Living with ADHD often means riding an emotional rollercoaster – from bursts of frustration to moments of excitement – yet some people with ADHD struggle not with feeling emotions, but with recognizing and naming them.
This difficulty is known as alexithymia, often described as “emotional blindness” or an inability to identify and express one’s feelings. For someone with ADHD, this can add a confusing layer to daily life.
What Is Alexithymia?
Alexithymia is not a formal disorder, but rather a trait characterized by difficulty in identifying and describing emotions.
In practical terms, a person with alexithymia often struggles to answer questions like “What are you feeling right now?”
They might feel physical signs of emotions (like a racing heart or a lump in the throat) but not easily connect those sensations to an emotion such as anxiety or sadness.
Key features of alexithymia include:
- Difficulty recognizing feelings: Emotions may register as vague physical sensations or just a sense of being unwell, with little clarity on whether one is sad, anxious, angry, etc.
- Difficulty describing feelings: Even when an emotion is felt, putting it into words is challenging. One might say “I’m upset” without pinpointing whether it’s frustration, loneliness, or something else.
- Externally oriented thinking: There is a tendency to focus on external facts and events rather than inner emotional states, making self-reflection on feelings limited.
This trait exists on a spectrum – some people are mildly alexithymic, while others are strongly so.
The Overlap Between Alexithymia and ADHD
Many adults with ADHD will recognize themes of emotional impulsivity or overwhelm in their lives, but also alexithymia and ADHD often co-occur.
In fact, multiple studies show a significantly higher prevalence of alexithymia among people with ADHD compared to the general public.
“Those with ADHD often struggle with emotional regulation, and alexithymia can intensify these challenges, complicating social interactions and emotional management.”
Kristen McClure, Therapist
Research finds that around 40% of people with ADHD have co-occurring alexithymia. This means if you have ADHD and you’ve always found your emotions puzzling or muted, you are certainly not alone.
Why does this overlap happen?
ADHD is a neurodevelopmental condition known for symptoms like inattention, hyperactivity, impulsivity – and importantly, difficulties with emotional regulation.
People with ADHD often feel emotions intensely but may struggle to manage or regulate those emotions due to impulsivity and executive function deficits.
Alexithymia, on the other hand, is about emotional awareness – a disconnect in recognizing and labeling feelings.
Despite seeming opposite (intense emotions vs. lack of emotional insight), these two can feed into each other.
In ADHD, emotions can surge so quickly that the person doesn’t have a chance to identify them before reacting.
Over time, one might become so used to this rapid, stormy emotional process that they pay little attention to the nuances of what they feel, only noticing when emotions boil over.
How Alexithymia Feels: Personal Perspectives
For people with both ADHD and alexithymia, emotions can feel muted, confusing, or simply hard to grasp. Many describe a sense of emotional flatness—not because they lack emotions, but because they can’t easily recognize or name them.
One forum user shared:
“Of all my symptoms, alexithymia is the one that scares me the most. It makes me feel not human. I can’t remember the last time I felt happiness, sadness, or anger. I know when I’m ‘okay’ or a bit down, but the needle really doesn’t move much either way.”
This sense of emotional disconnection is common. You might logically know you should be feeling something—joy, grief, pride—but the feeling never quite registers. It’s there, just out of reach.
Others describe the opposite problem: too many emotions at once, all tangled and unlabelled.
“Sometimes it’s almost like I have so many emotions all at once, I can’t pinpoint what I’m actually feeling,” one person wrote. The result can feel overwhelming or even paralyzing.
This emotional ambiguity can spill into daily life. Some people confuse physical symptoms—like fatigue, stomach tension, or restlessness—for emotional states.
For example, someone might feel irritable or physically agitated and assume they’re just hungry or tired, when in fact they’re anxious.
Another forum user reflected on how they had to learn what calm and contentment actually felt like:
“I used to call it ‘feeling blah,’ but I’ve realized that’s just what calm feels like for me. When nothing is wrong, I don’t really notice it—it just feels neutral.”
For many, the lack of emotional insight creates challenges in relationships. People with ADHD and alexithymia might come across as cold or emotionally distant—not because they don’t care, but because they struggle to express what they’re feeling.
Others describe delayed emotional reactions. In the moment, they appear calm or unfazed by difficult events, only to be hit by intense emotions hours or days later.
Friends or family might expect an immediate emotional response and misread the quiet as apathy.
Still, alexithymia doesn’t mean a person lacks empathy or depth. It means their emotional awareness is filtered or delayed. As one therapist explained to a client:
“You do have emotions—they’re just harder for you to hear. We’re going to work on turning up the volume.”
That insight captures the experience well. Emotions are present, just quieter, harder to interpret, or buried beneath other layers of thought and sensation.
Consequences of Alexithymia in ADHD
Living with both ADHD and alexithymia doesn’t just make emotions harder to identify—it can also have broader effects on mental health, relationships, and daily functioning.
Below are key ways this combination can impact a person’s life:
Increased Risk of Anxiety and Depression
When emotions are hard to recognize or name, they can build up unnoticed and unprocessed. This emotional bottleneck may lead to chronic tension, irritability, or low mood that’s difficult to understand or manage.
Alexithymia may be associated with increased social anxiety in adults with ADHD. More broadly, emotional dysregulation in ADHD contributes to various forms of psychological distress and a high risk of mental illness
Difficulty Regulating Emotions
Alexithymia doesn’t just affect emotional recognition—it also interferes with emotional regulation. If you can’t tell what you’re feeling, it becomes much harder to soothe yourself, make informed decisions, or communicate your needs.
For someone with ADHD, who may already experience intense emotional reactivity, this can be a major challenge.
You might suddenly lash out, withdraw, or shut down—not because the emotion is irrational, but because it wasn’t understood until it overwhelmed you.
Strained Relationships
In close relationships, emotional expression helps build trust and connection. But for people with alexithymia, emotions often stay unspoken or are expressed in unclear ways.
This can cause confusion, conflict, or distance in friendships, partnerships, and family dynamics.
Partners might feel shut out. Friends may misread emotional flatness as indifference. Over time, this can lead to miscommunication, feelings of isolation, and a sense that something important is missing from interactions.
Delayed Emotional Processing
Many people with ADHD and alexithymia describe a delay between events and their emotional impact. You might get through a stressful situation feeling fine, only to feel anxious or overwhelmed days later without knowing why.
This delayed reaction can make emotional triggers harder to track. It also means that you may not respond in real time to feedback, disappointment, or even positive moments—making emotional learning and growth more difficult.
Challenges in Therapy
Alexithymia can also make talk therapy more complicated. Traditional forms of therapy often rely on a person’s ability to reflect on feelings and explore inner experiences.
If those feelings are vague or unavailable, therapy might feel frustrating or slow.
However, when therapists understand alexithymia and adapt their approach—using more concrete language, focusing on physical sensations, or practicing emotion labeling—therapy can still be highly effective.
Managing Emotions When You Have ADHD and Alexithymia
While there is no quick “cure” for alexithymia, there are ways to build a stronger connection with your emotions and mitigate the difficulties it causes. If you recognize these traits in yourself, consider the following approaches:
ADHD Treatment
First, ensuring your ADHD itself is managed can lay the groundwork. One person with ADHD remarked how their unrecognized emotions became clearer once they started ADHD meds – feelings “unzip” when the mind isn’t as scattered.
Always discuss with a doctor, but know that addressing ADHD can have emotional benefits beyond just focus.
Learn the language of emotions
It might sound basic, but many people with alexithymia benefit from intentionally expanding their emotional vocabulary.
One practical tip is to use emotion charts or lists (sometimes called an “emotion wheel” or list of feeling words) and regularly check in with yourself.
For instance, ask: “Physically, what do I notice? My heart is fast and hands sweaty – could that mean I’m nervous or scared?”
Even if it feels forced at first, naming a feeling (or at least giving it a rating like “mild, moderate, strong”) can gradually build the habit of internal awareness.
Journaling a couple of sentences each day about any small mood changes can also help.
Therapy and skill-building
Working with a mental health professional, especially one familiar with neurodivergent clients, can greatly help in untangling emotions.
Therapies like Cognitive-Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT) teach concrete skills for identifying and regulating emotions.
In therapy, you might practice noticing bodily sensations and thoughts that correspond to feelings. The trick is to rebuild that connection through mindful introspection.
Keep in mind that these types of therapies may not be helpful for those with ADHD, so make sure to check the therapist is neurodiversity-affirming at least.
Mindfulness exercises (such as short daily body scans or breathing exercises) are often recommended: they train you to focus on internal signals in a non-judgmental way, which over time can increase your ability to recognize emotions as they arise.
Externalize and explain
It can help to let close family or friends know about alexithymia, so they don’t misinterpret you.
You might say, “Sometimes I genuinely don’t know what I’m feeling in the moment – so if I seem distant or react oddly, please understand I might need time to figure it out.”
Educating loved ones can prevent a lot of hurt feelings and pressure. They’ll realize that when you don’t immediately say “I’m happy” or “I’m upset,” it’s not lack of trust or affection – it’s how your brain works.
In supportive relationships, you can even enlist their help: for example, a partner might gently ask, “Do you think maybe you’re feeling anxious or angry about this situation?”
Not to put words in your mouth, but to help you consider possibilities.
Routine check-ins
Set up structures in your day that prompt emotional check-ins. For someone with ADHD, prompts can be very useful.
This might mean an alarm on your phone that goes off a couple of times a day with a note like “Pause – what are you feeling now?” Even if the answer is often “I don’t know,” the practice of asking is key.
Over time, you might start noticing patterns (e.g., every day around 3pm you feel “empty” which you later identify as fatigue and boredom, not depression).
These insights can guide you to make practical changes (maybe a stimulating break in the afternoon) and reassure you that emotions do fluctuate and can be understood.
Creative outlets
Some people with alexithymia find that creative activities (art, music, writing poetry or lyrics) allow them to express emotions they can’t verbalize. The process of art can tap into feelings indirectly.
For example, sketching with intense colors when you’re restless, or making a playlist of songs that match your unspoken mood, can be ways of acknowledging emotions when words fail.
Later, you might reflect on why you chose those expressions, gradually connecting them to feelings.
References
Kiraz, S., Sertcelik, S., & Taycan, S. E. (2021). The relationship between alexithymia and impulsiveness in adult attention deficit and hyperactivity disorder. Turk Psikiyatri Dergisi, 32(2), 109.
