Psychology Chartered

The Impact of Alexithymia on Relationship Quality and Satisfaction Following Traumatic Brain Injury.

Posted by Ellen Shaw

9th January 2019

People can face a number of ongoing challenges following a traumatic brain injury (TBI), not least issues surrounding their relationships with a spouse or partner. Research suggests that many relationships experience strain due to factors such as a reduced rate of relational communication, adjustment and affectional expression. There is a great variation in the reported rates of relationship breakdowns following TBI, with some studies suggesting a divorce rate of up to 55% 6 years post-injury. There is consensus however, that relationship quality is low. Interestingly, individuals with a TBI can lack insight and awareness of the impact of their behaviour on relationships; this often results in fewer reported relationship problems and greater levels of overall adjustment and satisfaction from the injured spouse compared to their partner.

Arguably, one of the most damaging behaviours following injury is the loss of companionship and emotional reciprocity. One possible explanation for this is alexithymia; individuals with this trait demonstrate a reduction in emotion perception and responsivity. Although present in a small number of the population (7-13%) the rate of ‘acquired alexithymia’ following a traumatic brain injury is high, and may account for the limited perception of their own, and others’ feelings, resulting relationship breakdown.

Williams and Wood (2013) set out to explore the quality and satisfaction in relationships following TBI; hypothesising that there would be differences in the reported relationship quality between the injured and non-injured spouse, and in the alexithymia group. Employing well established measures (The Toronto Alexithymia Scale, The Index of Marital Satisfaction and The Dyadic Adjustment Scale), the authors investigated the relationships of 47 individuals with a moderate to severe traumatic brain injury, as indicated by Post Traumatic Amnesia for longer than 24 hours, or a Glasgow Coma Scale score of less than 12. Furthermore, a number of additional factors were highlighted as important variables when considering the impact of TBI on relationship quality; time since injury, length of relationship, and the presence/absence of children.

In line with previous research, there was a difference in the reported relationship quality between partners; with the non-injured spouse reporting greater problems and reduced dyadic adjustment. This highlights the difficulty some individuals have with recognising the challenges they face as a result of their injury. Significantly poorer relationship satisfaction, adjustment, cohesion and consensus were reported by the spouses of those with a TBI and ‘acquired’ alexithymia. More specifically, they reported a reduction in positive and affirming interactions such as laughing together or jointly engaging in outside interests. Interestingly, as time following injury increases, as does the number of reported problems. This possibly lends weight to the existing evidence that the likelihood of relationship breakdowns increases over time. The present study also found a positive correlation between length of relationship and measures such as level of dyadic consensus, affectional expression and overall relationship adjustment.

The authors conclude that this study offers evidence to suggest that relationship quality and satisfaction can be affected by ‘acquired’ alexithymia following TBI. Furthermore, these findings have important implications for the rehabilitation of individuals with an acquired brain injury and those involved should remain open to the possibility that emotional deficit disorder may be a factor in the challenges they face.


Williams, C., & Wood, R. (2013). The impact of alexithymia on relationship quality and satisfaction following traumatic brain injury. Journal of Head Trauma Rehabilitation, 28 (5).