For many autistic people, being asked “How do you feel?” can be surprisingly difficult to answer. It’s not that they don’t have feelings – often they feel emotions very deeply – but there can be a disconnect between experiencing an emotion and knowing how to identify or describe it in words.
This experience is known as alexithymia, a term literally meaning “no words for emotion.”
Alexithymia refers to difficulty recognizing and articulating one’s own feelings, and it is common among autistic people.
Research indicates that roughly half of all autistic individuals have significant alexithymic traits, much higher than the general population.
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.
Autism, Alexithymia, and Overlapping Challenges
Alexithymia often co-occurs with autism, affecting around 50% of autistic people. This overlap can shape how emotions are experienced, expressed, and understood.
Researchers have proposed the alexithymia hypothesis: suggesting that many of the stereotypes about autistic individuals having low empathy or being “emotionally distant” are actually due to alexithymia, not autism itself.
When an autistic person appears unaware of another’s feelings or doesn’t express their own emotions in expected ways, it may be because they can’t readily identify those emotions – not because they lack empathy or don’t feel anything.
“For those of us with alexithymia, we may know in a vague way that we’re distressed, but might not be able to name a specific feeling… We also struggle to figure out why we’re feeling [it].“
Autistic psychologist Dr. Devon Price
One reason for this overlap is differences in interoception—the ability to sense internal body signals like heart rate or tension. If your body feels off but the signal is unclear, it’s harder to identify the emotion behind it.
Social learning also plays a role. Many autistic people are taught to mask emotions or prioritize others’ reactions, which can weaken emotional awareness over time.
Dr. Price notes that alexithymia may arise partly because autistic individuals aren’t given the tools to understand their own emotions, being taught to prioritize others’ feelings or to hide their genuine responses. Over time, this can sever the connection between what one feels and one’s awareness of it.
It’s important to note: not all autistic people have alexithymia. But for those who do, it can make emotional communication harder, both internally and with others.
How Alexithymia Feels: Autistic Perspectives
For autistic people with alexithymia, emotions are often intense but hard to name. Many describe feeling something deeply—without knowing what it is.
“The worse I feel, the more I default to saying ‘I’m fine,’” one forum user shared.
Another said, “I know something’s wrong, but I don’t know what that something is.”
Emotional insight can come hours or days later. One person explained they often write to figure out how they feel:
“At first I say ‘I don’t know.’ Then later, I can explain it in paragraphs.”
These delays are often misunderstood. Loved ones may see “I don’t know” as avoidance, but for many, it’s an honest answer.
“My mum thought I was hiding something when I really didn’t know,” recalled one autistic woman.
This disconnect can strain relationships. Some feel pressure to fake or exaggerate emotions just to meet expectations.
“I used to think I was broken because I couldn’t express things like others,” one person admitted.
For many, alexithymia feels like emotional static—there’s a signal, but it’s hard to tune in. Understanding this can reduce shame and open up better ways to connect.
Common Challenges with Alexithymia in Autism
Alexithymia can affect many aspects of an autistic person’s daily life and mental health. Here are some common challenges that individuals and families may encounter:
Anxiety and stress spikes
Because it’s hard to sense and label emotions in the moment, feelings like anxiety can build up unnoticed until they become overwhelming.
Physical symptoms (e.g., a racing heart or nausea) might be confusing and unpredictable, making the anxiety feel even worse.
An autistic person might suddenly have a panic reaction without earlier warning signs, simply because they couldn’t identify the subtle anxiety as it grew.
Emotion regulation difficulties
When you can’t pinpoint what you’re feeling, it’s tougher to calm yourself or seek help. Alexithymia can thus make emotional meltdowns or shutdowns more likely – the feelings aren’t addressed until they “overflow.”
Autistic individuals with alexithymia may have a harder time regulating difficult emotions. It may also be harder to accept or cope with stress (for example, brushing off everyday worries), since the distress can’t be named and processed, only felt as an uncomfortable state.
Misunderstandings in communication
Loved ones and peers might misinterpret an autistic person’s emotional neutralness or “I don’t know” answers.
They may assume the person is indifferent, lying, or doesn’t trust them enough to share feelings. In reality, the person would share if they knew their own feelings!
This gap can cause frustration on both sides. For instance, the mother of the woman above felt her daughter was hiding something, when in fact she genuinely couldn’t identify her emotions at the time.
Strains on relationships
Beyond specific miscommunications, alexithymia can create a general mismatch of expectations.
A partner might expect emotional reassurance or enthusiastic responses that the alexithymic person simply doesn’t provide, possibly leading to the partner feeling unloved.
Likewise, the autistic individual may feel guilty for not meeting social “norms” of emotional expression.
Without understanding alexithymia, both parties might feel hurt. (On the flipside, some alexithymic individuals note they stay calmer during conflicts, since they don’t get swept up in emotional tides as easily – but this calmness might be misread as not caring.)
Mental health implications
Alexithymia often co-occurs with conditions like anxiety disorders or depression. It can be a vicious cycle: not understanding your own emotions can lead to internalized stress and isolation, which in turn can contribute to depression or heightened anxiety.
Studies have found that in autistic people, higher alexithymia is associated with more mental health challenges and even reduced quality of life.
The good news is that when alexithymia is recognized and accommodated, it’s possible to improve mental well-being by targeting that missing emotional insight.
Coping Strategies and Support
Living with alexithymia can be confusing, especially when emotions feel overwhelming but hard to name.
While there’s no quick fix, many autistic people find ways to build emotional awareness and communicate more effectively over time.
Strengthen the Mind–Body Connection
Because alexithymia is closely tied to interoception—your ability to recognize internal bodily signals—improving body awareness is often a helpful first step.
Try these approaches:
- Mindfulness and body scans: Pause during the day to ask, “What is my body feeling right now?” Start with sensations like tension, heat, or movement before linking them to emotions.
- Breathwork or yoga: Gentle, structured movement can help you notice subtle internal changes.
- Interoception-based programs: Some therapies specifically target emotional awareness through sensory and body-focused exercises.
Over time, this practice helps make vague or physical feelings easier to name.
Use Journaling to Identify Emotions
For many autistic adults, writing is an effective tool for processing emotions.
One autistic person shared:
“At first I say ‘I don’t know.’ Then a few days later, I can explain everything in detail. I had to write it out to figure it out.”
If speaking in the moment feels difficult, try:
- Writing a few sentences a day about what happened and how your body reacted.
- Using prompts like “What made me feel different today?” or “When did I feel ‘off,’ and what was happening?”
Even brief notes can help you recognize emotional patterns over time.
Use Emotion Tools
Sometimes it’s not that you’re not feeling—but that the right words are missing. Visual or structured tools can help bridge this gap.
Consider:
- Emotion wheels with a wide range of words (e.g., agitated, hopeful, withdrawn).
- Feelings charts or emoji-based tools, especially for visual thinkers.
- Apps that help track moods and label feelings over time.
One person shared:
“I don’t find happy/sad/mad useful. I have a chart with more nuanced words—like drained or restless—and that helps me connect to what I’m actually feeling.”
Having language that fits your internal state can make it easier to express and regulate emotion.
Seek Neurodiversity-Affirming Therapy
Therapy can support emotional understanding—if it’s adapted to your needs. Some common approaches include:
- CBT (Cognitive Behavioral Therapy): Helps link thoughts, body signals, and reactions.
- DBT (Dialectical Behavior Therapy): Focuses on emotional regulation and mindfulness.
- Mentalization-based therapy: Builds awareness of your own and others’ emotional states.
The key is finding a therapist familiar with autism and alexithymia. They should be flexible, avoid pushing for instant emotional insight, and use concrete strategies that support self-reflection.
Communicate Your Needs to Others
Let loved ones know that saying “I don’t know how I feel” is honest—not avoidance. You might agree on alternatives like:
- “Can I tell you later after I think about it?”
- “I’m not sure yet, but I think something’s off.”
Parents can also help children by:
- Using emotion cards or books to label feelings together.
- Validating confusion (“It’s okay not to know how you feel right away”).
- Avoiding pressure to respond emotionally on demand.
When others understand alexithymia, it reduces misunderstandings and emotional strain on both sides.
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.
Be Patient With Yourself
Alexithymia isn’t a flaw—it’s a different way of processing emotions. Progress can be slow and non-linear. What matters is building awareness over time.
One autistic adult put it simply:
“Alexithymia doesn’t mean I don’t feel. It just means I process those feelings differently—and that’s okay.”
Celebrate small wins. If you noticed a shift in mood earlier than usual, or managed to express even part of what you were feeling—that’s growth.
References
Bird, G., & Cook, R. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3(7), e285. https://doi.org/10.1038/tp.2013.61
Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80-89.
