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Alexithymia: When it is Hard to Know What You Are Feeling

  • Writer: Petra
    Petra
  • 4 hours ago
  • 4 min read

Some people find it surprisingly difficult to answer questions like “How are you feeling?” or “What upset you about that?” This is not because they are avoiding their emotions. Often, it is because they genuinely cannot identify what they are feeling in the moment.

This experience is called alexithymia.


Alexithymia is not a diagnosis. It describes a pattern of difficulty recognising and describing emotions. It exists on a spectrum, and many neurodivergent people, particularly those with ADHD and/or autism, recognise parts of themselves in it.


Alexithymia does not mean someone lacks emotions. It means emotions are harder to notice and interpret.


What alexithymia can Look like

People with alexithymia often describe knowing that something is happening internally, but not being sure what it is. They may rely more on thinking than feeling when making decisions, struggle to explain their reactions, or find emotional conversations confusing or effortful.


A common experience is noticing physical sensations before recognising emotions. Someone might experience tension, restlessness, fatigue, or headaches without immediately realising these are signals of stress or anxiety. Others only understand what they felt hours or days after something happened.


How alexithymia affects self-understanding

Emotions carry useful information. They help us recognise what matters to us, when something feels wrong, when we are overwhelmed, and what we need from others.

When emotions are difficult to identify, it can be harder to notice stress building, understand reactions, make decisions confidently, or recognise personal limits.


I clearly remember one of my clients, over a decade ago, who made a serious suicide attempt, but was unable to describe what triggered it, what she was thinking, or how she was feeling. Her adult children reported a long history of complicated grief after the premature death of her husband, but no emotions were ever spoken about, despite her sobbing uncontrollably in bed periodically for months, extending into years. Because she was unable to access and describe how she felt in the past or currently and how it changed over time, I was not able to make a useful plan for managing suicide risk. It was quite disconcerting, and I found it hard to understand at the time, even though we did label it as alexithymia.


How alexithymia can affect relationships

Relationships depend partly on being able to recognise and communicate emotional experiences. When this is difficult, misunderstandings can happen easily.


Someone with alexithymia may care deeply about others but struggle to explain their needs or respond in expected emotional ways. Partners or family members sometimes interpret this as distance or lack of interest, when the difficulty is actually about recognising and translating internal experiences into words.


Alexithymia in ADHD and autism

A systematic review and meta-analysis of 15 studies using the Toronto Alexithymia Scale found much higher alexithymia scores in autistic people than in the general population (just under 50% of the autistic sample met the cut-point for significant alexithymia, versus just under 5% in the general population sample).


While a meta-analysis does not exist for people with ADHD at the time of writing, one study found a rate of significant alexithymia symptoms in 22% of the ADHD sample, again compared to an expected 5% for a general population sample, while another study found a prevalence of significant alexithymia in 41.5% of an ADHD sample.


In ADHD and autism, emotional experiences often move quickly. Reactions can feel immediate and strong, but understanding what happened emotionally may take longer. Some people only recognise later that something mattered to them, or why they reacted the way they did. Difficulties with working memory can also make it harder to reflect on emotional experiences while they are happening. The second ADHD study noted above found that higher scores on alexithymia were associated with higher impulsivity scores, which may lend some support to this emotional impulsivity hypothesis.


Some other possible hypotheses for why alexithymia is more common in neurodivergent people include:

  • differences in interoception (body-signal awareness)

  • emotion regulation differences

  • working memory limitations affecting emotional reflection

  • attentional variability during emotional processing

  • developmental differences in learning emotion language

  • masking and social learning experiences


Can emotional awareness improve?

The encouraging news is that emotional awareness is a skill that can develop over time.

One helpful starting point is expanding emotional vocabulary. Many people were never taught language beyond words like happy, sad, or stressed. Learning more specific words often makes emotional experiences easier to recognise. One way to do this is to use an emotion wheel to identify more simplistic emotions and work outward to more nuanced ones.


It can also help to pay attention to body signals. Tight shoulders, shallow breathing, fatigue, or restlessness are often early signs of emotional states rather than purely physical problems.


Some people find it easier to notice emotional patterns across time rather than in single moments. For example, repeatedly feeling drained after certain interactions or unsettled when plans change can provide clues about underlying emotions.


Therapy can also support this process by helping people link experiences, body signals, and reactions together in ways that gradually make emotions feel clearer and more predictable.


Final Thoughts

If you are often unsure what you are feeling, you are not alone. Alexithymia reflects a difference in emotional awareness. With time and practice, many people become better at recognising their emotional signals and understanding themselves, and perhaps others, more clearly.



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