TL;DR The Quick Version

• What it is: Alexithymia is a way of processing the world where identifying and describing internal emotions feels difficult or impossible.
• Why it happens: For many autistic and ADHD people, the brain focuses more on external facts or physical body sensations than on “emotional labels.”
• The body connection: Emotions often show up as physical sensations (like a racing heart or a heavy stomach) rather than words.
• The goal: You don’t have to “fix” this. The goal is to find your own personal language; whether that is through art, metaphors, or simply noticing your body to understand your internal world on your own terms.

Introduction

In a typical therapy session, the most common question is: “How does that make you feel?” For many people, that question is an invitation to explore. But for many autistic people, that question feels like being asked to solve a complex math equation in a language you don’t speak. You might feel a “blankness,” a sense of “static,” or you might start describing exactly what happened in the room rather than what is happening inside you.

If this sounds familiar, you aren’t “bad at therapy.” You are likely experiencing alexithymia.

What is Alexithymia?

Alexithymia is a term used to describe a specific internal experience where a person has a hard time identifying, describing, and distinguishing between feelings. Research shows it affects about 10% of the general population, but it is significantly more common among autistic and ADHD individuals.

It is generally broken down into three main experiences:

• Difficulty Identifying Feelings

This is the “I don’t know” factor. You might feel a surge of energy in your body, but you can’t tell if it’s “excitement,” “anxiety,” or just the fact that you had too much caffeine. The signals are there, but they are blurry and undifferentiated.

• Difficulty Describing Feelings

Even if you know you are “upset,” finding the right words to explain how you are upset to another person feels like an impossible task. This can lead to frustration in relationships because others might assume you are being distant when you are actually just stuck in a “wordless” state.

• Focus on the External World

Many people with alexithymia have an “externally oriented” way of thinking. This means your brain is naturally tuned to facts, logic, and what is happening outside of you. You are likely a great problem solver or observer of patterns, but looking “inward” feels like trying to look into a dark room without a flashlight.

The Connection to the Autistic Experience

It is important to approach alexithymia from a neuroaffirming perspective. Having alexithymia does not mean you “lack” emotions. In fact, many autistic people feel emotions quite intensely; sometimes too intensely.

The challenge lies in the translation.

Sensory Overload and Muting

For an autistic person, the world is often very loud, bright, and sensory heavy. To survive in a world that wasn’t built for your neurotype, your brain may have learned to “mute” internal signals so you can focus on navigating the external environment. Over time, this muting becomes the default setting.

Interoception: Your Internal GPS

Interoception is the sense that tells you what is happening inside your body: things like hunger, thirst, heart rate, or the need to use the bathroom. In many autistic people, this “internal GPS” is calibrated differently. If you struggle to notice when you are hungry until you are “hangry,” you will likely also struggle to notice when you are stressed until you are in a state of total burnout.

When Emotions Become Physical (Somatization)

One of the most important findings in recent research is that for people with alexithymia, emotions don’t just disappear; they change shape. If the brain cannot label a feeling as “sadness,” it might process that energy as a physical sensation instead.

This is why you might experience:

• Tightness in the chest instead of anxiety.
• Heavy limbs or fatigue instead of depression
• Headaches or stomach pain instead of stress.
• Muscle tension instead of anger.

In my practice, we don’t try to force you to use “feeling words” if they don’t fit. Instead, we start by looking at the geography of the body. If we can understand the “blue heaviness” in your legs, we are doing deep, meaningful work, even if we never call it “sadness.”

A Different Way Forward: The “Menu” of Expression

Traditional therapy often relies on a “front door” approach: Think about a feeling, name the feeling, talk about the feeling. For alexithymia, we need a “back door;” a way to explore the internal world without the pressure of direct emotional labeling.

Here are some ways we might collaboratively explore your internal world:

• Mapping the Body: We can use a simple drawing that is the outline of a human body to map out what you notice.
  • You choose the symbols: You don’t have to use “standard” colors. If a sensation feels like “purple static,” that is what we record.
  • Non-verbal awareness: This allows us to see the “weather patterns” of your body without needing a dictionary.
• Using Sensory Landscapes:  Sometimes, it is easier to describe a place than a feeling. If the sensation in your chest was a physical environment, what would it look like?
  • Is it a cave? A stormy beach? A quiet library?
  • What is the temperature? Is there any sound?
  • This uses your brain’s natural ability to observe patterns and environments to give us a “snapshot” of your internal state.
• The “Observer” Stance: We practice the skill of noticing. Instead of the pressure of “I am (emotion),” we try “I notice a sensation of (physical feeling.” This takes the judgment out of the experience. You aren’t “anxious;” you are just a person who notices a “fast-beating heart” right now.
• Creative Expression: We can explore physical sensations through various creative lenses; such as keeping a somatic observation log or personifying specific sensations as “internal characters.” These are simply tools on the menu to help translate physical feeling into meaningful language.

An Adlerian Perspective: You Are a Whole Person

As a therapist, I believe in the unity of the individual. This means your alexithymia isn’t a “broken part” of you; it is a part of how you have learned to move through the world.

Perhaps focusing on facts and logic was a way to stay safe in a confusing world. Perhaps “muting” your emotions was the only way to handle the intense sensory input of being autistic in a loud environment. My goal is to offer encouragement; to help you see that your way of experiencing the world is valid and that you can find a sense of belonging and understanding without needing to “perform” emotions like a neurotypical person.

Conclusion: Understanding Your Own Language

Alexithymia is not a lack of feeling; it is a different way of feeling.

If you are tired of thinking that you are “failing” at therapy because you don’t have the “right” words, please know that your internal language is simply different. Whether you express yourself through art, through the physical sensations of your body, or through the logical observation of the world around you, your experience is real and meaningful.

We don’t need to find “the word.” We just need to find your language.

A Note on the Research: As a therapist, I stay up-to-date on the latest science so I can better support you. Much of the information in this post comes from a 2024 systematic review published in Behavioral Sciences (DOI:10.3390/bs14121173), which analyzed the most effective ways to treat alexithymia over the last 14 years. This study highlights that there isn’t just one way to ‘fix’ things; rather, there is a showcase of different treatments that can be tailored to your unique needs.