Alexithymia is characterized by deficits in the ability to identify, differentiate, and describe emotions--abilities that are of importance for social interactions, well-being, and, consequently, also for health. The aim of this study was to investigate whether achievements in cultural activities are associated with alexithymia. Participants from the Swedish Twin Registry were 2,279 men and 3,152 women in the ages 27 to 54. Cultural achievement was measured with the Creative Achievement Questionnaire (CAQ) in which participants estimate their achievement in the domains writing, music, visual arts, theater, and dance on a 7-point scale. Alexithymia was measured with the Toronto Alexithymia Score (TAS 20). In sex separated, age, and education-adjusted multivariate analyses, nonpractitioners, amateurs, and professionals in the 5 different CAQ domains were compared with regard to alexithymia scores. For both men and women, achievement in writing and music contributed statistically and independently of one another to a low alexithymia score. In addition, achievement in visual arts contributed independently to low alexithymia score in men and achievement in theatre to low alexithymia score in women. Total creative achievement was calculated as a sum score across domains, and the distribution divided into tertile groups. These groups were compared with regard to alexithymia scores. Large tertile differences were found in both sexes. The results show differences between modalities and cumulative effects of multiple creative achievements.