Alexithymia refers to difficulties in recognizing and describing one's emotions. We studied potential connections of alexithymia with severity of earthquake exposure, panic/somatic symptoms, posttraumatic stress disorder (PTSD) and depression in 5,195 adolescents affected by the Wenchuan earthquake. Participants completed the Toronto Alexithymia Scale (TAS-20), the Children's Revised Impact of Event Scale (CRIES)-13, the abbreviated Kutcher Adolescent Depression Scale (KADS), and the panic/somatic subscale of the Screen for Child Anxiety-Related Emotional Disorders. The rate of alexithymia was 6.7%, and a greater proportion females were alexithymic than males (7.6% vs 5.7%). Alexithymia was more frequent among older subjects and those who were only-children. Alexithymia, severity of earthquake exposure and negative life events were independently associated with post-disaster psychological or somatic symptoms, and alexithymia was a mediator between traumatic experiences and psychopathology. Our data highlight the importance of alexithymia in the development of psychological distress, implying that alexithymia-targeted interventions may help treat or even prevent psychological distress after a disaster.