The purpose of this study was to assess whether alexithymia is a risk factor for autonomic dysregulation in cervical dystonia (spasmodic torticollis, ST). Alexithymia was assessed by an authorized German version of the TAS-20. In a first step, we recruited 10 ST-patients with high alexithymia scores (> 62; M = 69.2, SD = 3.0) and compared them with 10 ST-patients with low alexithymia scores (< 35; M = 28.7, SD = 4.3) on physiological and subjective responses to a cognitive and an emotional laboratory stressor. High-alexithymic ST-patients generally showed increased levels of autonomic arousal (higher SCL, more NS.SCF and lower T; 0.016 </= p </= 0.065) under all experimental conditions. In a second step, we used a less extreme alexithymia-definition (high >/= 57 vs. low </= 36) in a sample of 2 x 20 probands and found no significant differences. Our results suggest a chronically increased level of sympathetic activation in high-alexithymic patients with spasmodic torticollis.