It's not found relation betwen alexithymia and a specific medical or psyquiatric diagnosis, but it's probed more symptomatology in people with higher level of alexithymia .

Deary, Scott and Wilson (1997) proposal the negative affectivity as a mediator betwen alexithymia and medical unexplained symptoms. 

Alexithymia, neuroticism and Extroversion are diferent constructs, as are explained by Taylor et al. (1997).

My own studies showed a best prediction of emotional recognition via emotional distress than with alexithymia.

You can get more information about this arguments in this document I link you (my thesis, in spanish); pages 58 and more:

http://dspace.umh.es/handle/11000/688?mode=full

Conclusion: In my opinion,  it's important to be aware with alexithymia, but no more than negative emotion or specifics factors of alexihymia as skills to emotional regulation.

 Dear Herman,

Thanks for your interesting topic. Psychodynamic therapists have talked about this phenomenon for decades. I wonder if the following articles are of interest to you:

http://psycnet.apa.org/psycinfo/1984-25953-001

http://www.gainingmomentum.com.au/alexithymia_article.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832802/

Article In search of a framework for the treatment of alexithymia

Interesting question Herman,

As others have mentioned, Alexithymia at the moment is conceptualized as a psychopathological dimension/feature that was first described mostly by psychiatrists working in Consultion Liaison who would see patients in medical wards who would display difficulties expressing their emotional/affective states.

More recent research has found this phenomenon in other conditions, interestingly schizophrenia. I suspect Alexithymia, like other psychopathological phenomena, represents the phenotypic expression of the working of a characteristic underlying brain circuitry. The ethiopathogenic mechanisms to bring about those circuits to work that way would be the topic of a extensive debate.

Some references re recent work in schizophrenia below:

best regards,

fidel

Fogley, R., Warman, D., & Lysaker, P. H. (2014). Alexithymia in schizophrenia: Associations with neurocognition and emotional distress. Psychiatry Research, 218(1-2), 1–6. doi:10.1016/j.psychres.2014.04.020

Kubota, M., Miyata, J., Sasamoto, A., Kawada, R., Fujimoto, S., Tanaka, Y., … Murai, T. (2012a). Alexithymia and reduced white matter integrity in schizophrenia: a diffusion tensor imaging study on impaired emotional self-awareness. Schizophrenia Research, 141(2-3), 137–43. doi:10.1016/j.schres.2012.08.026

Kubota, M., Miyata, J., Sasamoto, A., Kawada, R., Fujimoto, S., Tanaka, Y., … Murai, T. (2012b). Alexithymia and reduced white matter integrity in schizophrenia: a diffusion tensor imaging study on impaired emotional self-awareness. Schizophrenia Research, 141(2-3), 137–43. doi:10.1016/j.schres.2012.08.026 

O’Driscoll, C., Laing, J., & Mason, O. (2014a). Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis. Clinical Psychology Review, 34(6), 482–95. doi:10.1016/j.cpr.2014.07.002

Todarello, O., Porcelli, P., Grilletti, F., & Bellomo, A. (2005). Is alexithymia related to negative symptoms of schizophrenia? A preliminary longitudinal study. Psychopathology, 38(6), 310–314. doi:10.1159/000088919

van ’t Wout, M., Aleman, A., Bermond, B., & Kahn, R. S. (2007). No words for feelings: alexithymia in schizophrenia patients and first-degree relatives. Comprehensive Psychiatry, 48(1), 27–33. doi:10.1016/j.comppsych.2006.07.003

van der Velde, J., Swart, M., van Rijn, S., van der Meer, L., Wunderink, L., Wiersma, D., … Aleman, A. (2015). Cognitive alexithymia is associated with the degree of risk for psychosis. PloS One, 10(6), e0124803. doi:10.1371/journal.pone.0124803

http://www.tandfonline.com/eprint/xNMFEbgK3GbAMhynSr4n/full

Hi Herman, the short answer (in my opinion) is alexithymia as a symptom rather than disorder itself. This means it is a common feature of disorders such as conversion, but is also common across many conditions. IE alexithymia itself does not allow one to differentiate among specific disorders. It does likely associate with personality patterns such as introversion, conforming and inhibited, something we are looking at in a current pediatric study. It is a very important feature to consider when making psychiatric treatment recommendations.

In our conceptual model of alexithymia we introduced in 2017 (the attention-appraisal model of alexithymia) we used a cognitive-framework to discuss how people's overall level of alexithymia likely reflects two main sources of variance: ability deficit alexithymia (i.e., the developmental level of the emotion schemas, or cognitive structures, that people use to process their emotions) and avoidance alexithymia (i.e., the extent to which people are avoiding focusing on their emotions as an emotion regulation strategy). Both these can exist in combination, and there is growing evidence from experimental and correlational studies supporting the role of both ability deficits and avoidant defences in alexithymic presentations. From this perspective, in some cases of high alexithymia it may be mostly ability deficits, in others mostly avoidant defences, and in others a more even combination. We think this conceptualisation helps to explain study findings showing that alexithymia levels can often increase or fluctuate during periods of distress or mental health symptoms (i.e., increased avoidance alexithymia to try to cope with negative affect), whilst still showing an underlying level of relative stability (i.e., reflecting the underlying developmental level of one's emotion schemas).

Conceptually, we think ability deficits and avoidant defences in high alexithymia might both be targeted by interventions that guide patients in focusing on the most pertinent aspects of an emotional response, and linking the cognitive experiences, behaviours, physiological responses, triggering events, and labels associated with that emotion. The aim being to develop a patient's emotion schemas and reduce experiential avoidance of emotions. There is some recent evidence, for example, that mindfulness activities could be quite helpful in reducing alexithymia levels (e.g., Edwards, Shivaji, & Wupperman, 2018), and therapy approaches which specifically target emotional awareness and regulation skills may be quite relevant in this respect (e.g., Dialectical Behaviour Therapy, or the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders).

It might be that, in cases where high alexithymia is due primarily to ingrained or longstanding deficits in the developmental level of people's emotion schemas, that addressing this might be more difficult or require longer time periods (as compared to cases where emotion schemas are well developed, and the emotion processing difficulties are due primarily to high usage of avoidant emotion regulation strategies). However, I think this is certainly an area where we need more research, looking at how different profiles of alexithymia may respond to different types of targeted treatment approaches.

We discuss these issues in some more detail in this paper: Article Establishing the theoretical components of alexithymia via f...