Deficits in emotional recognition and perception following traumatic brain injury (TBI) have been associated with alexithymia (Henry et al., 2006; Williams et al., 2001). This study examined the prevalence of alexithymia in a TBI population, and its relationship to injury severity, neuropsychological ability and affective disorder. A total of 121 patients completed the Toronto Alexithymia Scale-20 (TAS-20), a measure that addresses 3 distinct characteristics of the alexithymia concept; difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. Patients also completed a neuropsychological assessment and measures of depression and anxiety. Results confirm a high prevalence of alexithymia after TBI, relative to the general population and an orthopedic control group. There was no relationship between injury severity and the presence of alexithymia. A negative relationship was found between alexithymia and verbal and sequencing abilities, but there was no relationship with executive dysfunction or any other cognitive domain. Moderate correlations were obtained between alexithymia and affective disorder; regression analyses indicated that alexithymia, depression, and anxiety should be considered distinct, but overlapping constructs. The results of this study suggest that increased neuropsychological attention should be directed towards emotional change after head injury and its relationship with cognition and psychosocial outcome. (JINS, 2007, 13, 471–479.)