Alexithymia and Autism
Alexithymia, which translates to “no words for emotion” in Greek, is where someone has difficulty identifying and describing the emotions that they are experiencing.
Alexithymia is thought to affect 1 in 10 people, but is much more common amongst autistic people. It can make it hard for us to identify what emotion we are feeling, understand why we are feeling that way, and communicate our emotional needs to other people.
Some people with alexithymia can feel specific emotions but not others. For example, some can identify and feel anger, but are unable to feel or recognise happiness or excitement. Some can recognise that they are feeling SOMETHING, but are unable to tell what emotion it is. Moreover, some may find it difficult to distinguish between different emotions, so may think that excitement is anxiety, or sadness is anger. This can be frustrating. Sometimes they may just be able to tell if the emotion they are feeling is positive or negative. They might not be able to tell what they are feeling, but they might know if they feel uncomfortable or if they feel good.
Not only is recognising emotions difficult, but it can be hard for us to match our body language or facial expressions with what we are expected to be feeling. Many have to act out their responses, by learning how they are meant to appear in different situations. Many of us often get asked why we look angry or sad, when in-fact we are happy. Or we may be asked why we look happy when we are witnessing something sad. This means that many of us have to focus a lot of energy onto making sure our facial expressions match what is expected of us.
I think alexithymia is highly linked to the myth that autistic people don’t have emotions, because some of us don’t portray emotions in the ways others would expect us to. This doesn’t mean we aren’t feeling anything.
Alexithymia can also make it difficult to interpret other people’s emotions. A study by Geoff Bird found that usually those with alexithymia can tell that there is a difference between a photo of someone smiling and one of them frowning, but they can’t tell which photo is which.
Alexithymia is closely linked to interoception (the ability to recognise and interpret what is happening inside our bodies). I wrote a thread specifically about interoception here. People with alexithymia may notice that their heart rate has increased, but might not associate this with feeling anxious. Hence, their anxiety might increase because they can’t understand what is going on inside their body.
If we don’t know what we are feeling, it can be hard for us to know what our needs are, and even harder for us to get our needs met. It’s very confusing not knowing what you are feeling and why, and this can make it harder for us to engage in normal therapies like CBT.
Some sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331035/
https://www.healthline.com/health/autism/alexithymia#treatments
https://www.spectrumnews.org/news/people-alexithymia-emotions-mystery/