When Feelings Hide in the Body: Alexithymia Strengthens the Link Between Trauma and Physical Symptoms

For many people who have lived through interpersonal trauma, distress does not always announce itself as sadness, fear, or anger. Instead, it shows up in the body: headaches, stomach pain, fatigue, and a stream of unexplained physical complaints that send patients from clinic to clinic in search of answers. A new study published in the Journal of Behavioral Medicine by Hannah F. Dobbs and Michelle M. Lilly of Northern Illinois University offers a fresh clue about why this happens, and the answer may lie in a little-known psychological trait called alexithymia.

Alexithymia, a term drawn from Greek roots meaning roughly “no words for feelings,” describes a difficulty in identifying and describing one’s own emotional states. People high in alexithymia often feel the physiological stirrings of emotion, such as a racing heart, tight chest, or knotted stomach, but cannot label those sensations as fear, grief, or shame. Instead of being recognized as feelings, these signals remain ambiguous bodily noise. Researchers have long suspected that this emotional blindness could push psychological distress into physical channels, a process known as somatization, in which emotional pain is experienced and expressed as bodily symptoms.

The connection between trauma and somatic symptoms is well established. Decades of research have shown that survivors of physical assault, sexual violence, childhood abuse, and intimate partner violence report higher rates of medically unexplained symptoms, greater use of healthcare services, and poorer quality of life. What has remained less clear is why only some trauma survivors develop this pattern. Dobbs and Lilly hypothesized that alexithymia might be the missing piece: a moderator that determines how strongly interpersonal trauma translates into bodily distress.

To test this idea, the researchers analyzed data from 531 young adults aged 18 to 29. They measured interpersonal trauma exposure using a subset of items from the Traumatic Life Events Questionnaire, somatization with the somatization subscale of the Symptom Checklist-90-Revised, and alexithymia with the Toronto Alexithymia Scale. The statistical approach was moderation analysis, a regression-based technique that asks whether the strength of one relationship depends on the level of a third variable. In this case, the question was whether the link between trauma and somatic symptoms grows stronger as alexithymia increases.

The results confirmed both predictions. Interpersonal trauma and somatization showed a small but statistically significant relationship, with a correlation of 0.178, meaning that higher trauma exposure was associated with more bodily symptoms even though the association was modest. More striking was the moderation finding: alexithymia significantly changed the strength of that relationship. When alexithymia was low, the effect of interpersonal trauma on somatization was 0.018. When alexithymia was high, the effect more than doubled to 0.043. In plain terms, trauma-exposed individuals who struggle to name and understand their emotions were considerably more likely to convert that trauma into physical complaints.

The mechanism makes intuitive sense once the psychology of alexithymia is unpacked. Emotions are not purely mental events; they are embodied experiences involving autonomic arousal, muscle tension, and visceral sensations. Most people use these bodily signals as data, interpreting a pounding heart as anxiety or a lump in the throat as sadness. For someone with high alexithymia, this interpretive step falters. The arousal remains raw and unlabeled, and the brain, searching for an explanation, may attribute the sensations to illness or injury rather than to emotional distress. Trauma amplifies this problem because it floods the nervous system with intense, often fragmented emotional responses that are especially hard to integrate when the capacity for emotional awareness is impaired.

The clinical implications of this finding are substantial. Somatization is not a trivial problem. Studies cited by the authors show that it drives elevated medical utilization and costs, independent of underlying psychiatric or medical conditions, and that patients with somatic symptom disorder often experience significant functional impairment and comorbid depression. There is also a stigma problem: people with medically unexplained symptoms frequently report feeling dismissed or disbelieved by healthcare providers, which can delay diagnosis and erode trust in the medical system. Understanding who is most at risk could help clinicians intervene earlier and more compassionately.

Encouragingly, alexithymia is not necessarily a fixed trait. Research on emotional awareness and expression therapy, a treatment developed specifically for patients with somatic symptoms, has shown promising results in randomized trials, including for fibromyalgia and in internet-delivered formats. Reviews of psychological interventions suggest that alexithymia can improve with treatment, and studies of trauma therapy have found that reductions in alexithymia are associated with better outcomes for PTSD, dissociation, and interpersonal difficulties. The authors of the new study argue that screening for alexithymia in trauma-exposed individuals could help identify those at greatest risk of developing somatic symptoms, allowing clinicians to target emotional awareness skills as part of prevention or treatment.

The study also fits into a broader scientific picture. Trauma is remarkably common worldwide, with global surveys indicating that a majority of people experience at least one traumatic event in their lifetime, and psychological trauma is increasingly recognized as a transdiagnostic risk factor that cuts across many mental disorders. Childhood maltreatment in particular has been linked to somatization and reduced health-related quality of life decades later, and somatic symptoms in adolescence have been shown to predict anxiety, depression, and severe mental illness in adulthood. By pinpointing alexithymia as a moderator, the new research adds a specific psychological mechanism to this landscape, one that could be measured and addressed.

Like all studies, this one has limits. The design was cross-sectional, meaning the data capture a single moment in time rather than tracking participants over years, so the findings show association rather than proof that alexithymia causes somatization in trauma survivors. The sample consisted of young adults, and it remains to be seen whether the same moderation pattern holds in older populations, clinical samples, or across cultures. Still, the message is clear and potentially transformative: the body often speaks for emotions that the mind cannot name, and for trauma survivors with high alexithymia, that translation from feeling to symptom is especially powerful. Teaching people to recognize and verbalize their emotions may be one of the most direct routes to easing the physical burden of psychological trauma.

Subject of Research: The moderating role of alexithymia in the relationship between interpersonal trauma and somatization

Article Title: How alexithymia impacts the association between interpersonal trauma and somatization

Article References: Dobbs, H. F., & Lilly, M. M. (2026). How alexithymia impacts the association between interpersonal trauma and somatization. Journal of Behavioral Medicine. https://doi.org/10.1007/s10865-026-00718-7

Image Credits: AI Generated

DOI: 10.1007/s10865-026-00718-7

Keywords: alexithymia, somatization, interpersonal trauma, somatic symptoms, trauma psychology, emotional awareness, somatic symptom disorder, Toronto Alexithymia Scale, Journal of Behavioral Medicine, mental health, childhood trauma, PTSD