Dual alexithymia: A relational framework for clinical communication in oncology

Effective oncology communication depends on both patients' and clinicians' capacity to recognize and convey emotional information. Alexithymia has predominantly been studied as an individual trait. This Letter proposes dual alexithymia - an emergent interactional state arising when emotional awareness is constrained on both sides of the clinical encounter - and argues that it may disrupt the compensatory scaffolding available in single-sided dyads, producing a communication breakdown that neither party readily registers. The construct is distinguished from burnout, empathy deficits and other competing explanations, situated against existing dyadic alexithymia research, and translated into falsifiable predictions, a concise measurement strategy, and a hypothesized structural role for a third detecting node such as oncology nursing.