific consensus, as I said, whether alexisomia is a personality trait, a medical symptom, a mental disorder, neurodevelopmental issue and so on and so forth. But we do know that this thing exists. Actually, there are about a dozen tests for alexisomia, dedicated tests to alexisomia. We also believe that alexisomia occurs anywhere between 5 and 10% of the general population. And we know for sure that it co-occurs with mental disorders, neurodevelopmental disorders such as autism, but also certain personality disorders. There is a difficulty in recognizing and discussing emotions. Now, alexisomia could be subclinical. In certain cultures, for example, it's not okay to express emotions. This is frowned upon. The United Kingdom comes to mind. Alexisomia could also be gender-specific. Men are much less likely to express emotions than women owing to cultural conditioning, a culturation and socialization. Norms of masculinity, especially by the way, toxic masculinity. Sadness, for example, is considered feminine emotions. Men don't cry. It's a form of alexisomia. Culture-bound alexisomia, known clinically as normative male alexisomia. I'm not talking about this. These are cultural phenomena. And when the environment changes, cultural and social mores are transformed, the attitude to emotions similarly undergoes transformation. So we are not talking about this, not a clinical entity. We're talking about people who, regardless of age, of gender, of culture, of society, are unable to express emotions because they are not aware of any emotions. They can't recognize emotions in themselves and in others. They cannot label them. They cannot identify them. They cannot recognize them. They cannot act on them. And the question here is why? So I adhere to two answers, not the genetic one, not neurodevelopmental. I adhere to two answers, the psychoanalytic one and the cognitive behavioral one. And I'll come to that in a minute. But first, what are the impacts of alexisomia in relationships? Huge impact. Emotions are the foundation and the pivot of relationships. In the absence of emotions, there's no relationships. Period. Sex is a way to communicate emotions within relationships. It's just an extension of emotions. Even cognitions are related to emotions. Memories cannot be recalled without emotions. If there's an impaired access to emotions, there is overwhelming dissociation, there are memory gaps. Because when we remember something, we remember not only the event, but how we felt, how we felt at the time. And the event and the emotions attendant upon the event are stored as a memory and recreated on the fly when we try to recall something. If we have trouble interacting with emotions, then we have trouble forming memories. And in the absence of memory, there's no identity. And in the absence of memory and identity, what kind of relationships could we ever hope to have? None. Indeed, there are serious problems in relationships for people with alexisomia. And again, I propose that alexisomia is a form of perfectionism, the rejection of emotions because they render the person imperfect and render the world substandard and dysregulated, not ruled rigidly. So, in close relationships, the alexithymic person acquires a position of independence, dominance, impersonal interaction. It is very reminiscent of an insecure attachment style, avoidant for example, or fearful to some extent. But it's not. It's not about the attachment style. There's no attachment there, not because the individual is incapable of attachment, but because there's no emotional input, so the individual is unable to form bonds. I would call it flat attachment, and I have several videos dedicated to this. The relationship remains superficial, which is more or less the language the DSM uses in the alternative model of narcissistic personality disorder, by the way. So there's an act, when the alexithymic person is unable to differentiate between self and others, he cannot tell the difference between external objects and internal objects. Sounds familiar? It's narcissism. It's exactly what happens in narcissism. The narcissism is unable to perceive the separateness and the externality of other people. Instead, he interacts with internal objects that represent these people in his mind, and this is exactly what has been observed with alexithymic people. So the difficulty in processing interpersonal connections develops with age, probably because of constant failures, and so there's been a huge study of alexithymic individuals. They use something called the IIP64 questionnaire, never mind. They came to the following conclusion. Two interpersonal problems are significantly and stably related to alexithymia, called distant and non-assertive social functioning. All other sub-scales, by the way, were not significantly related to alexithymia. So the interpersonal relationships of people with alexithymia are painful to the partner, very hurtful and very chaotic as Syphenus has observed. They are inhering difficulties in identifying and describing emotional states in self and in others, and alexithymia negatively affects relationships. And so there's growing dissatisfaction, especially of the partner. There was a study in 2008, and alexithymia was correlated to impaired understanding and demonstration of relational affection. This impairment contributed to poor outcomes in mental health, relational well-being, relationship quality, and so on and so forth. This sounds a lot like relationships with narcissists and psychopaths, where the lack of empathy is such that there is not true interest in the partner. Intimacy can never grow in on such soil. This is infertile soil, arid. Individuals high on alexithymia report less distress when they see other people in pain, and they are less altruistic and of course less empathic. As I started the video, I started the video by saying that emotions are the foundation of empathy. And so alexithymia as a clinical entity, as a mental health issue, is destructive to one's life and one's relationship. All interpersonal relationships, not only romantic, are founded on emotions, the reading of emotions, the decoding of emotions, the anticipation of emotions, the interpretation of emotions, and the experiencing of emotions, of course. If you lack all these, you are not human in a basic sense, and definitely you are not able to decipher humans or to read them properly. You misinterpret cues, social, sexual, and individual psychological cues. So there are environments where alexithymia is encouraged, for example in the army, or in an operating theatre, in a hospital, or if you're a cop, policeman. So whenever you come across situations where emotions would be disruptive to functioning, would endanger or undermine functioning, you're encouraged to be alexithymic, which again convinces me that alexithymia could be and probably is an acquired feature, an acquired mental health element, whatever it may be. You know, we're not, what I believe is that alexithymia reflects a set of expectations from oneself, internalized expectations. If one perceives oneself as a bad object, then one must cleanse oneself. One must establish rituals to fend off the evil within. There's catastrophizing going on. I'm a bad object. I'm going to do bad things. I'm going to end badly. I'm going to hurt people around me, including my nearest and dearest. And so the individual develops withdrawal symptoms, an avoidant strategy, which is I think another way of capturing the essence of alexithymia. French psychoanalyst, inappropriately named Joyce McDougall, thought a very French name, she suggested that alexithymia is not actually a neuropsychological thing. She introduced an alternative term. She called it disaffectation. She said that alexithymia is psychogenic. It is a psychological thing and it involves disaffectation. The disaffected individual, according to her, had at some point, as she puts it, I'm quoting, experienced overwhelming emotion that threatened to attack their sense of integrity and identity. And then they had to defend themselves against this, for example, abuse and trauma in early childhood. They had to create boundaries and protect themselves somehow. And what the solution they have chosen is to eliminate emotions. Exposure to the environment, exposure to caretakers and caregivers, parental figures, primary objects, influential peers, role models, teachers. Exposure to these people has become very painful and hurtful and threatened the functioning and the integrity of the self. And so the child chooses to not feel, to pulverize and eject and reject all emotional representations from consciousness, to repress emotions, to pretend that they don't exist. And this is exactly what the narcissist does. The narcissist self-inhibits. The narcissist refuses to access his positive emotions because they are intimately and inextricably linked to negative emotions. The narcissist says, if I were to feel love, I would also be forced to experience shame and pain. If I were to go through the motions of intimacy, I would also experience rejection and abandonment, so better not. Alexithaemia is a crucial aspect of narcissism. It is the narcissist's rejection of positive emotions. The narcissist believes that positive emotions are vulnerabilities, weaknesses, dangerous risks. While negative emotions are self-efficacious, negative emotions get you places, allow you to attain goals and to self-actualize. So narcissists are very strong on negative affectivity, envy, anger, hatred, but they are incapable of experiencing positive effects, positive emotions. McDougall said that the disaffected individual has made a choice as a child. And this is very reminiscent of phenomenologies in psychology. I'll dedicate the video to this school of psychology. Anyhow, what McDougall says is that all infants are born unable to emote, unable to identify, organize emotional experiences, unable to speak about emotions, unable to express emotions. The word infant, by the way, is from Latin and it means not speaking, so that's very apt. And McDougall said that infants are divorced from emotions by reason of their immaturity and they are, as she puts it, inevitably alexithymic. In 1985, McDougall proposed that the alexithymic part of an adult personality is probably an extremely arrested and infantile psychic structure. Again, this is very reminiscent of narcissism. The first language of an infant is nonverbal, mainly mother's facial expressions. The child learns to read expressions and reflexively respond to them. This is known as reflexive empathy. The parent's emotional state is very crucial because the child needs to read the mother's face in order to gauge when, for example, to get food. The child's survival and development crucially depend on the child's ability to decode mother. So gradually the child gives up on alexithymia. Why is that? Because if you don't experience emotions yourself, you would be unable to decipher or decode or identify or recognize emotions in others. It's exactly like self-love. If you have never loved yourself, you would never be able to love and you would never be able to be loved by anyone, because you would consider yourself unlovable. Similarly, if you have never experienced emotions, you would never be able to recognize emotions in others and interpret them correctly and then act accordingly. So the infant to survive has to give up on alexithymia. But this is only when the mother is good enough. When the parental figure is capricious, arbitrary, absent, metaphorically dead, depressive, selfish, instrumentalizing, parentified. In other words, when the parental figure, mainly the mother, is rejecting and frustrating, the child is no incentive to give up on alexithymia. So we all start as alexithymic and some of us never give up on it because we are not incentivized to give up on it. There's no reward to giving up on alexithymia and there's a very high reward for keeping it. Because if you're exposed to a bad parent, a withholding, avoiding, abusive, neglectful, hateful, fearful parent, then not experiencing emotions is a brilliant survival strategy. Experiencing emotions has no beneficial outcomes, so why would you? It consumes energy and leads nowhere. Only to frustration, only to rejection, only to abandonment and only to pain, emotions of bed, emotions of weaknesses, emotions of vulnerabilities. Abused and traumatized children remain alexithymic for life. Neglect or indifference in a child's facial expressions without proper feedback by the parent promotes invalidation of the child's facial expressions and later on of the child's emotional expressions. In the lack of validation, there is essentially negative reinforcement and the child regresses back to alexithymia, the safe haven of alexithymia where emotions don't threaten him with pain and with hurt. The parent's ability to reflect self-awareness is a crucial factor. If the child's parents, especially the mother, if they are alexithymic because they are, I don't know, narcissistic or schizoid or avoidant or whatever, then again the child is no incentive to transition from alexithymia to emotionality. I think the transition from alexithymia to emotionality is a close correlate or a reflection of the transition from narcissistic libido, self-invested libido and object relations, the ability to discern the separateness and externality and existence of other people and the wish to interact with them. This kind of wish, the very concept of object relations, crucially depend on access to emotions. Emotions are the engines of action, not cognitions. Emotions are a form of cognition, but this subspecies of cognition is what drives action. Emotions are directional. You love someone, while cognitions are solipsistic and autistic. Your thoughts are inside your head. They don't have to motivate you, they don't have to move you outside yourself. Your thinking doesn't have to deal with the world as it is. Your thinking doesn't necessarily motivate you to act, but all emotions motivate you to act, anger, love, hatred, you name it. They are all motivational, they are all attitudinal. Watch a movie I posted yesterday about cognition. So, another model which I find useful was proposed by priest, P-R-E-E-S-E, and his colleagues. It's essentially an attention appraisal model of alexithymia, cognitive behavioral framework, so to speak. In this model, alexithymia levels are due to the developmental level of people's emotion schema, the cognitive structures used to process emotions. The extent to which people are avoiding their emotions is an emotion regulation strategy. It's not very different. This conception is not very different to McDougals, by the way, and to my modifications that I'm proposing. The avoidance of emotion alexithymia is a strategy. It's a choice. It's a regulatory strategy. It's a way to regulate your internal environment and to avoid being overwhelmed and dysregulated, as is the case in borderline personality disorder, for example. So, a person's alexithymia is measured, can be measured, I told you, there are a dozen tests and so on and so forth. And in the attention appraisal model, we distinguish three components in alexithymia. Difficulty to identify feelings, this is known as D-I-F. Difficulty to describe feelings, this is known as D-I-F. And externally oriented thinking, E-O-T, tendency to not focus attention on emotions, actually to not focus attention on the internal world, but on the external world. And this, again, links to unenquistion. Unenquistion is perfectionism, but it's about performance. Unenquistion is performance-oriented, and we perform in the external world. Unenquistion is public-facing, is outward-oriented, so it fits well with alexithymia. We used to think erroneously that alexithymia goes hand in hand with inability to imagine, constricted, imaginal processes, it was called. In other words, inability to fantasize, for example, or to daydream, or to plan, or to perceive other people appropriately, something known as aphantasia. That is not the case. Today we know it's not the case. Okay, so alexithymia, as we said, probably has psychodynamic roots, developmental, psychological developmental roots, as well as maybe neurological and genetic roots. Michael Bagby and Graham Taylor suggested that alexithymia is somehow related to an absence or lack or deficiency in psychological mindedness and emotional intelligence. They said, and I'm quoting, there is strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress. Psychological mindedness is the capacity for self-examination, self-reflection, introspection, personal insight, and again we're beginning to see the links with, for example, narcissistic personality disorder. All these are lacking. Narcissists are very lacking when it comes to psychological mindedness, which includes also the ability to recognize meanings that underline overt words and actions, to appreciate emotional nuance and complexity, to recognize links between past and present, to gain insight into ones and others, motivations and intentions. So the narcissist lacks all these, and what these psychologists, Bagby and Taylor proposed, is that this is actually the problem with alexithymia. So in a way they're saying that alexithymia is a form of narcissism in effect. They haven't said it, but this is the outcome of their work. So psychological mindedness is a person's ability to see relationships among thoughts, feelings and actions with the goal of learning the meanings and causes of experiences and behaviors. That's the definition. I was just citing it. It definitely describes the main lacuna, the main lack and deficiency in narcissism. Similarly, emotional intelligence is the ability to perceive, use, understand, manage and handle emotions, recognize one's own emotions and other people's emotions, use emotional information to guide thinking and behavior, discern between different feelings, label them appropriately, adjust emotions to adapt to environments. All this is missing in narcissism. So, and this is Goldman, mainly Goldman's work and Daniel Goldman's work. I'm going to discuss these issues in a future video, much more at length. So the alexithymic person has typical deficiencies. He has problems identifying, processing, describing and working with his own feelings. There's a lack of understanding of the feelings of others, difficulty to distinguish feelings and bodily sensations such as arousal, confusion of physical sensations often associated with emotions. Even dreaming and fantasies are a bit different because they kind of lack emotions. They're more action oriented, detail, highly specific detail, which again, and they involve logical thinking. And this again is strongly indicative of unenquistion. It's the dreams of alexithymic people are unenchastic. They are about performing. They're about action. They are about perfection. They're about getting things right. They're about logical sequences. There's no emotion there. There's no humanity in a way. Indeed, many alexithymic people compare themselves to machinery or to robots, which is something narcissists do all the time. They're very logical. They're very realistic. They're very structured, very structural. Now, it's not that people with alexithymia cannot experience anxiety, depression or dysphoria, cannot cry, cannot rage. It's not the issue here. It's not about the external manifestations of emotions, including effects. It's that they are incapable of describing what is happening to them. They appear confused when they are questioned. They mislabel things. That's why the narcissist mislabels the shared fantasy as love. Mislabels coordination as desire. There's a lot of misapprehension of the internal landscape. There's a reliance and dependence on other people. Not only for regulation, but for reality testing, including emotional reality testing. What it is that I'm feeling, tell me. According to Henry Crystal, individuals with alexithymia think in an operative way. They appear to be super adjusted to reality, but in a very cold, calculated and machine-like manner. They are focused on the trivial. They are very attuned to chronology. Their reactions and events in daily life are perceived as monotonous, but orderly, rigidly orderly and structured. This is all unencased here, in effect. So these individuals, alexithymic individuals, seem to be oriented towards things. That's why they objectify themselves. They describe themselves as robots or automatons, machines and so on and so forth. Their responsiveness is very limited. Not only to emotions, not only to other people's plight and conditions, not only to their environment, but also to proactive processes such as psychotherapy. So they are capable of expressing emotions, verbally, verbalizing emotions. That's a common misconception. A common myth. They are even capable of acknowledging that they're experiencing emotions, but they fail to identify. They mislabel them. That's very important to understand. I mean, decades before the term alexithymia has been coined in 1967, Sifnios noted that patients often mention things like anxiety and depression. And the distinguishing factor, according to him, was their inability to elaborate beyond the few limited adjectives. So they would say, I'm happy. I'm unhappy. But they couldn't go further than that. People with alexithymia have poorly differentiated emotions. They have no ability to distinguish and describe emotions to other people. There's a sense of emotional detachment from oneself and from others, no connection to others. And consequently, they're very prone to anhedonia, inability to experience pleasure, and to dysphoria, a general kind of diffuse sadness bordering on this cycle of themes. So life satisfaction is very low, happiness is very low, and so on and so forth. One key issue in alexithymia may be a problem with the theory of mind and inability to conceive of other people's minds. What makes other people tick? The psychology of other people, the inner experience of other people, they're all foreign to alexithymic people. And to narcissists, is this a coincidence? I don't think so. I think there's a shared etiology and probably a shared psychopathology because anhedonia is an element in narcissism and alexithymia is an element in narcissism. And the exact overlap is not clear. I'm not saying that I've solved the issue of how these disorders or problems overlap or interact even, but I'm quite sure there's a very strong connection. I can conceive or reconceive of narcissism as a combination of perfectionism and alexithymia, and it would cover 90% of the problem in my view. Difficulty to identify feelings, externally oriented thinking. They're common in ADHD, for example, as well. Hyperactivity goes with it. And in autism spectrum disorder. And we know that ADHD and ASD are increasingly more correlated with narcissism. And so another very important thing is that alexithymia is diagnosed in well over 40% of people with post traumatic stress disorder. So it's post traumatic in a sense. And this tends to lend support to Joyce McDougal's conception of alexithymia. And to my contention, that alexithymia is associated with narcissism because narcissism is a post traumatic condition. Same as borderline personality disorder. And this connection between PTSD and alexithymia is pretty impressive. It's very strong. It's not that alexithymia has been divorced from personality disorders. Alexithymia has been diagnosed, has been identified. In personality disorders such as schizoid, avoidant, dependent, schizotypal personality disorders, anxiety disorders, certain sexual disorders and so on. But I think it is also at the core of at least some dramatic erratic personality disorder such as narcissism and borderline. The inability to modulate emotions explains why some people with alexithymia are prone to what is called discharge tension. Rising from unpleasant emotional states through acting out, through impulsive acts, compulsive behaviors, which are very typical in borderline personality disorder and in conditions of extreme injury or modification in narcissism. The failure to regulate emotions cognitively results in prolonged neural activity, so to speak, in the autonomic nervous system, in the neuroendocrine system and is closely associated with somatic diseases. Anyhow. Crystal and Sifneus both suggested that limited ability to experience positive emotions is at the core of alexithymia. They said that people with alexithymia are unhedonic and I think this is one of the three key elements in pathological narcissism. Lack of access, inability to experience positive emotions, inability even to identify positive emotions, mislabeling other things as positive emotions. And this is where conflating alexithymia with narcissism would add clinical insight rather than impair it. Put together an alexithymia, alexithymia and narcissism and we may gain new insights as to the etiology and the developmental path of narcissistic disorders of the self which include borderline personality disorder and to some extent histrionic and antisocial schizoid and paranoid avoidant personality disorders.