Imagine experiencing an overwhelming emotional response but being unable to explain what you are feeling. Your heart races, your stomach tightens, and you become increasingly uncomfortable. You know something is wrong, but when someone asks, “How are you feeling?”, you struggle to find an answer.
You might say, “I don’t know.”
To someone observing, this may appear to be emotional detachment, indifference or an unwillingness to communicate. Yet the reality may be very different.
For some people, this experience is associated with alexithymia, a psychological characteristic that affects how individuals identify, interpret and describe their emotions.
Alexithymia is particularly relevant to discussions about autism because research suggests that it occurs more frequently among autistic people than among the general population.
However, alexithymia and autism are not the same thing, and understanding their differences can fundamentally change how we interpret emotional behaviour, relationships and support needs.
What is alexithymia?
The term alexithymia comes from Greek roots and is commonly translated as “no words for emotions”.
It describes a pattern of difficulties involving emotional awareness and expression. Individuals experiencing alexithymia may struggle to recognise what they are feeling, distinguish one emotion from another or communicate their emotional experiences to others.
Alexithymia is not classified as a standalone mental disorder in the DSM-5-TR or ICD-11. Instead, it is generally understood as a multidimensional psychological trait that can occur across different populations and alongside various mental health and neurodevelopmental conditions.
Its principal characteristics include:
- Difficulty identifying emotions: A person may recognise that they feel uncomfortable or distressed without knowing whether the underlying emotion is sadness, anger, anxiety or frustration.
- Difficulty describing emotions: Even when an emotional experience is recognised, translating it into language may be challenging.
- Confusion between emotions and physical sensations: Someone may notice a racing heartbeat, nausea or muscular tension without immediately recognising the emotional state associated with those sensations.
- Externally oriented thinking: Some individuals focus more readily on practical events, observable facts and external circumstances than on examining their internal emotional experiences.
Importantly, alexithymia does not mean that someone lacks emotions.
A person with alexithymia may experience love, affection, grief, fear, excitement and emotional attachment just as intensely as anyone else. The difficulty lies primarily in recognising, interpreting or communicating those experiences.
This distinction is essential because emotional expression and emotional experience are not interchangeable.
Understanding autism beyond social communication
Autism is a neurodevelopmental condition characterised by differences in social communication and interaction, alongside patterns of restricted or repetitive behaviours, interests or activities, which can include sensory differences.
Autistic individuals vary considerably in how they communicate, process sensory information, establish relationships and experience the world.
Some autistic people communicate emotions openly and fluently. Others may find emotional expression difficult, particularly during periods of sensory overload, anxiety or exhaustion.
Historically, difficulties involving emotional expression have sometimes been interpreted as inherent features of autism.
However, emerging research has challenged the assumption that all emotional processing differences observed in autistic populations are necessarily caused by autism itself.
This is where alexithymia becomes particularly important.
How common is alexithymia among autistic people?
Research consistently suggests that alexithymia is substantially more prevalent among autistic individuals than among non-autistic populations.
A 2020 systematic review and meta-analysis by Kinnaird and colleagues, published in the European Psychiatry journal, estimated that approximately 49.9% of autistic participants experienced alexithymia, although prevalence estimates varied considerably across studies.
Other studies have reported figures ranging from approximately 40% to 65%, depending on the population examined, the assessment instruments used and the criteria applied.
These findings suggest that alexithymia may affect a substantial proportion of autistic people.
However, two points are particularly important.
First, not every autistic individual experiences alexithymia.
Second, alexithymia is not exclusive to autism. It can also occur among non-autistic individuals and alongside conditions such as depression, anxiety disorders and other psychological difficulties.
The relationship therefore represents an important area of overlap rather than evidence that the two constructs are identical.
The alexithymia hypothesis: Rethinking emotional difficulties in autism
One of the most influential developments in this area is the alexithymia hypothesis.
Researchers, including Geoffrey Bird and Richard Cook, have proposed that some emotional processing differences traditionally attributed to autism may instead be more closely associated with co-occurring alexithymia.
This distinction has significant implications.
For example, imagine two autistic individuals.
The first person can recognise and describe their emotions but finds social situations exhausting because of difficulties interpreting implicit communication, sensory demands and unpredictable interactions.
The second person experiences similar autistic characteristics but also struggles to identify whether they are anxious, frustrated, disappointed or emotionally overwhelmed.
Although both individuals are autistic, their emotional support needs may be very different.
If alexithymia is overlooked, the second individual’s difficulties may be incorrectly attributed entirely to autism.
Consequently, opportunities to provide targeted emotional awareness support may be missed.
The alexithymia hypothesis does not explain every emotional difference associated with autism, and researchers continue to investigate the relationship. Nevertheless, it provides a valuable framework for understanding why autistic individuals can have very different emotional experiences.
Emotional empathy: Why alexithymia should not be mistaken for a lack of compassion
One of the most damaging misconceptions surrounding autism is the suggestion that autistic people inherently lack empathy.
Empathy is not a single psychological ability. It includes several processes, particularly:
Cognitive empathy, which involves understanding another person’s perspective, thoughts or emotional state.
Affective empathy, which involves emotionally responding to another person’s experiences.
These abilities can vary independently.
Some autistic individuals may struggle to infer what another person is feeling from facial expressions, tone of voice or indirect social cues, while still experiencing considerable emotional concern when they understand that someone is distressed.
Alexithymia adds another layer of complexity.
A person who has difficulty identifying their own emotions may also find certain emotional recognition tasks challenging. However, this does not establish that they are incapable of caring about others.
Research suggests that alexithymia may account for some differences in emotional recognition and empathy-related measures previously attributed to autism alone.
The evidence remains nuanced, and not all studies produce identical findings.
Nevertheless, the broader lesson is clear:
Difficulty recognising or expressing emotion should never automatically be interpreted as an absence of emotional experience, compassion or attachment.
Interoception: The connection between the body and emotions
Another important area of overlap between autism and alexithymia involves interoception.
Interoception refers to the nervous system’s processing of signals arising from within the body.
These signals include sensations associated with hunger, thirst, temperature, heartbeat, breathing and other internal physiological processes.
Interoception also contributes to emotional awareness.
For example, anxiety may involve a racing heartbeat, muscular tension or changes in breathing. Excitement can produce similar physiological sensations.
Recognising these bodily changes and interpreting them within a particular context helps people understand their emotional experiences.
However, some individuals experience difficulties detecting, distinguishing or interpreting internal bodily signals.
This can create a complicated relationship between physical sensations and emotional awareness.
An autistic person experiencing alexithymia might recognise that their stomach feels uncomfortable but struggle to determine whether they are hungry, anxious, overstimulated or experiencing several sensations simultaneously.
Similarly, someone may not recognise mounting emotional distress until it becomes overwhelming.
This can be particularly important when understanding emotional shutdowns, distress responses and difficulties with emotional regulation.
However, interoceptive differences are not universal among autistic people, and researchers continue to examine how interoception and alexithymia interact.
Emotional regulation: When you cannot identify what needs regulating
Emotional regulation involves recognising, managing and responding to emotional experiences.
For many people, identifying an emotion is an important first step in deciding how to respond.
Someone who recognises anxiety might use breathing exercises, seek reassurance or remove themselves from a stressful situation.
Someone who identifies frustration might take a break, communicate their needs or reconsider their approach to a difficult task.
But what happens when the emotion itself is difficult to identify?
For individuals experiencing alexithymia, emotional regulation may become more challenging because the information needed to select an appropriate coping strategy is less accessible.
An individual might recognise that they feel physically uncomfortable without understanding why.
They may become irritable without recognising underlying anxiety.
They may withdraw from social interaction without realising that they are emotionally exhausted.
For autistic individuals, these experiences may interact with sensory sensitivities, communication differences and environmental demands.
Consequently, emotional distress may sometimes become visible through behavioural changes before the individual can explain what they are experiencing.
This is particularly relevant for caregivers, educators and healthcare professionals.
Rather than assuming that an individual is being difficult, uncooperative or deliberately withdrawn, it may be more helpful to consider whether they are experiencing emotions they cannot readily identify or communicate.
Alexithymia, anxiety and depression
Research has identified associations between alexithymia and several mental health difficulties, particularly anxiety and depression.
When individuals struggle to recognise and articulate emotional experiences, communicating distress and seeking appropriate support can become more difficult.
For example, someone experiencing persistent anxiety might describe headaches, fatigue, stomach discomfort or difficulties sleeping rather than identifying emotional distress.
Another person may recognise that everyday activities have become increasingly difficult without understanding that they are experiencing symptoms of depression.
These challenges may be especially relevant to autistic individuals who already encounter barriers to accessing appropriate mental healthcare.
However, alexithymia does not inevitably lead to anxiety or depression, and the relationship between these experiences is complex.
It is also important to recognise that physical symptoms should not automatically be attributed to emotional causes. Genuine medical conditions may require assessment and treatment.
Relationships, attachment and emotional misunderstanding
Alexithymia can also influence interpersonal relationships.
Emotional communication is often treated as an essential component of intimacy, friendship and family relationships.
People are frequently expected to recognise their feelings, explain them clearly and respond appropriately to the emotional expressions of others.
For someone experiencing alexithymia, these expectations may be difficult to navigate.
An individual might deeply care about their partner but struggle to describe their affection.
A child might feel distressed after an argument but be unable to explain why.
An adult might become quiet during an emotionally charged conversation because they need additional time to process what they are experiencing.
These behaviours can be misinterpreted as indifference, avoidance or emotional unavailability.
Yet difficulties with emotional communication do not necessarily indicate a lack of emotional attachment.
Equally, it would be inaccurate to assume that alexithymia automatically causes an avoidant attachment style or relationship difficulties. Attachment patterns arise through multiple interacting developmental and interpersonal influences.
What matters is recognising that emotional communication may need to take different forms.
Some people communicate affection more comfortably through practical support, consistency, shared activities or actions rather than verbal expressions.
Understanding these differences can reduce unnecessary misunderstandings.
Why the distinction matters for children and young people
For autistic children and young people, alexithymia may be particularly difficult to recognise.
Children are still developing the language, cognitive abilities and emotional awareness needed to understand and describe internal experiences.
When alexithymia is also present, these developmental demands can become more complicated.
A child who repeatedly says “I don’t know” when asked how they feel may genuinely be unable to identify their emotional state.
Similarly, a child who becomes distressed after school may struggle to explain whether the underlying difficulty involves anxiety, sensory overload, frustration, social exhaustion or physical discomfort.
Adults may unintentionally interpret these responses as reluctance to communicate.
A more supportive approach involves reducing the pressure to provide immediate emotional explanations.
Visual emotion scales, body maps, simple choices, predictable routines and opportunities to communicate through writing or other methods may help some children.
Importantly, these approaches should be adapted to the individual’s preferences and communication abilities.
The objective should not be to force a child to express emotions in a particular way, but to help them develop an understanding of their internal experiences at a pace that works for them.
Supporting autistic individuals who experience alexithymia
Although alexithymia can present challenges, there are practical approaches that may support emotional awareness and communication.
1. Use accessible emotional language
Instead of asking broad questions such as “How do you feel?”, try more specific prompts: “Does your body feel tense or relaxed?” or “Would you describe this as comfortable or uncomfortable?”
2. Develop awareness of bodily signals
Where appropriate, help individuals explore connections between physical sensations, environmental circumstances and possible emotions, without assuming that every sensation has an emotional cause.
3. Allow additional processing time
Emotional recognition may not happen immediately. Some individuals need time to reflect before identifying or describing an experience.
4. Encourage alternative communication methods
Journalling, visual scales, emotion charts and digital check-ins can provide different ways to explore emotional experiences.
5. Avoid interpreting emotional differences as character flaws
Difficulty explaining emotions should not be mistaken for dishonesty, stubbornness, selfishness or a lack of empathy.
When emotional difficulties significantly affect wellbeing or daily functioning, support from a suitably qualified healthcare or mental health professional may be beneficial. Adapted psychological interventions, including approaches that develop emotional identification and regulation skills, may help some individuals, although evidence for specific interventions remains developing.
The role of technology in supporting emotional awareness and independent living
Digital technology offers opportunities to support individuals who experience difficulties with emotional awareness, communication and daily routines.
For example, accessible digital tools may help people record experiences over time, establish predictable routines, communicate support needs and identify recurring patterns associated with distress.
For autistic individuals experiencing alexithymia, these approaches may be particularly useful when they reduce reliance on immediate verbal explanations.
An individual may find it easier to record their experience privately than to explain it during a stressful interaction.
Similarly, a caregiver may benefit from understanding patterns in routines, reported wellbeing and support needs, provided that information is shared appropriately and with respect for the individual’s autonomy and privacy.
This is relevant to the broader purpose of My Virtual Carer, an AI-powered care support app designed to assist individuals, families and care networks through connected care, routine support and monitoring.
For neurodivergent individuals, tools that support structured routines, communication and coordinated care may help reduce some of the practical pressures associated with everyday life.
However, technology should complement rather than replace individualised care, professional assessment or direct communication. Digital records cannot independently establish what someone is feeling, diagnose alexithymia or reliably determine the cause of behavioural changes.
The most valuable technology is not technology that claims to understand someone’s emotions better than they do, but technology that gives individuals greater control over how they understand, communicate and manage their own needs.
Moving beyond assumptions about autism and emotion
Perhaps the most important lesson from research into autism and alexithymia is that outward emotional expression does not always reflect internal emotional experience.
Someone who struggles to describe sadness may still experience profound grief.
Someone who finds emotional conversations difficult may still form deep and meaningful attachments.
Someone who does not immediately recognise anxiety may nevertheless experience significant distress.
And someone who communicates differently may still possess considerable empathy and compassion.
Understanding alexithymia encourages us to reconsider assumptions about what emotional awareness, emotional intelligence and emotional connection should look like.
It also reminds us that autism is not a uniform experience.
Two autistic individuals may share certain diagnostic characteristics while having very different emotional processing abilities, communication preferences and support needs.
Recognising these differences is essential to providing genuinely individualised support.
Conclusion: Feeling emotions and understanding emotions are not the same thing
Alexithymia and autism frequently overlap, but they represent distinct constructs.
Autism involves broader neurodevelopmental differences in social communication, behaviour, interests and sensory processing.
Alexithymia primarily concerns difficulties identifying and describing emotional experiences.
When the two occur together, they can influence emotional regulation, relationships, mental health and everyday communication.
Understanding this overlap can help families, caregivers, educators and healthcare professionals move away from assumptions and towards more compassionate, evidence-informed support.
Above all, it challenges a persistent misconception: that people who struggle to communicate emotions necessarily experience them less deeply.
The inability to explain an emotion is not evidence of its absence. Sometimes, the greatest emotional struggle is not feeling too little, but feeling something deeply without having the words to describe it.
Further reading and research
For readers interested in exploring the scientific evidence, the following publications provide useful starting points:
- Kinnaird, E., Stewart, C., & Tchanturia, K. (2019/2020). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80–89. DOI: 10.1016/j.eurpsy.2018.09.004.
- Bird, G., & Cook, R. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3, e285. DOI: 10.1038/tp.2013.61.
- Brewer, R., Happé, F., Cook, R., & Bird, G. (2015). Commentary on “Autism, oxytocin and interoception”: Alexithymia, not autism spectrum disorders, is the consequence of interoceptive failure. Neuroscience & Biobehavioral Reviews, 56, 348–353. DOI: 10.1016/j.neubiorev.2015.07.006.
This article is intended for educational and awareness purposes. It does not constitute medical advice or a diagnostic assessment.
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