In alexithymia-type psychosomatic patients who do not have the capacity to mentalize, arousal is experienced non-symbolically within the body. These people also often have significant histories of attachment trauma and other adverse childhood experiences. This article extends a previous neuropsychodynamic formulation that takes into account recent work on how attachment trauma is internalized in developing brain circuits. Specifically, it considers the possibility that early attachment trauma impairs thalamo-amygdala-striatal-thalamic circuits, resulting in disconnect of subcortical arousal to the prefrontal cortex where the arousal can be mentalized. These impaired subcortical circuits perpetuate stress deep within these patients’ implicit procedural circuitry, making them very resistant to psychotherapy. Knowledge of this interaction deepens our understanding of these patients, who suffer greatly, and suggests guidelines for treatment approaches with which they are more likely to engage.