Introduction
Many autistic people describe knowing that something feels wrong but struggling to identify exactly what they are feeling. They may recognise a sense of discomfort, tension or overwhelm but find it difficult to determine whether they are anxious, frustrated, sad, tired or angry.
This experience may be related to alexithymia, a term that literally means “no words for emotions.”
Over the past decade, researchers have become increasingly interested in the relationship between autism and alexithymia. In fact, some researchers have suggested that a number of emotional difficulties previously attributed to autism may actually be explained by co-occurring alexithymia.
Understanding alexithymia can help autistic people, parents, teachers and professionals better understand emotional experiences, improve communication and develop more effective support strategies.
What Is Alexithymia?
Alexithymia is not a mental health condition or a diagnosis in its own right. Instead, it is a trait characterised by difficulties identifying, understanding and describing emotions.
People with alexithymia may experience:
- Difficulty recognising emotions in themselves
- Difficulty describing emotions to others
- Difficulty distinguishing emotions from physical sensations
- Challenges recognising emotions in other people
- A tendency to focus on external events rather than internal emotional experiences
Importantly, alexithymia does not mean that a person lacks emotions.
People with alexithymia experience emotions just like anyone else. The difference is that those emotions may be harder to identify, interpret or communicate.
How Common Is Alexithymia in Autism?
Research consistently shows that alexithymia is significantly more common among autistic people than in the general population.
A systematic review and meta-analysis by Investigating alexithymia in autism: A systematic review and meta-analysis found that approximately 49.93% of autistic individuals met criteria for alexithymia, compared with 4.89% of neurotypical individuals. The researchers concluded that alexithymia is common in autism, although it is not present in every autistic person.
This finding is important because it highlights that autism and alexithymia are related but distinct experiences.
Not every autistic person has alexithymia, and not everyone with alexithymia is autistic.
Why Is Alexithymia More Common in Autism?
Researchers are still exploring exactly why alexithymia occurs more frequently in autistic people.
Several theories have been proposed.
Differences in Interoception
One leading explanation involves interoception.
Interoception refers to the ability to notice and interpret signals coming from inside the body, including:
- Hunger
- Thirst
- Fatigue
- Pain
- Anxiety
- Stress
- Excitement
Many autistic people experience differences in interoceptive awareness. When internal signals are difficult to interpret, recognising emotions can become more challenging.
For example, you might notice:
- A racing heart
- Tight muscles
- Stomach discomfort
but struggle to recognise that these sensations reflect anxiety or stress.
Emotional Information May Be Processed Differently
Research suggests that some autistic individuals may process emotional information differently, making it harder to connect physical sensations, thoughts and emotions into a coherent emotional experience.
This does not mean emotions are absent.
Rather, the emotional experience can feel less clear, more confusing or harder to label.
What Does Alexithymia Look Like in Everyday Life?
Alexithymia presents differently from person to person.
Some common experiences include:
Difficulty Answering Questions About Feelings
Questions such as:
- “How are you feeling?”
- “What’s wrong?”
- “Are you upset?”
may feel surprisingly difficult to answer.
You may genuinely not know.
Emotional Delays
Many autistic adults describe understanding their emotional reaction hours or even days after an event occurred.
For example:
A difficult conversation may initially seem manageable, only for you to realise later that you were actually hurt, angry or anxious.
Struggling to Communicate Needs
If you cannot identify an emotion, it becomes much harder to understand what support you require.
For example:
- Are you tired?
- Overwhelmed?
- Anxious?
- Frustrated?
- Sensory overloaded?
Without recognising the cause, finding a solution becomes more difficult.
Frequent Emotional Overwhelm
Paradoxically, some people with alexithymia experience intense emotional reactions.
When emotional signals go unnoticed for long periods, they may build until the nervous system becomes overwhelmed.
This can contribute to:
- Meltdowns
- Shutdowns
- Emotional dysregulation
- Burnout
Alexithymia and Empathy
One of the most interesting areas of research concerns empathy.
Historically, autism was incorrectly associated with a lack of empathy. Modern research challenges this assumption.
Some researchers now suggest that difficulties recognising emotions in others may sometimes be linked more closely to alexithymia than autism itself. We now understand that autistic people often experience significant emotional empathy and compassion, but may find it difficult to identify or communicate emotions effectively when alexithymia is also present.
An autistic person with alexithymia may:
- Care deeply about others
- Experience strong compassion
- Feel emotionally affected by another person’s distress
while simultaneously finding it difficult to identify emotions or know how to express them.
Alexithymia in Children
Alexithymia can affect autistic children as well as adults.
Parents may notice that their child:
- Struggles to discuss feelings
- Has difficulty understanding emotional language
- Becomes overwhelmed quickly
- Appears confused by discussions about emotions
- Finds emotion-based social situations challenging
Questions such as “How do you think that made him feel?” may cause confusion or anxiety for some autistic children with alexithymia.
This does not mean the child lacks empathy or emotions. Rather, they may need support understanding and identifying emotional experiences.
The Impact on Mental Health
Alexithymia has been linked to increased vulnerability to:
- Anxiety
- Depression
- Emotional dysregulation
- Burnout
- Reduced wellbeing
When emotional experiences are difficult to identify, it can be harder to recognise stress early and take steps to regulate emotions before they become overwhelming.
For some autistic people, understanding alexithymia can be an important part of improving self-awareness and mental health.
What Can Help?
Although alexithymia cannot simply be “switched off,” there are strategies that many people find helpful.
Expanding Emotional Vocabulary
Learning the language of emotions can help build emotional awareness.
Tools may include:
- Emotion wheels
- Feelings charts
- Mood trackers
- Journals
Focusing on Physical Clues
Because emotions often appear as bodily sensations first, it can help to ask:
- Is my heart racing?
- Am I tense?
- Do I feel restless?
- Is my stomach uncomfortable?
Over time, these sensations may become linked to specific emotions.
Developing Interoceptive Awareness
Activities that encourage awareness of internal body states may be useful.
Examples include:
- Mindfulness practices
- Body scanning exercises
- Tracking hunger, thirst and fatigue
- Sensory awareness activities
Giving Yourself Time
Many autistic people process emotions more slowly.
You do not need to immediately answer questions about how you feel.
Sometimes understanding emerges later, and that is okay.
Key Takeaways
Alexithymia is a common but separate experience that frequently occurs alongside autism. It involves difficulties identifying, understanding and describing emotions, rather than an absence of emotions themselves.
Research suggests that approximately half of autistic individuals experience alexithymia, making it far more common than in the general population.
Understanding alexithymia can help explain why some autistic people struggle to answer questions about feelings, recognise stress early, communicate emotional needs or identify emotions in others. It can also challenge outdated misconceptions about empathy in autism.
Most importantly, alexithymia is not a sign that somebody is emotionally detached or does not care. Often, it simply means that emotions are harder to identify, understand and put into words.
References
Bird, G. and Cook, R. (2013) ‘Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism’, Translational Psychiatry, 3(7), e285.
Kinnaird, E., Stewart, C. and Tchanturia, K. (2019) ‘Investigating alexithymia in autism: A systematic review and meta-analysis’, European Psychiatry, 55, pp. 80-89.
Milton, D. (2012) ‘On the ontological status of autism: The “double empathy problem”’, Disability & Society, 27(6), pp. 883-887.
Shah, P., Livingston, L.A., Callan, M.J. and Player, L. (2019) ‘Trait autism is a better predictor of empathy than alexithymia’, Journal of Autism and Developmental Disorders, 49(10), pp. 3956-3964.
South, M. and Rodgers, J. (2017) ‘Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders’, Frontiers in Human Neuroscience, 11, p. 20.
Tchanturia, K. and Uljarević, M. (2021) ‘Alexithymia and autism spectrum disorder: Current evidence and future directions’, Current Opinion in Psychiatry, 34(2), pp. 80-86.
Williams, D. and Happé, F. (2010) ‘Recognising socio-emotional difficulties in autism: The role of alexithymia’, Research in Autism Spectrum Disorders, 4(4), pp. 706-712.
