It happens suddenly: tightened chest, clenched jaws, and racing thoughts. You feel something, but in the moment, you have no words to describe it. If asked, you might draw a blank and be at a loss for words. For many autistic people, this is a normal reality: a condition now described as alexithymia.
The link between autism and alexithymia tends to be widely misunderstood. It’s not that you don’t feel things, but often, the signal to describe how exactly you feel is just not there. To help you understand this link, this page will explore:
Alexithymia is not a condition you will find in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). It is a personality trait first described in the 1970s by Peter Sifneos, a psychiatrist. The word itself loosely translates to “no words for emotion.”[1] So, people who have it tend to have difficulties in three common areas:
What’s more, the condition exists on a spectrum, with some people only describing a cloud of mild fog around their feelings, while others feel completely locked out of their emotions.
About one in every ten people in the general population experiences this condition to a significant degree, making it far more common than many people think.[1] You might also see it described as “emotional blindness,” even though this label does not adequately capture the nuances of the condition.
Alexithymia is not just a state of being cold, or uncaring, or inner emptiness. People with this condition experience strong emotions just like every other person. The trouble, however, is in decoding these emotions, not just feeling them. For instance, a pounding heart may be vaguely described as “something off” without further sorting the emotion into anger, hunger, or excitement.
So, how do autism and alexithymia relate to each other?
It is more than just a simple connection between autism and alexithymia. Both have more deeply rooted physiology than chance could simply account for.
A research review pooled data from fifteen separate studies and discovered that about half of people with autism also meet the diagnosis criteria for alexithymia. Among people who are not autistic, the figure is around 5%.[2] This means that being autistic significantly increases the risk of developing alexithymia.
This large gap has shifted how researchers think about feelings and the autism spectrum disorder (known as ASD). For many years, the inability to read autism emotions was considered a core symptom of autism itself.
In 2013, Richard Cook and Geoffrey Bird developed a different idea: an “alexithymia hypothesis.” They proposed that the inability to understand one’s own emotions and those of other people is actually a co-occurring symptom of alexithymia rather than just autism.[3]
Later on, more studies supported this idea. The factor controlling how well people can read emotional facial expressions became dependent on alexithymia rather than just the severity of autism.[4]
These studies changed the protocols for managing and supporting people with alexithymia. Since the emotional processing difficulty was linked heavily with alexithymia rather than autism traits, it changed how therapy approached improving emotional awareness.
Also, these studies sit comfortably with a neurodiversity view: Being autistic is not an anomaly to be corrected, but that the accompanying difficulties that lead to distress are worthy of support.
Let’s be clear on a point: autism and alexithymia are two different things, although they may co-occur in many cases. In autism, neurodevelopmental differences shape sensory experience, communication, and relationships with the outside world. In alexithymia, the focus is on emotional awareness.
As such, autism can present without alexithymia. In fact, nearly half of all autistic people do not meet the threshold for alexithymia.[2] The reverse is also true. Alexithymia can present alongside anxiety, depression, and other conditions, without autism.
So why does the mix-up occur?
For one, the outward-presenting signs for both can be similar. Someone who often goes quiet, answers questions in a flat, factual way, or seems hard to reach may be exhibiting traits of either condition or both. So differentiating between both conditions requires a thorough assessment and not just a hunch.
Alexithymia can play out internally and can remain undetected for many years, sometimes a whole lifetime. In fact, many autistic adults only recognize it once someone finally describes it properly, and it clicks.
Usually, the signs of alexithymia show up in a handful of recurring ways, including:
Camouflaging autistic traits or masking to fit in can make the signs of alexithymia harder to spot. Not everybody will notice these signs immediately. However, what matters is if patterns are observed across autism and alexithymia and if understanding emotions has been a lifelong journey or a random one-off thing.
The impacts of alexithymia can be more severe than most people imagine. These impacts tend to be noticed in three areas:
In the early stages, relationships are often the first thing to get affected. When you simply can’t understand how you feel and how to share what you feel, people around you may label you as:
But these difficulties in expressing emotions have nothing to do with a lack of love. If left unattended, these translation problems may wear down a valuable relationship.
The mental effects are a bit more well-researched. In one study that followed autistic adults over time, difficulty identifying feelings specifically predicted more severe anxiety. At the same time, difficulty describing them lined up with greater social-communication and general communication difficulties.[5]
These findings make intuitive sense; if repeated bouts of worry never get labeled as worry, it accumulates within the body. Therefore, they can manifest as a racing heart or a sleepless night. As a result, rates of anxiety and depression are higher in autistic adults who also live with alexithymia.[6]
Emotional regulation can also become difficult. To manage a feeling, you must be able to adequately name and describe it. If this task fails, emotional dysregulation can follow. Small stresses can accumulate into full overwhelm without any serious warning.
Over time, self-esteem can dip, and a quiet layer of shame could set in, leading to you never feeling quite “right.”
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
An encouraging part of managing alexithymia is that emotional awareness is not static. It behaves more like a skill, and a skill can be built with the right practice and support through self-awareness.
The aim of autism and alexithymia treatment usually isn’t an outright “cure.” Treatment is aimed at widening your emotional vocabulary, connecting the sensations in your body to actual feelings, and easing the anxiety or low mood that so often worsens in autism and alexithymia.
Below, we consider some of the common, evidence-based support options for managing alexithymia.
Studies have shown that focusing on emotional self-awareness can significantly improve mood and communication.[5] Psychotherapy, also known as “talk therapy,” is the main approach for this. Cognitive behavioral therapy (CBT) works by connecting thoughts, feelings, and behavior. In the early stages, therapy looks like emotional language classes where you:
Dialectical behavior therapy (DBT) focuses more on emotional regulation and distress dissonance. It also leans heavily toward recognizing emotions as they happen. Both approaches can help you build genuine emotional intelligence over time, while also helping with co-occurring anxiety and depression that could show up.
One thing worth flagging: Therapy generally works best when it’s adapted for autistic clients.
For many people, the emotional burden of alexithymia and autism gets so heavy that weekly therapy sessions may be inadequate. This is especially true when anxiety, depression, or overwhelm starts interfering with:
At this point, more support is likely needed to make a difference.
Residential treatment provides a structured, around-the-clock setting where therapy, skill-building, and any needed medication support all come together in one place, well away from the usual daily pressures.
The plan is to give you enough space and support to ease pressures, learn effective tools, and step back out to your daily life with firmer footing under you. For plenty of people, this kind of dedicated reset is exactly where lasting change begins to take hold.
The connection between autism and alexithymia can shape a person’s entire emotional world, but it doesn’t have to be carried alone or left unaddressed. With the right therapy and autism support, emotional awareness can grow, relationships can steady, and the anxiety and shame that build up around “not being able to feel right” can genuinely start to lift.
A Mission For Michael (AMFM) provides treatment for adults experiencing various conditions. Anxiety support is a phone call away – call 866-478-4383 to learn about our current treatment options.
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At AMFM (A Mission For Michael) Mental Health Treatment, we work with adults facing the mental health challenges that so often accompany autism and alexithymia, from anxiety and depression through to that feeling of being chronically overwhelmed. Our approach is compassionate, evidence-based, and shaped around you as an individual.
We don’t treat the goal as erasing how you experience emotion. We treat it as helping you understand it and work with it, at a pace that actually feels manageable. Our team of expert clinicians believes in treatment persistence and will personalize your treatment plan so you can achieve lasting, life-changing outcomes.
AMFM Mental Health Treatment provides the full spectrum of care, including residential treatment and multiple levels of outpatient treatment programs. We offer an intimate, focused mental health treatment experience for adults in home-like settings that are carefully maintained to be peaceful, comfortable spaces.
Our locations in California, Minnesota, and Virginia accept insurance and are in-network with most major providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form or call us at 866-478-4383.
If you’re ready to take a step toward steadier ground, reach out to us. We’ll help you start the admissions process or share more about how we can support your mental well-being. Our compassionate team is available 24/7 to answer your questions and provide guidance with no obligation.
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