Alexithymia — when the feelings are there but the words are not

What we’re talking about

Alexithymia comes from Greek: a- (without) + lexis (word) + thymos (emotion) — “no word for the emotion”. The term was proposed by psychiatrist Peter Sifneos in 1972.

Clinically, alexithymia describes difficulty in:

1. Identifying what you feel in your body (“I feel something right now — but what?”).
2. Naming / describing that emotion with words (joy, anger, sadness, fear).
3. Distinguishing physical sensations from emotions (tight chest = fear? fatigue? hunger?).

It is mainly measured with the TAS-20 (Toronto Alexithymia Scale) ^[4] , which assesses three dimensions:

• DIF: Difficulty Identifying Feelings
• DDF: Difficulty Describing Feelings
• EOT: Externally-Oriented Thinking (outward-focused thinking, low introspection)

A TAS-20 score of ≥ 61 indicates clinically significant alexithymia.

I know something is wrong. I feel it in my body. But when someone asks what I’m feeling, I don’t have the words. It’s as if someone were speaking a language to me that I don’t understand — except it’s me trying to speak.

Alexithymia is not numbness

Very common confusion: “alexithymia” does not mean “feels nothing”. People with alexithymia:

• Do feel emotions (sometimes very strongly).
• Often have intense physiological activation (heart rate, sweat, tension, nausea).
• Poorly perceive the cognitive label that would translate that felt experience into a usable word.

It is a difficulty with conscious access, not an absence of emotion ^{[7] [1]} .

The numbers

General population

Roughly 5 to 10% depending on the study and the threshold ^[1] .

In autistic people

• Systematic review Kinnaird 2019 ^[1] across 15 studies: 49.93% of autistic people vs 4.89% of controls — a massive effect (d = 1.51).
• Specialised clinical cohorts: up to 66% ^[3] (patients followed for psychiatric disorders, with selection bias).
• All subdimensions are affected: DIF (d = 1.28), DDF (d = 1.29), EOT (d = 0.50) ^[1] .

In adults with ADHD

• Edel 2010 ^[2] on 73 German ADHD adults: 22% with TAS-20 ≥ 61. Mean score 50.94 — close to the threshold.
• The DIF and DDF dimensions are particularly elevated.
• Strong correlation with social anxiety and emotional dysregulation ^[2] .

In AuDHD people

Peer-reviewed literature specific to AuDHD is still very patchy. The clinical hypothesis — not yet tested in a large-scale study — is that AuDHD combines the risk factors of both profiles, potentially placing a majority of AuDHD people in clinically significant alexithymia.

Why it’s so common in autism: the interoceptive hypothesis

Interoception is the conscious perception of internal body signals (hunger, thirst, heartbeat, tension, urge to urinate, temperature).

Recent work ^{[7] [6]} suggests that:

• Autistic and alexithymic people show interoceptive differences: less precise or “noisier” perception of body signals.
• Emotions are above all bodily states that the brain interprets.
• If the bodily signal is blurry, the emotional label will be too.

A 2025 study ^[6] goes further and suggests a partial genetic link between autism, sensory sensitivity and alexithymia — the three may share a common biological mechanism.

What alexithymia does day to day

Documented implications ^{[3] [2]} :

• Mental health: strong association with depression, anxiety, eating disorders, somatisation.
• Relationships: difficulty expressing emotional needs, reassuring, repairing. Conflict is wrongly read as indifference.
• Therapy: classic “put words on your emotions” psychotherapy can be a wall. Body-based, art-based or structured CBT approaches work better.
• Sensory: strong correlation (r = 0.51 in Josyfon 2023 ^[3] ) between DIF and sensory hypersensitivity.
• Meltdowns / shutdowns: not knowing you are “filling up” until overflow explains crises that seem to “come from nowhere”.

Impact on emotional regulation

To regulate an emotion, you must first recognise it. Alexithymia short-circuits that first step — hence its mechanical link with emotional dysregulation. You don’t regulate what you can’t name.

What can help

Body-based approaches

• Interoception work: heartbeat perception exercises, conscious breathing, body scan. May improve emotional perception indirectly.
• Somatic Experiencing, gentle hatha yoga, qi gong: reconnect bodily sensations with their meaning.
• Physiological tracking (heart rate, muscle tension): sometimes more reliable than introspection to detect an emotional state.

Cognitive approaches

• Emotion wheels (Plutchik, Geneva): a visual tool to distinguish nuance. Especially useful at the start.
• Structured emotion journal: “at moment X, I felt Y in my body → hypothesis: emotion Z”. Build a personal vocabulary.
• Delayed labelling: you don’t have to name in real time. Coming back cold, 24 hours later, can enable identification.

Adapted therapeutic approaches

• Alexithymia-adapted CBT: starts by identifying body signals before cognitive labelling ^[3] .
• Art therapy / music therapy: a non-verbal channel, often more accessible.
• DBT: the “distress tolerance” and “interpersonal effectiveness” modules bypass the need to name emotions precisely.

What doesn’t help (and hurts)

• Demanding “tell me what you’re feeling” in the heat of the moment.
• Reading silence as indifference or refusal.
• Intensely verbal psychodynamic therapy as a first-line approach.

What is solid, emerging, debated

Solid:

• Alexithymia is overrepresented in autism (~50%) and adult ADHD (~22–40%) ^{[1] [2]} .
• The TAS-20 is a validated tool used in hundreds of studies ^[4] .
• Strong link with depression, anxiety, sensory hypersensitivity ^[3] .

Emerging:

• The interoceptive hypothesis as underlying mechanism ^{[7] [6]} .
• The idea that much of “autistic emotional blunting” is really co-occurring alexithymia (alexithymia hypothesis) ^[1] .
• Shared genetic bases for autism/sensory/alexithymia ^[6] .
• Prevalence and clinical impact specifically in AuDHD.

Debated:

• Is the TAS-20 fully valid in autistic populations? Some items are ambiguous; adaptations (revised TAS-20) are proposed ^[5] .
• Is alexithymia a stable trait or a state modifiable through intervention?
• Exact boundary with early adversity (relational trauma) — overlaps are frequent.

To remember

• Alexithymia is feeling without being able to name. Not “not feeling”.
• Roughly 50% of autistic people and 22–40% of adults with ADHD have a clinically significant form.
• It is probably linked to interoception — perception of internal body signals.
• It complicates emotional regulation, verbal therapy, and close relationships.
• It is better addressed through body-based approaches and structured tools (emotion wheel, journaling) than through “tell me what you’re feeling”.
• It is a vulnerability factor for anxiety, depression, somatisation, meltdowns and shutdowns.

Going deeper

• Emotional dysregulation in adult ADHD
• Meltdown and shutdown
• RSD — rejection sensitive dysphoria
• Masking — the invisible cost
• AuDHD — when ADHD and autism coexist