Understanding Alexithymia

Image of a person holding up a white circular feelings wheel in front of their face.

By: NeuroSpark Health

Alexithymia is a term that describes difficulty in identifying, expressing, or understanding one’s own emotions. It is not a diagnosis in and of itself, and there’s no formal alexithymia test, but rather a commonly neurodivergence-related trait that can affect how people experience and process their feelings. For those who experience alexithymia, emotions can feel elusive or abstract, making it hard to pinpoint what they're feeling or communicate those emotions to others. Understanding alexithymia can help promote healthy and understanding relationships with those who experience it as well as help those people better understand themselves.

What is Alexithymia?

The term "alexithymia" comes from the Greek words "a" (without), "lexis" (word), and "thymos" (emotion). Essentially, it means "without words for emotions." People with alexithymia find it challenging to recognize and describe their own feelings. This is not simply a lack of emotional awareness or lack of feelings, but a deeper cognitive disconnect between one’s emotional experience and the ability to interpret and communicate it.

While everyone may experience certain moments where it's challenging to express emotions, alexithymia is more pervasive and consistent. It affects a person's ability to engage with emotions across many contexts—interpersonal relationships, self-reflection, and everyday situations. Alexithymia is typically seen as a spectrum, meaning that some individuals may experience mild difficulty with emotions, while others may struggle significantly.

Key characteristics of alexithymia include:

Difficulty identifying emotions: Individuals with alexithymia may not be able to distinguish between different emotions, such as anger and sadness, or even recognize when they are feeling emotional at all.
Difficulty describing emotions: Even when they can sense an emotional experience, it may be hard to articulate it or explain why they feel that way.
Limited imagination or introspection: People with alexithymia might have a limited capacity for imagination or introspection, often struggling to engage in tasks that require creative thinking or self-reflection.
Physical focus: Emotions can be experienced as physical sensations, such as headaches or stomach discomfort, that aren’t recognized as emotional states. People often experience physical sensations when they have emotions, but those with alexithymia may struggle to connect felt sensations with emotions.

Which Neurotypes Experience Alexithymia?

While anyone can experience alexithymia, it is especially common in certain neurotypes, particularly in autistic people, ADHDers, and other neurodivergent populations. Many autistics and ADHDers ask us for an alexithymia test and we are happy to explore their experiences as it relates to each neurotype.

1. Autistic People

Alexithymia is often associated with autism, with research suggesting that a significant number of autistic people experience some level of alexithymia. While not all autistic individuals have alexithymia, it is frequently discussed in the context of how autistic people process emotions differently from neurotypical individuals. This emotional disconnect can contribute to the challenges autistic individuals may face in social interactions, as it may be harder to recognize or respond to emotional cues in themselves and others. This doesn’t mean that autistic people don’t experience emotions; many autistic people feel things deeply. However, it can mean that they may struggle to identify what they’re feeling or communicate those feelings to others.

It’s important to note that alexithymia is separate from autism. While they can co-occur, they are not the same thing, and not all autistic individuals have alexithymia. Still, understanding the overlap can be helpful in creating more supportive environments for autistic people with alexithymia.

2. ADHDers

Alexithymia also occurs in people with ADHD. ADHD is characterized by difficulty with attention, impulsivity, emotional dysregulation, executive dysfunction, and hyperactivity, among others, and these traits can also intersect with emotional processing difficulties. For individuals with ADHD, alexithymia might manifest in a lack of emotional awareness or an inability to pinpoint why they are feeling a certain way, even when emotions are intense.

ADHDers may also struggle with emotional dysregulation, which complicates the picture further. Alexithymia in ADHD can lead to frustration when feelings are misinterpreted or when emotions go unrecognized for long periods, only to erupt later in unexpected ways. Dysregulation may be difficult to control and learn to regulate, especially when the ADHDer feels confused as to what emotions they are even experiencing. It can be like a whirlwind of emotions, sensations, and feelings without being able to decipher what they are. It can be very overwhelming!

3. Trauma and Mental Health Conditions

Alexithymia is also prevalent among individuals who have experienced trauma or who live with mental health conditions such as depression, anxiety, PTSD, or C-PTSD. Trauma, particularly when experienced early in life, can affect how emotions are processed and expressed. In these cases, alexithymia may act as a coping mechanism, with individuals emotionally "shutting down" in response to overwhelming or painful experiences. It can be a protective response that can be difficult to unlearn and process.

Additionally, alexithymia is found more frequently in people with eating disorders and substance use disorders, often as part of a broader struggle with emotional regulation. These challenges can perpetuate alexithymia as eating disorders and substance use disorders often increase a disconnect between the physical body and its sensations and the mind.

What Does Alexithymia Look Like?

The experience of alexithymia can vary from person to person, but it generally involves a difficulty in recognizing, labeling, and verbalizing emotions. For some, it can mean that emotions are experienced as vague, physical sensations—such as tension in the chest, an upset stomach, or headaches—rather than recognizable feelings like sadness or joy. This can mean that people with alexithymia have trouble connecting physical sensations to their corresponding emotions.

Alexithymia can impact a wide range of life experiences.

Interpersonal relationships: Individuals with alexithymia may struggle to form or maintain close relationships, as they find it challenging to understand their own emotions or express empathy to others, even if they do feel empathetic towards them. This can sometimes be perceived as emotional coldness or distance, even though the person with alexithymia is not intentionally withholding emotion.
Decision-making: Emotions often play a role in decision-making, and without the ability to clearly recognize emotions, people with alexithymia may find decision-making particularly difficult. They may struggle to understand why they feel drawn to or repelled by certain choices.
Physical symptoms: Because emotions are not recognized as such, people with alexithymia may experience them as physical symptoms like headaches, gastrointestinal issues, or unexplained fatigue. Without an understanding of the emotional origin of these sensations, medical treatment may focus on the physical symptoms rather than understanding and addressing the underlying emotional cause.
Avoidance of introspection: Introspection, or looking inward to understand thoughts and feelings, can feel like a foreign concept to people with alexithymia. Even when encouraged to reflect on their emotional state, they may find it difficult or impossible to identify what they are feeling.

Alexithymia Test: How Is It Measured?

There is no single test for alexithymia, but it can be screened using various self-report questionnaires and interviews. One of the most widely used tools is the Toronto Alexithymia Scale (TAS-20), a 20-item questionnaire that measures different aspects of alexithymia, such as difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking (a focus on external events rather than inner experiences).

The TAS-20 asks individuals to rate how much they agree with statements like:

"I am often confused about what emotion I am feeling."
"I prefer to analyze problems rather than just describe them."
"It is difficult for me to find the right words for my feelings."

The responses are then scored to determine the level of alexithymia.

Other tests, such as the Bermond-Vorst Alexithymia Questionnaire (BVAQ), offer a more comprehensive look at both cognitive and affective dimensions of emotional processing.

It is important to note that these tests are not definitive and are often used as part of a broader psychological evaluation. Alexithymia is best understood as a trait rather than a diagnosis, meaning it can be present to varying degrees in different individuals.

Benefits of Identifying Alexithymia

Identifying alexithymia can be beneficial for individuals who struggle with emotional processing. It provides a framework for understanding why emotions feel elusive or confusing. For some people, this understanding can be a relief, as it offers an explanation for long-standing difficulties in emotional awareness or interpersonal relationships.

However, identifying alexithymia can also be challenging. For individuals who are just beginning to explore their emotional lives, confronting emotional blind spots can be difficult. It can also be frustrating for people who feel disconnected from their emotions but want to build stronger emotional awareness. This is why utilizing the support of a professional with experience with alexithymia, like a neurodiversity-affirming therapist or coach, can be hugely beneficial.

Once alexithymia is recognized, individuals can seek support and strategies for managing it. Understanding alexithymia can lead to more compassionate self-reflection and, for some, more fulfilling relationships with themselves and others.

Strategies for Managing Alexithymia

While alexithymia can present challenges, some strategies can help individuals improve their emotional awareness and communication.

1. Neuroaffirming Therapeutic Support

Affirming therapists trained in working with neurodivergent individuals can help people with alexithymia develop better emotional insight. There are a number of therapeutic approaches that may be helpful, such as somatic modalities. Bottom up approaches can be helpful with building interoception and emotional awareness.

Emotion-focused therapy (EFT) can also be useful for people with alexithymia, as it encourages individuals to explore their emotional experiences in a safe and supportive environment. In EFT, individuals learn to recognize, name, and express emotions, which can improve emotional awareness and communication over time.

2. Journaling and Reflection

For some people with alexithymia, keeping a daily journal or mood log can be a helpful tool in identifying patterns in emotional experiences. While emotions may be difficult to pinpoint in the moment, journaling allows for reflection later on. Writing about events, physical sensations, and any emotional cues (even if vague) can help build a clearer picture of one’s emotional state over time. Setting reminders for a couple times a day to check in with one’s body can help increase one’s ability to become aware of their emotional experiences. Over time, just reminding themselves to check in with their physical and emotional realities can increase interoception.

3. Body Awareness

Because emotions are often experienced as physical sensations, cultivating body awareness can be an important step in emotional recognition. Practices such as mindfulness, yoga, or progressive muscle relaxation can help individuals tune in to their bodies and develop a greater understanding of how emotions manifest physically. ND-affirming therapists and coaches can help individuals increase this body awareness and explore sensory processing sensitivities through interoception practices and bottom up processing techniques.

Conclusion

Alexithymia is a unique trait that many neurodivergent individuals possess, particularly those who are autistic, ADHD, or have experienced trauma. While it presents challenges in emotional processing and communication, understanding and recognizing alexithymia can lead to better emotional awareness and relationships. Through self-assessment, therapeutic support, and reflective practices, individuals with alexithymia can work towards understanding their emotional lives in new ways. Recognizing alexithymia is an important step toward greater self-awareness and emotional connection for those who experience it.