What is alexithymia? Do all autistic people have this?

A Definition

Alexithymia is a difficulty with identifying one’s own emotions.

Prevalence

In general, about half of the autistic population has alexithymia (e.g. Bird and Cook 2013; Kinnaird, Stewart and Tchanturia 2019).

What I’m not getting into is the chicken-egg delineation of whether alexithymia is typically co-occuring with autism, or whether alexithymia is a definitive feature of autism, or something else explains them both.

I also don’t love using words like prevalence that suggest more of a medical model than a social model, as I prefer the latter. When I say prevalence, I’m just referring to how common this is, without any unintended pathologizing.

Illustration

Do you ever feel anxious? When do you feel anxious? How do you know that you are feeling anxious? Where do you feel it in your body when you are feeling anxious? 

I suspect if you do not have alexithymia, you can probably answer questions of this nature.

When I was recently asked these questions, they were hard for me to answer. I feel like I can identify having felt anxiety after the fact, but I think I do so by pointing to the observable experiences of it. For example, when I am anxious I might stay up all night thinking, instead of sleeping.

If you asked me why I didn’t sleep, I would say that I had thoughts. That’s why I didn’t sleep. But did I feel anxious? I guess so, because I always have thoughts, but they don’t always prevent me from sleeping, right?

Some of the main characteristics of alexithymia include the following, adapted from (Poquérusse et al. 2018):

• difficulty identifying feelings and distinguishing between emotions and bodily sensations of emotional arousal;
• difficulty describing feelings to other people;
• reduced capacity to imagine;
• having a more stimulus-bound, externally oriented cognitive style; and
• difficulty understanding and describing the emotions of others

How This Plays Out in my Marriage

That last one (re: understanding other people’s emotions) is actually the most common cause of miscommunication in our household. I suspect Rachael might write about it from her perspective at some point.

From my experience, I can often perceive that my spouse is feeling somehow different, and for whatever reason I often make a guess that she is angry. In these times, I used to ask, “Are you mad?”

This question, I’ve learned, makes her mad, since usually it’s not anger, but being asked if she’s mad, when she’s not mad, does make her mad. And I can appreciate that.

So now I ask, “Are you feeling… something?”

And I ask because I care. I sense something is wrong, and I want to know whether she is okay, if there is something I can do, or a way I can be supportive.

In reality, she still knows that I’m thinking she’s mad and so she still kinda gets mad when I ask.

So this is something we’re working on figuring out actually. It doesn’t come up all that often, because we both practice open and direct communication, but when it does come up, we don’t have a great resolution process yet. Stay tuned – we’ll write about it when we figure it out.

That struggle in figuring out other people’s feelings can make it hard to interpret and recognize things like facial expressions, tone of voice, and general emotional stimuli. This is going to influence relationships. Add this into the mix with autism in general and these are important considerations to understanding someone.

What about you? Do you have experience with alexithymia?

Want to discuss this topic? There is a thread about it on the facebook page.

References

Bird, G. and R. Cook. 2013. “Mixed Emotions: The Contribution of Alexithymia to the Emotional Symptoms of Autism.” Translational Psychiatry 3(7):e285-e85. doi: https://doi.org/10.1038/tp.2013.61.

Kinnaird, Emma, Catherine Stewart and Kate Tchanturia. 2019. “Investigating Alexithymia in Autism: A Systematic Review and Meta-Analysis.” European Psychiatry 55:80-89. doi: https://doi.org/10.1016/j.eurpsy.2018.09.004.

Poquérusse, Jessie, Luigi Pastore, Sara Dellantonio and Gianluca Esposito. 2018. “Alexithymia and Autism Spectrum Disorder: A Complex Relationship.” Frontiers in Psychology 9. doi: https://doi.org/10.3389/fpsyg.2018.01196.