Alexithymia has recently been recognized as a personality trait present in the general population (1, 2). Since it was first mentioned at a European psychosomatic research conference in 1970, alexithymia has been defined as an inability to recognize and describe emotions, the use of concrete words and thoughts related to external events, and a scarcity of imaginative life (1, 3). The alexithymia prevalence in the general population ranges from 8% to 23% (4).

Studies have demonstrated the association between alexithymia, anxiety, and depression in the general population (5–10). These studies have shown that alexithymia is linked to heightened levels of anxiety and depression in the general population. The primary hypothesis is that symptoms of anxiety and depression may impede a person's ability to learn how to recognize and express their emotions, thereby intensifying the challenges associated with alexithymia. Although it has been established that sports are a protective factor against anxiety and depression, some studies advocate for incorporating exercise as a supplement to medication in individuals with treatment-resistant depression (11). Sports are also strongly associated with alexithymia, especially in some high-risk sports. The high-risk environment is central to studies on alexithymia in sports. Theoretical perspectives suggest that such an environment may facilitate emotion regulation, thereby helping individuals to experience and manage anxiety effectively, which can be particularly beneficial (12). Additionally, a dose-effect of the number of training hours has been highlighted, with a higher prevalence of alexithymia among athletes training more than 5 h per week compared to those not exceeding this threshold, being at 34.4% vs. 27.7% (13). These individuals may over-adapt to their environments, becoming unaware of their internal cues (such as physical and emotional exhaustion), which ultimately contributes to a reduced motivation for competition (12). This phenomenon is also observed in the context of competitive preparation compared to recreational practice (13).

Professional dance is characterized by the integration of physical performances with artistic demands, clearly setting it apart from purely sporting or artistic activities. This specificity exposes professional dancers to high levels of stress and anxiety in their careers. Among the stress factors are the high expectations related to the pursuit of artistic perfection, weight constraints, intensive training programs, fierce competition, and notable job insecurity (14). Thus, the multiple risks associated with the practice of dance can make it a significant factor contributing to alexithymia.

This study aims to evaluate the prevalence of alexithymia within a company of professional contemporary dancers. It also intends to assess the maximal functional capacities under effort of this population.

We performed a transversal, monocentric study at the University Center of Sports Medicine and Adapted Physical Activity, University Hospital of Nancy, France, from 01/08/2020 to 01/05/2021 in a sample of professional dancers from a contemporary national company (Centre Chorégraphique National—Ballet de Lorraine) during annual medical pre-season assessment. This center is a recognized expertise hub for monitoring professional athletes and high-level sports performers. It has been overseeing the dance company since 2018. The different inclusion criteria were age, over 18 years old, and more than 10 years of dance practice. All dancers in the company are professional dancers with a dance practice exceeding 35 h per week.

This study, conducted with a national professional contemporary dance company, revealed a prevalence of alexithymia at 9.1%. Within the same sample, the prevalence of anxiety was 9.1%, and 7 dancers showed results indicative of minor depression.

The alexithymia prevalence in the general population ranges from 8% to 27% and from 23% to 40% in the athletes (4). The results of our study revealed 2 individuals with alexithymia, one in association with anxiety, and none with associated depressive states. A strong association between alexithymia, anxiety, and depression has nevertheless been demonstrated (20–22). Thus, we can an effective alexithymia prevalence of 4.6% (n = 1) in this study, which is significantly lower than what is reported in the literature. Although the maximal exercise capacity of the professional contemporary dancers in our sample are equivalent to those observed in high-level athletes (23, 24), we found a significantly lower prevalence of alexithymia. This may be explained by the artistic intent present in contemporary dance, which differs from the sole performance focus of high-level sports and classical dance.

Several studies have highlighted a strong association of psychological disorders, such as eating disorders, with a prevalence of 16.4% among ballet dancers compared to 12.0% in the general population, as well as anxiety and depression among professional dancers (14, 25–27). An increased presence of addictive disorders has also been observed in this population (14). These disorders show a notable association with alexithymia, with prevalence rates for psychosomatic disorders, depression, and alcoholism/substance abuse of 30%–60%, 50%, and 40%–80%, respectively (4, 28, 29). However, although this study did not record the presence of addictions, as it was conducted within a routine care setting, the low prevalence of alexithymic individuals observed is reassuring. This suggests that dance could serve as a tool for emotional expression. As in the study by Bojner et al., the low presence of alexithymia in our study could be explained by a more developed awareness of emotional processing and interpretation among dancers (30). Dance allows strong emotional communication with others. Thus, although the subjects are in the field of performance, ballet, like any other type of dance, aims to convey emotional experiences, unlike non-artistic sports, which function as emotional regulators for alexithymic athletes through bodily overstimulation (sensation-seeking). Therefore, dance may promote the development and understanding of emotional qualities, as suggested by Behrends' study on empathy (31). In this sense, a study highlighted a positive effect of rhythmic movement therapy on alexithymia (32).

The limitations of this study lie in its monocentric nature. By focusing on a single contemporary dance company, representing a specific type of dance, these results cannot be generalized to all types of practice. Although the small sample size of the study may appear to be a weakness, the inclusion of one of the three national contemporary dance companies with a practice time greater than 35 h per week is a strength. Additionally, the absence of data collection on eating or addictive disorders within this population represents another limitation. Then the study was conducted during the COVID-19 pandemic, which may have impacted the psychological state of the dancers. However, the fact that this study focuses on a professional company allows for the control of extrinsic factors specific to artistic/sporting practice (hours of training, tours, number of performances per year). Furthermore, conducting effort tests for the entire population allows for the evaluation of the physiological capacities under effort of this population and confirms its comparability with that of high-level athletes.

In conclusion, this study, conducted on a population of professional dancers from a national contemporary dance company, observed a lower prevalence of alexithymia and anxiety compared to the general population and to what has been described in the literature for athletes. These results may suggest a protective effect of physical activities aimed at artistic expression against alexithymia. However, it will be necessary to conduct similar studies on a larger population and from multiple professional companies to confirm these observations.