The alexithymia & autism guide15 min read

(This article was orig­i­nally pub­lished on Embrace ASD)

Alexithymia is very common among autistic people. Research indi­cates 40–65%1)The validity of using self-reports to assess emo­tion reg­u­la­tion abil­i­ties in adults with autism spec­trum dis­order (Berthoz & Hill, 2005)2)Brief report: cog­ni­tive pro­cessing of own emo­tions in indi­vid­uals with autistic spec­trum dis­order and in their rel­a­tives (Hill et al., 2004) of us have alexithymia—or even as high as 70%3)Measuring the effects of alex­ithymia on per­cep­tion of emo­tional vocal­iza­tions in autistic spec­trum dis­order and typ­ical devel­op­ment (Heaton, 2012)—com­pared to 4.89% in the gen­eral pop­u­la­tion.4)Investigating alex­ithymia in autism: A sys­tem­atic review and meta-analysis (Kinnaird, Stewart & Tchanturia, 2019)

It’s so common that some symp­toms gen­er­ally attrib­uted to autism (to the point of being part of the diag­nostic cri­teria for autism) actu­ally stem from alex­ithymia instead! More about that later in this post.

So what is alex­ithymia, and how does it develop?


An illustration of a butterfly, used as a symbol for alexithymia.

Alexithymia

Alexithymia (also called emo­tional blind­ness) is a con­di­tion where you have chal­lenges iden­ti­fying and describing emo­tions in the self. Essentially, alex­ithymia is a dif­fer­ence in emo­tion pro­cessing.

The term was intro­duced by Peter Emanuel Sifneos in 1972, from the Greek a for lack, lexis for word, and thymos for emo­tion, meaning lack of words for emo­tions or simply no words for emo­tions.5)Peter Emanuel Sifneos | The Harvard Gazette (2010)

More com­pre­hen­sively though, alex­ithymia is defined by:

  1. Difficulty iden­ti­fying feel­ings.
  2. Difficulty dis­tin­guishing between feel­ings and the bodily sen­sa­tions (inte­ro­cep­tion) of emo­tional arousal.
  3. Difficulty describing feel­ings to other people.
  4. Difficulty iden­ti­fying facial expres­sions.
  5. Difficulty identifying/remembering faces. (an extreme form of the latter is prosopag­nosia/face blind­ness)
  6. Difficulty fan­ta­sizing.
  7. A thinking style focused on external events (often avoiding inner expe­ri­ences).

You don’t need to expe­ri­ence all or most of these to qualify for alex­ithymia, how­ever. I will explain later in this post which of the 7 points above we tend to see in autistic people.


My alexithymia

When I got diag­nosed with autism at 25, my diag­nos­ti­cian said I “have a lack of internal dynamics”. It took me quite a while to figure out what he meant, but I now think what he was alluding to was alex­ithymia. I used to express my emo­tions with vague approx­i­ma­tions (I feel good, or I feel con­tent, or I feel bad) if at all; and I still do to a degree, but I have gotten a lot better at exploring my inner emo­tional world and giving it a more nuanced expres­sion when someone asks me about my feel­ings. Learning about alex­ithymia has been pro­foundly useful for me. I hope it is as illu­mi­nating for you as well.

For more infor­ma­tion on the expe­ri­ence of alex­ithymia,
I rec­om­mend reading the post below, which I wrote when
my alex­ithymia was par­tic­u­larly high:

The experience of alexithymia

Also con­sider reading Yo Samdy Sam’s expe­ri­ence of alex­ithymia:

Alexithymia: What It’s Like to Not Know How You Feel

An illustration of a butterfly with different colors for both wings, representing two different types of alexithymia.

Types of alexithymia

Alexithymia can be divided into two types:

  • Cognitive alex­ithymia — The cog­ni­tive dimen­sion of alex­ithymia has to do with dif­fi­cul­ties in iden­ti­fying, ver­bal­izing, and ana­lyzing emo­tions. Basically, this is #1–4 from the list above.
  • Affective alex­ithymia — The affec­tive dimen­sion of alex­ithymia has to do with dif­fer­ences in imag­i­na­tion and emo­tional arousal (height­ened emo­tional activity as a result of a stim­ulus). This refers to #6 and #7 from the list above.

There are also a few more types of alex­ithymia based on eti­ology (meaning dif­ferent causes), which I will dis­cuss below.


An illustration of three butterflies in rotational symmetry, each representing a different etiological type of alexithymia.

Causes

Alexithymia can develop in three dif­ferent ways:

Primary alexithymia

  • Cause: genetics & family rela­tions
  • Description: Primary alex­ithymia is a life­long con­di­tion, caused by child­hood trauma6) or neg­a­tive pri­mary care­givers inter­ac­tions.7) So pri­mary alex­ithymia develops early, and becomes molded during child­hood and early adult years as per­son­ality traits.8) Hence pri­mary alex­ithymia is also called trait alex­ithymia.

Secondary alexithymia

  • Cause: psy­cho­log­ical dis­tress
  • Description: Secondary alex­ithymia refers to alex­ithymic char­ac­ter­is­tics resulting from psy­cho­log­ical stress, chronic dis­ease, or organic processes (such as brain trauma or a stroke) that occur after child­hood.9) Secondary alex­ithymia is less ingrained, as it’s based on (tem­po­rary) states rather than per­son­ality traits. As such, it’s also referred to as state alex­ithymia.

Organic alexithymia

  • Cause: trauma (vas­cular or other brain damage)
  • Description: A sub-category of sec­ondary alex­ithymia, organic alex­ithymia is caused by damage to brain struc­tures involved in emo­tional pro­cessing.10)

An illustration of a shield with a butterfly design, representing the defensive aspect of alexithymia.

Defense mechanism

In our ini­tial post on alex­ithymia (enti­tled Alexithymia), I argued how alex­ithymia is likely a pro­tec­tion mechanism—not just a nui­sance. I argued that in an envi­ron­ment where your emo­tions just get you into trouble or makes things too hard to bear, alex­ithymia can increase and con­se­quence reduce your emo­tional expe­ri­ence so you are less bur­dened by your emo­tions. As it turns out, I was cor­rect!

Research shows that alex­ithymia is a defense or pro­tec­tion against highly emo­tional events.11) The higher levels of alex­ithymia in holo­caust sur­vivors12)Alexithymia in Holocaust sur­vivors with and without PTSD (Yehuda et al., 1997) and sexual assault vic­tims13)Alexithymia in vic­tims of sexual assault: an effect of repeated trauma­ti­za­tion? (Zeitlin et al., 1993) sup­ports this.

Research from 2012 by Oriel FeldmanHall , Tim Dalgleish, and Dean Mobbs also shows that people who are high on alex­ithymia report less dis­tress at seeing others in pain.14)Alexithymia decreases altruism in real social deci­sions (FeldmannHall, Dalgleish & Mobbs, 2012) That may sound good for the alex­ithymic indi­vidual (although per­sonal dis­tress in alex­ithymics is high15)Correlation between theory of mind and empathy among alex­ithymia col­lege stu­dents (Xue, Hongchen & Lei, 2017)), but as a con­se­quence, they also behave less altru­is­ti­cally.16)Alexithymia decreases altruism in real social deci­sions (FeldmannHall, Dalgleish & Mobbs, 2012)


My empathy

I can per­son­ally attest to that. For example, when I was 27 or so, as I was walking to the gro­cery store, a few meters away from me a woman in her early 30s fell off her bike. I chuckled as I con­tinued walking, and to my sur­prise, a man and a woman (who had no con­nec­tion with each other as far as I saw) came run­ning to help her get back on her bike. I thought it was all a bit dra­matic, like you might see in the movies. I thought to myself, “If it was a guy falling you would likely not have come to the rescue.”

The reason I could laugh about what hap­pened was that I saw she was fine anyway. Had it been serious, I would have helped out if no one else did. But I also fig­ured I had a lesser incli­na­tion to help because I fell off my bike many times. Yes, it hurts. And then I get up. People “helping me out” has always embar­rassed me; it was much better if everyone just pre­tended they hadn’t seen any­thing.

That was the old alex­ithymic me. Today I am a new alex­ithymic me. While I think I would likely respond the same way to that sit­u­a­tion as I did then if it were to happen today, I also rec­og­nize that not helping out because I didn’t want to be helped when I fell off my bike is pro­jec­tion; how I want others to respond to me is not nec­es­sarily how others want people to respond. Being autistic and alex­ithymic, I’m not nec­es­sarily in tune with how people want me to respond.

Let’s look at how alex­ithymia presents itself in autism specif­i­cally. It’s actu­ally really fas­ci­nating!


An illustration of a butterfly, used as a symbol for alexithymia.

Alexithymia in autism

Although I have not been able to sub­stan­tiate this with research, I believe autistic people tend to have pri­mary alex­ithymia, though sec­ondary alex­ithymia could also occur in autistic people.17)Response to “Features of Alexithymia or fea­tures of Asperger’s syn­drome?” by M. Corcos in European Child and Adolescent Psychiatry 12, 2003 (Fitzgerald, 2004) Organic alex­ithymia likely has the same occur­rence in both autis­tics and non-autistics.

As it hap­pens, when I was 13 I was cat­a­pulted out of a tree (long story) and cracked my skull. Although my expe­ri­ence is dif­ferent, according to my mother I changed per­son­ality since then, so I might have organic alex­ithymia on top of pri­mary alex­ithymia. Over the years I man­aged to reduce it con­sid­er­ably, how­ever.

In any case, research from 2005 by Sylvie Berthoz and Elisabeth Hill shows that autistic people have cog­ni­tive alex­ithymia specif­i­cally.18)The validity of using self-reports to assess emo­tion reg­u­la­tion abil­i­ties in adults with autism spec­trum dis­order (Berthoz & Hill, 2005) So that means chal­lenges with iden­ti­fying and describing feel­ings, chal­lenges with dis­tin­guishing between feel­ings and bodily sen­sa­tions (called inte­ro­cep­tion), dif­fi­cul­ties with iden­ti­fying facial expres­sions, and dif­fi­cul­ties with iden­ti­fying and remem­bering faces.

So, issues with theory of mind often attrib­uted to autism? Research shows that’s alex­ithymia19)Impaired self-awareness and theory of mind: An fMRI study of men­tal­izing in alex­ithymia (Moriguchi et al., 2006)20)Correlation between theory of mind and empathy among alex­ithymia col­lege stu­dents (Xue, Hongchen & Lei, 2017) (although research by Bethany Oakley, Rebecca Brewer, Geoff Bird and Caroline Catmur shows it’s not chal­lenges with theory of mind but with emo­tion recog­ni­tion that relates to alex­ithymia21)No Evidence for an Opposite Pattern of Cognitive Performance in Autistic Individuals with and without Alexithymia: a response to Rødgaard et al.) Do you tend to forget people’s faces? That’s alex­ithymia. Do you not rec­og­nize that you are hungry until hours later, at which point your sugar levels have dropped and you feel sick? Yep, that’s alex­ithymia. Specifically, that’s dimin­ished inte­ro­cep­tion due to alex­ithymia. So we may be less aware of our breathing, hunger, thirst, or our heart rate.

Interestingly, research by Punit Shah, Caroline CatmurGeoff Bird from 2016 shows that emo­tional and inte­ro­cep­tive sig­nals don’t influ­ence the decision-making process in autistic people with alex­ithymia, unlike in neu­rotyp­ical people with alex­ithymia.22)Emotional decision-making in autism spec­trum dis­order: the roles of inte­ro­cep­tion and alex­ithymia (Shah, Catmur & Bird, 2016)

But essen­tially, it seems all emo­tion pro­cessing dif­fer­ences thought to be part of autism are actu­ally due to alex­ithymia!23)The Multifaceted Nature of Alexithymia – A Neuroscientific Perspective (Goerlich, 2018) In a paper from 2013, Geoff Bird and Richard Cook refer to this as the alex­ithymia hypoth­esis.24)Mixed emo­tions: the con­tri­bu­tion of alex­ithymia to the emo­tional symp­toms of autism (Bird & Cook, 2013)

What we don’t tend to expe­ri­ence is affec­tive alex­ithymia; so we do not gen­er­ally have a lim­ited imag­i­na­tion or a lack of fan­tasies. I think our imag­i­na­tion is often quite rich (as a kid I was always described as a dreamer, and would write imag­i­na­tive sto­ries), and a lot of us have cre­ative abil­i­ties and inter­ests. However, I have heard some accounts of autistic people who only dream about prac­tical and mun­dane things, which sug­gests that some autistic people have affec­tive alex­ithymia as well.

So now let’s talk about the aspects we thought were part of autism, but are actu­ally due to alex­ithymia.


An illustration of a butterfly in a box with other butterflies flying outside of it, as a representation of alexithymia-induced social isolation.

Social isolation

The first aspect we per­haps mis­tak­enly thought was part of autism for the longest time is low socia­bility. Research from 2019 by Matthew D. Lerner et al. shows that:25)Alexithymia – not autism – is asso­ci­ated with fre­quency of social inter­ac­tions in adults (Lerner et al., 2019)

  • Autistic adults had a sim­ilar amount and pat­tern of social inter­ac­tions with others, com­pared to non-autistic adults.
  • Difficulties with iden­ti­fying emo­tions in both the self and others were asso­ci­ated with fewer social inter­ac­tions.
  • The severity of alex­ithymia symp­toms pre­dicts fewer social inter­ac­tions regard­less of autism status.

This seems to sug­gest that when you have a lower aware­ness of emo­tions in the self and others, you are less likely to be socially moti­vated, or maybe more likely to be put off by the social chal­lenges.

I can imagine that if you don’t have good aware­ness or a sig­nif­i­cant under­standing of the emo­tions of your­self and others, you will not be inter­ested in emo­tions and inter­acting, and are more likely focused on activ­i­ties and exploring con­cepts. That is cer­tainly true for me. I am a lot more object-oriented than people-oriented. Talking a lot about feel­ings and rela­tions bore me, unless there are inter­esting psy­cho­log­ical or philo­soph­ical layers to be explored.

Research from 2010 by Jamileh Zareia and Mohammad ali Besharatb also shows a range of inter­per­sonal prob­lems related to alex­ithymia, including:26)Alexithymia and inter­per­sonal prob­lems (Zarei & Besharat, 2010)

  • Assertiveness
  • Sociability
  • Submissiveness
  • Intimacy
  • Responsibility
  • Controlling

Research from 2015 by Lucy Foulkes et al. also showed that:27)Common and Distinct Impacts of Autistic Traits and Alexithymia on Social Reward, Foulkes et al., 2005

  • Both autistic traits and alex­ithymia reduce admi­ra­tion (the enjoy­ment of being flat­tered).
  • Both autistic traits and alex­ithymia increase neg­a­tive social potency (the enjoy­ment of being cruel, cal­lous and using others for per­sonal gains), but more so due to alex­ithymia.
  • Both autistic traits and alex­ithymia increase pas­sivity (the enjoy­ment of giving others con­trol and allowing them to make deci­sions).
  • Both autistic traits and alex­ithymia decrease proso­cial inter­ac­tion (the enjoy­ment of having kind, rec­i­p­rocal rela­tion­ships), but alex­ithymia more so.
  • Both autistic traits and alex­ithymia decrease sexual rela­tion­ships (the enjoy­ment of having fre­quent sexual expe­ri­ences), but autism more so.
  • Both autistic traits and alex­ithymia decrease socia­bility (the enjoy­ment of engaging in group inter­ac­tions), but autism much more so.

In the table below, you can see an overview of the asso­ci­a­tions of dif­ferent fac­tors of social reward with autistic traits and alex­ithymia.

Correlations between autistic traits, alex­ithymia and social reward.

So if you iso­late your­self a lot, or expe­ri­ence other inter­per­sonal chal­lenges, it may be due to your (co-occurring) alex­ithymia rather than your autism specif­i­cally, although both fac­tors seem to influ­ence social reward in dif­ferent ways.


An illustration of two intersecting people representing (mutual) empathy, and a butterfly that obscures that intersection.

Lower empathy

According to the sim­u­la­tion theory of empathy, people sim­u­late the feel­ings they observe in others in their mind, so that they can better under­stand and pre­dict the feel­ings of others. So having chal­lenges with inter­preting and describing your own emo­tions and internal processes will result in dif­fi­cul­ties empathizing with others’ feel­ings.

So that myth about autistic people not showing empathy? Well, it IS a myth, but for dif­ferent rea­sons than you might think; autistic people indeed some­times fail to respond empa­thet­i­cally, but it’s not due to their autism, but because of their alex­ithymia! The higher the alex­ithymia, the more poten­tial prob­lems with empathy.

And it’s not just cog­ni­tive empathy that is dimin­ished by alex­ithymia! Research from 2018 by Cari-lène Mul et al. shows that autistic people with alex­ithymia have both lower cog­ni­tive and emo­tional empathy than autistic people without alex­ithymia.28)The Feeling of Me Feeling for You: Interoception, Alexithymia and Empathy in Autism (Mul et al., 2018)

The research also showed that autistic people have a reduced inte­ro­cep­tive sen­si­tivity (they don’t feel internal bodily sen­sa­tions such as hunger as readily) which was not influ­enced by alex­ithymia, and a reduced inte­ro­cep­tive aware­ness (meaning we are less aware of the bodily sig­nals we already feel less), which was found to be influ­enced by both alex­ithymia and empathy.29)The Feeling of Me Feeling for You: Interoception, Alexithymia and Empathy in Autism (Mul et al., 2018)

Research also shows that decreased empathy causes a sense of lone­li­ness, so that’s another reason why it’s in your best interest to focus on resolving your alex­ithymia.30)Trait empathy as a pre­dictor of indi­vidual dif­fer­ences in per­ceived lone­li­ness (Beadle et al., 2012)

It’s impor­tant to note though that autism itself is not related to low emo­tional empathy. Quite the oppo­site, in fact. Research from 2017 by Adam Smith shows our emo­tional empathy is intact and even ele­vated31)The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development (Smith, 2017) (which some call empa­thetic over­arousal,32)The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development (Smith, 2017) though I don’t think this is really going to catch on with the ladies). No, it’s our cog­ni­tive empathy that tends to be lower than average.33)Impairments in cog­ni­tive empathy and alex­ithymia occur inde­pen­dently of exec­u­tive func­tioning in col­lege stu­dents with autism (Ziermans & de Bruijn et al., 2018)

And this is a problem for us, because research from 2018 by Jason Boss and Mark A. Stokes showed that for autistic people only, cog­ni­tive empathy is required for emo­tional empathy to lead to per­sonal well­being.34)Cognitive empathy mod­er­ates the rela­tion­ship between affec­tive empathy and well­being in ado­les­cents with autism spec­trum dis­order (Boss & Stokes, 2018)

What does that mean? Well, what Natalie sees in her prac­tice is that when it comes to autistic people and trauma, they tend to be the eas­iest patients to help, because basi­cally you just have to explain things to them, and just by under­standing it now they tend to get better. So first cog­ni­tive empathy needs to be present, so you under­stand the emo­tions of your­self and others. It’s that under­standing you need to make sense of your own emo­tional expe­ri­ences. If you can’t make sense of them, it is dif­fi­cult to find hap­pi­ness in that. But also, with high alex­ithymia and low cog­ni­tive empathy, a lot of emo­tions and feel­ings will fly under the radar of your own aware­ness, while still having an effect on your mood and behav­iors.

So only when cog­ni­tive empathy is high are autistic people able to expe­ri­ence the pos­i­tive rela­tion­ship between affec­tive empathy and per­sonal well­being. When cog­ni­tive empathy is low, that rela­tion­ship becomes neg­a­tive, meaning when more feel­ings come up that you are unable to process and may not even be fully aware of, your well­being will go down.

For more infor­ma­tion on empathy and autism, have a look at:

Empathy & autism

An illustration of a person making two ambiguous faces, and a question mark surrounded by two butterflies.

Face-perception differences

It is often stated that autistic people have dif­fi­culty iden­ti­fying facial expres­sions, but research from 2013 by Richard Cook et al. shows that the face-perception dif­fer­ences which we thought were due to autism are actu­ally the cause of alex­ithymia.35)Alexithymia, Not Autism, Predicts Poor Recognition of Emotional Facial Expressions (Cook et al., 2013) The research study con­sisted of two exper­i­ments:

Experiment 1 showed that alex­ithymia cor­re­lates strongly with the pre­ci­sion of expres­sion attri­bu­tions, whereas autism severity was unre­lated to expression-recognition ability.

In other words, alex­ithymia low­ered the pre­ci­sion with which both the autistic group and the con­trol group could iden­tify facial expres­sions.

Experiment 2 con­firmed that alex­ithymia is not asso­ci­ated with impaired ability to detect expres­sion vari­a­tion; instead, results sug­gested that alex­ithymia is asso­ci­ated with dif­fi­cul­ties inter­preting intact sen­sory descrip­tions.

Experiment 2 was a matching task, where either fea­tures of dif­ferent people or dif­ferent facial expres­sions were merged to show 20% of another photo. The exper­i­ment showed that people with alex­ithymia (regard­less of whether they are autistic or not) had no prob­lems with detecting these phys­ical dif­fer­ences, but nev­er­the­less had dif­fi­culty iden­ti­fying facial expres­sions cor­rectly. So it’s not that we see no phys­ical dif­fer­ences, but we don’t nec­es­sarily know what those dif­fer­ences mean.

My expe­ri­ence is that facial expres­sions are some­times quite ambiguous to me, so rather than not knowing what dif­ferent facial expres­sions mean, my chal­lenge is that some­times I can imagine dif­ferent emo­tional moti­va­tions for making that par­tic­ular facial expres­sion. I don’t believe I have a lot of dif­fi­cul­ties iden­ti­fying or describing facial expres­sions in gen­eral though, even though my alex­ithymia is high.

In any case, the researchers of the study sug­gest that cur­rent diag­nostic cri­teria of autism may need to be revised, because some of the diag­nostic cri­teria for autism actu­ally refer to alex­ithymia instead.36)Alexithymia, Not Autism, Predicts Poor Recognition of Emotional Facial Expressions (Cook et al., 2013) But given that alex­ithymia occurs so often in the autistic pop­u­la­tion, I would argue it can still con­tribute sig­nif­i­cantly to an autism diag­nosis.


Do you want to know if you have alex­ithymia?
Take the Alexithymia Questionaire here:

Alexithymia questionnaire online test

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References   [ + ]

1. The validity of using self-reports to assess emo­tion reg­u­la­tion abil­i­ties in adults with autism spec­trum dis­order (Berthoz & Hill, 2005)
2. Brief report: cog­ni­tive pro­cessing of own emo­tions in indi­vid­uals with autistic spec­trum dis­order and in their rel­a­tives (Hill et al., 2004)
3. Measuring the effects of alex­ithymia on per­cep­tion of emo­tional vocal­iza­tions in autistic spec­trum dis­order and typ­ical devel­op­ment (Heaton, 2012)
4. Investigating alex­ithymia in autism: A sys­tem­atic review and meta-analysis (Kinnaird, Stewart & Tchanturia, 2019)
5. Peter Emanuel Sifneos | The Harvard Gazette (2010)
6.
7.
8, 9, 10, 11.
12. Alexithymia in Holocaust sur­vivors with and without PTSD (Yehuda et al., 1997)
13. Alexithymia in vic­tims of sexual assault: an effect of repeated trauma­ti­za­tion? (Zeitlin et al., 1993)
14, 16. Alexithymia decreases altruism in real social deci­sions (FeldmannHall, Dalgleish & Mobbs, 2012)
15, 20. Correlation between theory of mind and empathy among alex­ithymia col­lege stu­dents (Xue, Hongchen & Lei, 2017)
17. Response to “Features of Alexithymia or fea­tures of Asperger’s syn­drome?” by M. Corcos in European Child and Adolescent Psychiatry 12, 2003 (Fitzgerald, 2004)
18. The validity of using self-reports to assess emo­tion reg­u­la­tion abil­i­ties in adults with autism spec­trum dis­order (Berthoz & Hill, 2005)
19. Impaired self-awareness and theory of mind: An fMRI study of men­tal­izing in alex­ithymia (Moriguchi et al., 2006)
21. No Evidence for an Opposite Pattern of Cognitive Performance in Autistic Individuals with and without Alexithymia: a response to Rødgaard et al.
22. Emotional decision-making in autism spec­trum dis­order: the roles of inte­ro­cep­tion and alex­ithymia (Shah, Catmur & Bird, 2016)
23. The Multifaceted Nature of Alexithymia – A Neuroscientific Perspective (Goerlich, 2018)
24. Mixed emo­tions: the con­tri­bu­tion of alex­ithymia to the emo­tional symp­toms of autism (Bird & Cook, 2013)
25. Alexithymia – not autism – is asso­ci­ated with fre­quency of social inter­ac­tions in adults (Lerner et al., 2019)
26. Alexithymia and inter­per­sonal prob­lems (Zarei & Besharat, 2010)
27. Common and Distinct Impacts of Autistic Traits and Alexithymia on Social Reward, Foulkes et al., 2005
28. The Feeling of Me Feeling for You: Interoception, Alexithymia and Empathy in Autism (Mul et al., 2018)
29. The Feeling of Me Feeling for You: Interoception, Alexithymia and Empathy in Autism (Mul et al., 2018)
30. Trait empathy as a pre­dictor of indi­vidual dif­fer­ences in per­ceived lone­li­ness (Beadle et al., 2012)
31, 32. The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development (Smith, 2017)
33. Impairments in cog­ni­tive empathy and alex­ithymia occur inde­pen­dently of exec­u­tive func­tioning in col­lege stu­dents with autism (Ziermans & de Bruijn et al., 2018)
34. Cognitive empathy mod­er­ates the rela­tion­ship between affec­tive empathy and well­being in ado­les­cents with autism spec­trum dis­order (Boss & Stokes, 2018)
35, 36. Alexithymia, Not Autism, Predicts Poor Recognition of Emotional Facial Expressions (Cook et al., 2013)

6 Comments

  1. Excellent and well ref­er­enced article Embrace. Alexithymia is one of the least well known facets of autism and almost unknown out­side our cir­cles. Thanks for such a thor­ough and infor­ma­tive sum­mary 👍

  2. This was such an enlight­ening article. I’m autistic, but I don’t have alex­ithymia. I’ve often won­dered why I’m autistic, yet miss these seem­ingly autistic traits like not being able to rec­og­nize emo­tions or facial expres­sions. Now I under­stand much better.

    1. Author

      Thank you! I’m really glad to hear it clar­i­fied some things for you.

  3. Fun article! You lost me in the mess about “cog­ni­tive empathy” and other types of empathy. I feel like you were trying to say some­thing really mean­ingful, but there was just too much new and not well under­stood ter­mi­nology in that sec­tion to really follow it.

    1. Author

      Thank you! Do you mean the sec­tion enti­tled ‘Types of alex­ithymia’ is con­fusing? Is there some­thing I can do to make it more clear?

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