Question 1

What is alexithymia in autism and ADHD?

Accepted Answer

Alexithymia is a neuropsychological trait characterised by difficulty identifying, describing, and distinguishing emotions from physical sensations. The term comes from Greek meaning 'no words for emotion'. It is not a mental health diagnosis but affects how people perceive, process, and communicate their emotional states. Research published in 2025 shows alexithymia is dramatically more common in neurodivergent populations: 50-60% of autistic people have alexithymia compared to only 4.89% of the general population (Kinnaird et al., 2019; Yorke et al., 2025). Additionally, 40%+ of people with ADHD have alexithymia (Bloch et al., 2021). For AuDHD individuals (both autistic and ADHD), prevalence is even higher as the conditions compound each other. People with alexithymia experience three core difficulties: inability to identify what emotion they're feeling (knowing something is happening but unable to name it), inability to describe emotions to others even when identified, and difficulty distinguishing emotions from physical sensations (confusing anxiety with hunger, excitement with nervousness). Recent research by Yorke et al. (2025) in Translational Psychiatry found that the genetic relationship between autism and sensory sensitivity may actually be explained by alexithymia, not autism itself, suggesting alexithymia is a core mechanism rather than just a co-occurring trait. This explains why many autistic and ADHD adults struggle with traditional therapy approaches that assume emotional awareness.

Question 2

What does alexithymia feel like in women with ADHD and autism?

Accepted Answer

Women with ADHD and autism describe alexithymia as feeling 'something' in their body but being completely unable to name what that feeling is. Common experiences include: mind going blank when asked 'how do you feel about that?' despite genuinely trying to answer, constantly confusing emotions with each other (thinking anxiety is actually excitement, or sadness is hunger), inability to tell when basic needs arise (hungry, thirsty, need toilet, tired all register as vague discomfort rather than distinct signals), appearing fine externally while experiencing internal crisis because facial expressions don't match internal state, going from 'fine' to complete meltdown with no warning because early overwhelm signs aren't perceived, and making all decisions based on logic because emotional preferences are inaccessible. The experience varies - some people can identify specific emotions like anger or sadness but not others like contentment or joy. Some can tell positive from negative but can't get more specific. Some know they're feeling something but it's completely undefined. For AuDHD women specifically, alexithymia is worsened by masking (decades of suppressing authentic responses disconnects you from internal state), ADHD emotional dysregulation (emotions shift so rapidly there's no time to identify them before they change), sensory overload (drowns out subtler emotional signals), and hormonal fluctuations (ADHD symptoms worsen premenstrually and during perimenopause, but alexithymia prevents recognising the mood shift). Many women report feeling 'broken' or 'bad at feelings' for years before discovering alexithymia explains their experience.

Question 3

Why is alexithymia so common in autistic people with ADHD?

Accepted Answer

Alexithymia affects 50-60% of autistic people and 40%+ of those with ADHD, making it 10-fold more common than in the general population (4.89%). When both conditions are present (AuDHD), prevalence is even higher due to compounding factors. The connection is rooted in interoception - the 8th sensory system that perceives internal body signals including hunger, thirst, temperature, pain, and emotional states. Dr Megan Anna Neff explains: 'Interoception is the link that connects alexithymia and autism. When a person has a deficit of interoception awareness, they will also have alexithymia. Alexithymia can be thought of as a byproduct of poor interoception awareness.' Many autistic people experience poor interoception and struggle to perceive and differentiate internal body signals. Since emotions are physical sensations in the body (anxiety is increased heart rate and muscle tension, sadness is heaviness in chest, anger is heat and tension), poor interoception makes it impossible to identify emotions. For AuDHD individuals specifically, multiple factors compound: ADHD emotional dysregulation creates rapidly shifting emotions that are difficult to track before they change, masking behaviour (performing neurotypical responses) disconnects people from their authentic internal state, sensory overload uses all processing capacity leaving none for emotional signals, and chronic dismissal by healthcare professionals teaches people to ignore their emotional signals. Research by Hus and Segal (2025) found that ADHD and alexithymia comorbidity creates 'new phenotypes' with profound effects on language development, social-emotional functioning, and learning - the conditions interact and worsen each other rather than existing separately.

Question 4

Why doesn't therapy work for alexithymia?

Accepted Answer

Most therapeutic approaches assume you can access and identify your emotions, but alexithymia makes this fundamentally impossible without specific accommodations. Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), and psychodynamic therapy all require the ability to notice, name, and process feelings. Research shows alexithymia is associated with poor response to psychotherapeutic treatments. A 2025 review by Hus and Segal states: 'Awareness of alexithymia's poor response to psychotherapeutic treatments necessitates clinicians searching for effective targeted treatments that may alleviate symptoms.' In practice, traditional therapy creates this impossible scenario: Therapist asks 'what are you feeling right now?', person with alexithymia genuinely doesn't know, therapist instructs 'just notice what comes up', nothing specific comes up or something vague appears that cannot be articulated, therapist assumes the person is avoiding, resistant, or not trying hard enough when the reality is alexithymia makes the fundamental task impossible. Many people with alexithymia report years of ineffective therapy and feeling like they're 'bad at therapy' before discovering alexithymia explains why traditional approaches don't work. The issue isn't lack of effort - it's that therapy tools designed for neurotypical emotional processing don't work on brains that process emotions differently. Effective approaches for alexithymia require different strategies: interoception training to build body awareness before expecting emotional awareness, emotion wheels and lists as external tools when internal awareness is unavailable, reduced pressure for immediate articulation (allowing time to process), structured emotional check-ins using physical sensations as clues, and ADHD coaching that builds foundational skills before expecting emotional insight. Treatment must account for alexithymia rather than assuming emotional awareness exists.

Question 5

Can antidepressants make alexithymia worse?

Accepted Answer

Yes, antidepressants can worsen alexithymia symptoms through a side effect called 'emotional blunting'. A study of nearly 2,000 adults on antidepressants found: 60% described feeling emotionally numb, 52% reported not feeling like themselves, 42% experienced decreased positive feelings, and 39% cared less about others (Kajanoja et al., 2018). If you already have alexithymia (difficulty identifying emotions) and then take medication that further numbs emotional perception, you become even more disconnected from your internal state. For autistic and ADHD individuals, this is particularly problematic because alexithymia is already highly prevalent in these populations. Many neurodivergent people are prescribed antidepressants for what appears to be depression but is actually undiagnosed ADHD, autism-related difficulties, or alexithymia itself being misinterpreted as depression. Research by Behavioral Health Care Services found: 'Among several of our patients it seemed that antidepressant treatment caused symptoms of alexithymia. Interestingly, once the medication was discontinued the symptoms dissipated.' The emotional blunting that's a manageable side effect for neurotypical people becomes devastating for someone who already struggles to perceive emotions. SSRIs and SNRIs are the most common culprits. This doesn't mean antidepressants are never appropriate - severe depression may require medication regardless. But if you have alexithymia, the risk-benefit calculation is different. Before starting antidepressants, discuss alexithymia with your prescriber, ensure underlying ADHD or autism is properly treated first, consider whether symptoms are depression or alexithymia being misinterpreted, and monitor for worsening emotional numbness if medication is necessary. Many people find that properly treating ADHD with stimulant medication improves emotional awareness by reducing chaotic dysregulation, making emotions more stable and therefore easier to identify.

Question 6

What is the connection between interoception and alexithymia?

Accepted Answer

Interoception is the 8th sensory system (beyond the traditional five plus proprioception and vestibular) that allows you to perceive internal body signals: hunger, thirst, temperature, heart rate, breathing, muscle tension, need for toilet, pain, fatigue, and emotional states. Alexithymia is essentially poor interoception specifically for emotional signals. Dr Megan Anna Neff, clinical psychologist and autism researcher, explains the mechanism: 'Interoception is the link that connects alexithymia and autism. In fact, it may be more accurate to consider alexithymia as an extension of interoception difficulties. When a person has a deficit of interoception awareness, they will also have alexithymia. Alexithymia can be thought of as a byproduct of poor interoception awareness.' The connection works like this: Emotions are fundamentally physical sensations that happen in your body. Anxiety manifests as increased heart rate, shallow breathing, muscle tension. Sadness creates heaviness in chest, low energy, changed breathing pattern. Anger produces heat, muscle tension, increased heart rate. Joy creates lightness, energy, expanded breathing. If you cannot perceive these physical signals due to poor interoception, you cannot identify the emotion. Many autistic people experience poor interoception awareness and struggle to perceive and differentiate their internal body signals. When body signals are weak or muddled, emotional awareness becomes impossible. This explains why people with alexithymia often have difficulty with multiple interoception signals beyond just emotions: not noticing hunger until dizzy and irritable, not realising need for toilet until urgent, not recognising cold until shivering, not knowing they're overwhelmed until melting down. The signals were there - they just couldn't be perceived. Building interoception awareness through structured practice (body scans, tracking physical sensation patterns, connecting sensations to needs) can improve alexithymia over time by strengthening the fundamental skill of perceiving internal signals.

Question 7

How do you identify emotions when you have alexithymia?

Accepted Answer

When you have alexithymia, emotional identification requires external tools and structured approaches since intuitive awareness isn't accessible. Effective strategies include: Using emotion wheels and lists - visual tools showing gradients from basic emotions (happy, sad, angry, afraid) to more nuanced variations. When you feel 'something', methodically work through options until one fits. Conducting structured physical sensation checks - set alarms throughout day to pause and notice: What physical sensations do I notice? (heart rate, breathing depth, muscle tension, temperature, energy level, stomach sensations). Based on these physical clues, what might I be feeling? What do I need right now? (food, water, rest, movement, quiet, social connection). Building interoception awareness through body scans - practice noticing internal body signals without immediately labelling them as emotions. Notice heart rate, breathing pattern, muscle tension, temperature, digestive sensations. Over time, patterns emerge connecting specific physical states to specific emotions. Tracking patterns over time - keep records: 'When I feel shaky and irritable, I'm usually hungry. When my chest is tight and thoughts are racing, I'm usually anxious. When I feel heavy and low energy, I'm usually sad or overwhelmed.' These become reference points. Allowing time for processing - you don't have to answer 'how do you feel?' in real-time. 'I need to think about it and get back to you' is valid. Writing or drawing emotions often works better than speaking. Using clear, explicit language - avoid vague terms. 'I'm feeling something in my chest that might be anxiety or might be excitement - I can't tell which' is more useful than forcing certainty you don't have. Working with ADHD coaches or therapists who understand alexithymia - approaches that build foundational interoception skills before expecting emotional insight, rather than assuming emotional awareness already exists. The goal isn't to force emotions to feel 'normal' - it's to develop alternative pathways for emotional awareness that work with your neurology.

Question 8

Why does alexithymia lead to substance use in autistic adults?

Accepted Answer

Research published in 2025 on self-medication in autistic adults found that alexithymia plays a significant role in substance use patterns. When you cannot identify or articulate emotions, substances offer a tangible, controllable way to change your internal state. Researcher Rebecca Brewer explains: 'Alexithymia is associated with individuals using substances to manage behaviour and manage mental health difficulties.' The mechanism works like this: You feel 'something' vague and uncomfortable but cannot identify what it is or what you need. Traditional coping strategies (talking to someone, identifying the trigger, processing the emotion) are inaccessible because you cannot access what you're feeling. Substances provide immediate, predictable effects: alcohol reduces the vague discomfort, cannabis quiets sensory and emotional overwhelm, stimulants compensate when executive function fails and you cannot organise your internal state. You might not know what you're feeling, but you know alcohol makes it different. This creates a vicious cycle: Alexithymia makes it hard to identify what you need, you cannot communicate distress effectively to get appropriate support, you don't receive proper treatment for underlying ADHD or autism, substances provide immediate (though temporary) relief, substance use can worsen interoception and alexithymia over time, the cycle deepens. The 2025 study by Papadopoulos et al. found 87% of self-medicating autistic adults had anxiety, 75% had depression, and 80% also had ADHD - creating a perfect storm where alexithymia prevents recognition of distress, ADHD impairs executive function needed for healthy coping, autism-related sensory overwhelm is constant, and substances become the only accessible form of emotional regulation. This isn't a character flaw or addiction in the traditional sense - it's what happens when your neurology makes traditional emotional regulation strategies inaccessible and the healthcare system doesn't recognise or treat alexithymia. Proper treatment requires addressing the root alexithymia and ADHD, not just treating substance use as a standalone issue.

Question 9

What actually helps with alexithymia in ADHD and autism?

Accepted Answer

While traditional talk therapy often doesn't work for alexithymia, several evidence-based approaches show promise. Interoception training is the most effective approach - since alexithymia is rooted in poor interoception (inability to perceive internal body signals), building body awareness helps. This includes: body scans focused on physical sensations not emotions, mindfulness practices noticing hunger/thirst/temperature cues, tracking patterns between physical sensations and needs ('shaky = need food, chest tight = overwhelmed'). Using external tools when internal awareness fails - emotion wheels showing gradients from basic to nuanced emotions, lists of emotion words organised by category, structured check-ins throughout day asking 'what physical sensations do I notice?' rather than 'how do I feel?'. Proper ADHD treatment - research suggests treating ADHD with appropriate medication (particularly psychostimulants) can improve emotional awareness by reducing the chaos of ADHD emotional dysregulation. When emotions are less volatile and rapid, they become easier to identify. Some people report that once ADHD medication stabilised their emotional state, they could finally start building emotional vocabulary. ADHD coaching that accounts for alexithymia - traditional therapy assumes emotional awareness exists. Coaching that understands alexithymia focuses on: building interoception skills first, practical strategies for identifying needs through physical sensation tracking, external structure that doesn't rely on emotional awareness, reducing overwhelm that drowns out emotional signals. Avoiding medications that worsen emotional blunting - unless depression is severe and clearly present (not just misdiagnosed alexithymia), antidepressant emotional blunting side effects might worsen the core problem. Discuss alexithymia with prescribers before starting SSRIs/SNRIs. Reduced pressure for immediate articulation - allowing time to process, using writing or drawing instead of speaking, clear explicit language about uncertainty ('I feel something but can't identify it' rather than forcing false certainty). In the UK, Access to Work can provide up to £66,000 annually for employed individuals with ADHD diagnosis to fund coaching and workplace support. For someone with alexithymia, proper ADHD support is preventative - building interoception skills, creating frameworks for emotional awareness, addressing executive dysfunction that drowns out signals.

Question 10

Is alexithymia the same as depression or emotional numbness?

Accepted Answer

No, alexithymia is fundamentally different from depression though they can co-occur and are often confused. Depression is a mood disorder characterised by persistent low mood, loss of interest, hopelessness, and other symptoms. Emotional numbness in depression means emotions are blunted or absent - you're not feeling much of anything. Alexithymia is difficulty identifying and describing emotions that you ARE experiencing - the emotions exist but you cannot perceive or articulate them. Key differences: In depression, you might feel persistently sad or empty and be aware you feel this way. In alexithymia, you feel something but cannot identify what it is - it might be sadness, might be anxiety, might be hunger, you genuinely don't know. Depression typically responds to treatment (therapy, medication, lifestyle changes). Alexithymia shows poor response to traditional psychotherapeutic treatments and can actually be worsened by antidepressant emotional blunting effects. Depression is a diagnosable mental health condition in the DSM-5. Alexithymia is not a diagnosis but a neuropsychological trait. However, they frequently co-occur: Research shows alexithymia is closely linked to depression, with people who have both demonstrating more severe depression symptoms (2019 review). Many autistic and ADHD adults are misdiagnosed with depression when the underlying issue is alexithymia combined with untreated neurodivergence. A study by Behavioral Health Care Services found most of their neurodivergent patients carried depression diagnoses for years with ineffective treatments, but when properly assessed, met criteria for only mild depressive symptoms despite the major depressive disorder diagnosis - the real issue was alexithymia and undiagnosed ADHD/autism. The confusion occurs because inability to identify positive emotions can look like anhedonia (depression symptom), difficulty describing distress can look like emotional withdrawal, and chronic stress from untreated ADHD/autism/alexithymia can eventually cause actual depression. Proper assessment should differentiate: Can you identify that you feel sad/hopeless (depression)? Or do you feel something but cannot identify what it is (alexithymia)? Treatment approaches differ significantly between the two conditions.

Why You Feel Nothing All the Time (Alexithymia)

What Alexithymia Actually Is (And Why You’ve Never Heard of It)

📺 Additional Learning Resource

The Numbers That Explain Why This Feels Familiar

What Alexithymia Actually Feels Like

Why Alexithymia Is So Common in Autistic and ADHD People

The Interoception Connection Nobody Explains

Why Therapy Hasn’t Worked (And It’s Not Your Fault)

The Antidepressant Problem Nobody Warned You About

Why Alexithymia Drives Self-Medication

What Actually Helps When You Have Alexithymia

The Access to Work Angle: Prevention Through Proper Support

The Research Limitations You Should Know

The Bottom Line

References and Further Reading

Leave a Reply Cancel reply

Contact