Alexithymia: What It Is, How It Shows Up, and Related Conditions

AlexithymiaCo-occurring ConditionsNeurodivergent Affirming PracticeFor Practitioners
Written By Neurodiversity Wellness Collective
What is alexithymia? Explained through a neurodiversity-affirming lens — how emotional identification differences show up in autism, ADHD, trauma & what support looks like.

What Is Alexithymia?

Alexithymia is a neurodevelopmental variation in how someone experiences, identifies, and expresses emotions. In neurodiversity-affirming practice recognizes alexithymia as a processing difference in the emotional awareness system.

Core features (measured on the Toronto Alexithymia Scale, TAS-20):

  • Differences in how emotions are identified and labeled, within themselves and others

  • Differences in describing or expressing emotions verbally

  • Concrete, externally oriented cognitive style (focusing on facts and actions rather than feelings)

  • Interoceptive attention differences (reduced awareness of internal body signals)

✦ Note: Emotion still occurs for alexithymic individuals; what differs is their internal awareness and vocabulary to name feelings, such as but not limited to, grief, joy, or fear.

How Alexithymia Shows Up

Alexithymia presents differently across people and contexts. Common manifestations include:

Emotional experience

  • Feeling "outside" emotional life, observing rather than experiencing

  • Knowing something matters without knowing why it matters

  • Physical sensations experienced primarily as bodily responses

  • Confusion about internal states ("I don't know what I'm feeling")

In relationships

  • Differences in discussing feelings with partners, family, or close others

  • Love expressed through action (showing up, solving problems) rather than words

  • Misperceived as being "cold" or "unfeeling"

  • Navigating emotional intimacy or vulnerability in their own ways

In daily functioning

  • Decision-making based on external facts rather than gut feeling

  • Disconnection from bodily signals (hunger, fatigue, physical pain sometimes less noticeable)

  • Strengths in logical problem-solving and practical thinking

  • Potential for burnout before recognizing distress signals

Gender Differences

Recent meta-analyses by Mendia et al. (2024) show that while men score higher on Externally Oriented Thinking (focusing on external events rather than internal states), women score higher on Difficulty Identifying Feelings (distinguishing emotions from physical body sensations).

Women often go unidentified longer because they use compensatory strategies:

  • Intellectualizing Emotion: They use logic, context, and physical clues to deduce what they feel (e.g., "My heart is racing, so I must be stressed") rather than feeling it directly.

  • Cognitive Empathy & Fluency: Strong verbal skills and the ability to read others mask their inability to read themselves.

  • Social Masking: Social pressure to appear emotionally attuned forces women to mirror and fake emotional competence early on.

Moreover, women with unrecognized alexithymia seek mental health support, their struggle to identify emotions is often mislabeled. Therapists and doctors frequently mistake it for:

  • Mood Disorders: Problems like emotional numbness, physical pain, or sudden overwhelm are misdiagnosed as standard depression or anxiety.

  • Hidden Distress: Social pressure forces women to hide emotional outbursts. Instead, the stress turns inward, showing up as physical issues like chronic fatigue, headaches, or stomach problems rather than obvious emotional breakdowns.

Who Experiences Alexithymia?

The comorbidity rates (when a person has two or more conditions) for alexithymia varies by condition, research shows that it appears in roughly 50% of neurodivergent individuals (Kinnaird et al., 2019).

Autism

  • A study by Chalghaf et al. (2026) 33% to 50% (and up to 65% in some clinical cohorts) of autistic individuals meet the clinical threshold for alexithymia, making it roughly 5 to 10 times more common than in neurotypical populations.

ADHD

  • A study by Kiraz et al. (2021) found 41.5% of ADHD adults experience alexithymia.

Functional Neurological Disorder

  • A study by Hogveen & Grafman (2021) found that 40% of adults with Functional Neurological Disorder have high autistic traits and 40% have alexithymia, with both traits being strongly linked to higher rates of depression, anxiety, and other cognitive or physical challenges.

Eating Disorders

  • A study by Westwood et al. (2017) found that people across the entire spectrum of eating disorders frequently experience difficulties identifying and describing their emotions.

Post-traumatic Stress Disorder

  • People with PTSD, especially males and veterans, have higher rates of alexithymic traits than those without (Edwards, 2022), with an estimated 42% presenting with clinically relevant alexithymia (Putica et al., 2021).

Alexithymia as Difference, Not Disorder

Alexythymia is a neurological variation in how emotions are processed and experienced. In neurodiversity-affirming practice, we move away from deficit-focused language.

Rather than saying:

  • "You struggle to name or identify feelings."

  • "Your emotional range is restricted."

We ground our support in curiosity and connection:

  • How does this person navigate and make sense of their internal emotional landscape?

  • How do they show care, affection, and connection ?

  • What skills or tools support their well-being without trying to mask?

  • How do supportive, accepting relationships shape their emotional experience?

References

Chalghaf, N., Chokri, I., Dhahbi, W., Ceylan, H. I., Stefanica, V., Guelmami, N., & Dergaa, I. (2026). Alexithymia in neurodevelopmental populations: A scoping review of Down syndrome, autism spectrum disorder, and dual diagnosis. Frontiers in Psychology, 17, Article e1705694. https://doi.org/10.3389/fpsyg.2026.1705694

Edwards E. R. (2022). Posttraumatic stress and alexithymia: A meta-analysis of presentation and severity. Psychological trauma : theory, research, practice and policy, 14(7), 1192–1200. https://doi.org/10.1037/tra0000539

Hogeveen, J., & Grafman, J. (2021). Alexithymia. Handbook of Clinical Neurology, 183, 47–62. https://doi.org/10.1016/B978-0-12-822290-4.00004-9

Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80–89. https://doi.org/10.1016/j.eurpsy.2018.09.004

Kiraz, S., Sertçelik, S., & Erdoğan Taycan, S. (2021). The relationship between alexithymia and impulsiveness in adult attention deficit and hyperactivity disorder. Turkish Journal of Psychiatry, 32(2), 109–117. https://doi.org/10.5080/u23775

Mendia, J., Zumeta, L. N., Cusi, O., Pascual, A., Alonso-Arbiol, I., Díaz, V., & Páez, D. (2024). Gender differences in alexithymia: Insights from an updated meta-analysis. Personality and Individual Differences, 227, 1–11. https://doi.org/10.1016/j.paid.2024.112710

Putica, A., Van Dam, N. T., Steward, T., Agathos, J., Felmingham, K., & O'Donnell, M. (2021). Alexithymia in post-traumatic stress disorder is not just emotion numbing: Systematic review of neural evidence and clinical implications. Journal of Affective Disorders, 278, 519–527. https://doi.org/10.1016/j.jad.2020.09.100

Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (2017). Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66–81. https://doi.org/10.1016/j.jpsychores.2017.06.007

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