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When Feelings Have No Words: Understanding Alexithymia in Autistic Adults

By Tim Aiello, MA, LPC, NCC, ADHD-CCSP, ASDCS



Have you ever struggled to put your emotions into words? Maybe someone asks, “How are you feeling?” and you freeze—not because you don’t want to answer, but because you genuinely don’t know. If that sounds familiar, you might be experiencing something called alexithymia—a common yet often misunderstood trait in autistic adults.


As a therapist who specializes in working with ADHD, Autistic, and AuDHD adults, I see alexithymia show up in sessions all the time. More personally, I struggle with it myself. For much of my life, I didn’t realize that my difficulty identifying and expressing emotions wasn’t just a personality quirk—it was part of how my brain processes feelings. In this article, we’ll break down what alexithymia is, how it affects autistic adults, and what we can do to navigate life with emotions that often feel just out of reach.


What is Alexithymia?

Alexithymia is a neuropsychological trait characterized by difficulty identifying, describing, and processing emotions. The term comes from Greek: a (without), lexis (words), and thymos (emotions)—literally, “without words for emotions.” It is not a mental health disorder but rather a difference in emotional processing, which can affect self-awareness, relationships, and emotional regulation (Kinnaird, Stewart, & Tchanturia, 2019).


Research suggests that 50-85% of autistic individuals experience alexithymia to some degree, compared to around 10% of the general population (Bird & Cook, 2013). This means that for many autistic adults, emotional awareness isn’t just difficult—it’s a fundamental challenge shaped by the way the brain processes emotions.


How Alexithymia Shows Up in Everyday Life

For those of us who experience alexithymia, emotions don’t always show up as clear, distinct feelings. Instead, they might feel like:


✅ Physical sensations: Instead of recognizing “I’m anxious,” you might just feel a tight chest or nausea.

✅ Overwhelming emotional build-up: Feelings may accumulate without recognition, leading to sudden emotional outbursts or shutdowns.

✅ Struggling to name emotions: You might know you feel something, but when asked to describe it, you come up blank.

✅ Emotional numbness: Sometimes, emotions seem distant, muted, or absent altogether.


This can be frustrating—not just for the person experiencing it, but also for partners, friends, and therapists who may misinterpret the lack of verbal expression as a lack of emotion altogether (Trevisan et al., 2016).


Personally, I can recall countless moments when someone asked me how I felt, and my brain simply shut down. It wasn’t that I didn’t feel anything—I just didn’t have the internal language to describe it in the moment.


Why Do So Many Autistic Adults Experience Alexithymia?


1. Neurological Differences in Emotional Processing

Autistic individuals often have differences in interoception—the brain’s ability to perceive internal bodily signals, such as heart rate, muscle tension, or breathing patterns. Interoception plays a key role in recognizing emotions, so when these signals are less clear or harder to interpret, emotions can feel vague or disconnected (Shah et al., 2016).


2. Polyvagal Theory (PVT) and Emotional Awareness

From a Polyvagal Theory (PVT) perspective, alexithymia can be seen as a disconnect between emotional states and conscious awareness. The autonomic nervous system (ANS) constantly shifts between different states—safe and engaged (ventral vagal), mobilized and anxious (sympathetic), or shut down and numb (dorsal vagal).


  • When emotions stay in the body but don’t translate into conscious awareness, it may indicate a disrupted feedback loop between the nervous system and cognitive processing.


  • For autistic individuals who frequently experience sensory overwhelm or chronic fight-or-flight states, emotional processing may take a backseat as the brain prioritizes survival and sensory regulation (Quinde-Zlibut et al., 2023).


In short, if your body is busy managing stress, there may not be enough resources left to process emotions in a typical way.


Coping Strategies: Learning to Navigate Alexithymia

The good news? Emotional awareness is a skill that can be developed. While alexithymia won’t simply “go away,” there are ways to build a better connection with your emotions.


1. Develop a “Feelings Cheat Sheet”

For those of us who struggle with emotional identification, it helps to have a visual aid. Tools like emotion wheels or lists of physical sensations tied to emotions can help bridge the gap between body signals and emotional language.


2. Track Physical Sensations

Instead of forcing yourself to name emotions, start with body awareness. Ask:

  • “Where do I feel tension right now?”

  • “Is my breathing fast or slow?”

  • “Am I hot, cold, or neutral?”


Over time, this builds a stronger interoceptive-emotional connection.


3. Use External Prompts

Journaling with structured prompts like “What happened today that made me react?” can help piece together emotional patterns without needing immediate self-awareness.


4. Leverage Safe Sensory Input for Emotional Regulation

Because alexithymia is often tied to sensory processing, certain sensory experiences can help unlock emotional expression:

  • Deep pressure (weighted blankets, tight hugs)

  • Rhythmic movement (rocking, walking, pacing)

  • Auditory grounding (listening to music that matches your internal state)


These strategies help the nervous system shift states, making emotions more accessible.


Final Thoughts: Alexithymia is a Challenge, Not a Deficit

If you experience alexithymia, you are not broken or emotionless. Your brain simply processes emotions differently. The challenge isn’t that you don’t feel—it’s that your feelings may not always translate into conscious awareness or words.


As both a therapist and someone who personally experiences alexithymia, I know this process can be frustrating. But awareness is the first step. Learning your unique emotional cues, tracking patterns, and experimenting with strategies can help create a stronger connection between body, brain, and feelings.


If this resonates with you, you’re not alone. Alexithymia is a challenge, but it’s also a journey of learning yourself in a deeper way.



References

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© 2023 by Aiello Counseling Services, PLLC

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