Alexithymia. I don’t know what I’m feeling?

Аня ВершковаJune 23, 20267 min read

“It’s hard for me to understand what I’m feeling” doesn’t really seem like such a big problem, right?

I have a well-developed intellect—isn’t that enough to make sound choices based on facts and live happily? Especially since these feelings usually just get in the way. Because of them, people make strange decisions, dramatize, get attached to the wrong people, take offense, get angry, do impulsive stupid shit. Maybe, on the contrary, it’s better to be a rational person and not depend on all these emotional swings?

Sounds logical. Until at some point it becomes clear that intellect alone can be insufficient.

If there is no clear understanding of your feelings, then you don’t understand what is unpleasant for you, and for years you may tolerate people, work, environments, and life formats that don’t suit you at all. Or you may understand that something is wrong, but fail to choose what would actually suit you, because your internal compass isn’t working.

What is alexithymia?

Alexithymia is a condition characterized by significant difficulties in recognizing, understanding, and verbally describing one’s own emotions. According to robust scientific data, this trait is extremely common among neurodivergent people, in autism spectrum disorders (ASD), ADHD, and the aftermath of trauma. Researchers link this phenomenon to disruptions in the functioning of the anterior insular cortex, which integrates our bodily sensations with cognitive appraisal (Kinnaird et al., 2019, Scientific Reports).

This does not mean that a person feels nothing. Very often it can be the opposite—there are too many feelings, they just register as something incomprehensible.

What can this look like?

“I feel bad,” “Everything pisses me off,” “I want to disappear,” “I don’t know what’s happening, but I can’t do this anymore.”

And you sit there trying to understand: is this anxiety? anger? fatigue? shame? hunger? sensory overload? do I need to change jobs? sleep? eat? leave the relationship? lie down in a dark room and have nobody touch me?

Alexithymia usually has several main manifestations:

it’s hard to understand what exactly you’re feeling. Not “I’m angry,” “I’m scared,” “I’m ashamed,” “I’m disappointed,” but simply “I feel bad,” “I don’t know,” “mush,” “fine,” “nothing.”
it’s hard to describe feelings in words. A person may understand that something is happening inside, but when asked “what are you feeling?” it is as if they lose access to that state. Especially if the question is asked during a conflict, in therapy, or at a moment of overload.
Because of poor access to internal signals, a person starts orienting mainly toward external criteria. (externally oriented thinking). If I don’t really understand what I feel, what I want, and what suits me, I still have to make decisions somehow. And then I begin to rely on what seems clearer and more reliable: what my parents said, what a partner/boss/society considers right, where the salary is higher, what is “more logical,” what I have already invested a lot of effort into, etc.

Why is alexithymia so common among neurodivergent people?

In people with ASD, ADHD, AuDHD, CPTSD, anxiety, and chronic stress, the processing of internal signals often works differently.

An emotion is not just the thought “I’m sad.” An emotion is assembled from bodily sensations, context, memory, behavior, impulses, thoughts, and feelings.

According to the large meta-analysis by Kinnaird et al. (2019), alexithymia occurs in about 50% of autistic people, whereas in the general population this figure is only about 5%. In ADHD, consistently high levels of alexithymia are also recognized as a major factor disrupting emotion regulation. In 2013, researchers Bird and Cook proposed the elegant “alexithymia hypothesis,” suggesting a fundamental shift in how the problem is understood. They stated that many deficits in emotion processing and empathy traditionally attributed to autism itself are in fact explained precisely by co-occurring alexithymia. A neurodivergent person may possess boundless affective empathy, literally absorbing another person’s pain with their whole body, while at the same time experiencing a tremendous deficit in cognitive empathy, being unable to name what is happening and separate their own feelings from someone else’s.

How can it show up?

Some signals are too loud: a clothing tag, sound, light, smell, touch. And some barely get through: hunger, fatigue, tension, the beginning of overload.

you don’t notice hunger until you start shaking;
you don’t notice fatigue until you collapse;
you don’t notice anger until you snap;

Causes of alexithymia in neurodivergent people:

Interoception. It is responsible for perceiving signals from the internal organs, including heart rate, body temperature, fatigue, hunger, and pain. The same brain areas are responsible for processing both these basic bodily signals and complex emotions—the anterior insular cortex (insula) and the anterior cingulate cortex (ACC). People with alexithymia often show atypical patterns of functioning specifically in these zones, accompanied by altered concentrations of neurotransmitters such as glutamate and GABA. If your brain has enormous difficulty reading a basic signal of thirst or overexertion, then recognizing the subtlest boundary between anticipation and anxiety becomes an elite-level task.
Masking and invalidation. If the first case is an inborn trait, here environmental factors come into play. A neurodivergent child often experiences the world much more intensely, inevitably encountering adults’ lack of understanding. “Stop making things up, it doesn’t hurt at all,” “Stop crying over nonsense,” “You’re too sensitive.” When your unique needs and sincere emotions are systematically ignored or cruelly invalidated, the child learns a terrible lesson: their internal compass absolutely cannot be trusted.

How is alexithymia connected to constant anxiety?

If I poorly understand what is happening to me, bodily signals can seem frightening.

Research does indeed show a link between alexithymia and anxiety and depressive symptoms. For example, in the work of Quinto and colleagues, alexithymia was positively associated with both anxiety and depression, as well as with lower indicators of mental and physical health. In reviews on anxiety disorders, alexithymic traits are also described as frequently occurring in different anxiety states, including panic attacks and generalized anxiety.

The relationship turns out to be bidirectional: Alexithymia interferes with recognizing one’s state → There is more uncertainty → Anxiety increases. Anxiety intensifies bodily sensations and self-monitoring → more avoidance and fear → Panic Attacks, for example.

What alexithymia can look like in life

💔 In relationships

you don’t understand whether you are genuinely uncomfortable in the relationship or you’re “just anxious”;
you may not realize for a long time that your boundaries are being violated;
you may tolerate something for a long time and then explode;
you feel “butterflies in your stomach” and mistake them for being in love, although your body is literally shaking with fear;
you can’t explain to your partner what you feel and consider conversations about it a waste of time.

💼 In career

you choose a profession because it’s “promising,” “stable,” “your parents approved,” but you don’t understand whether you even like living this way at all;
you work for years driven by anxiety and perfectionism, and then wonder why you burned out;
it is hard for you to understand which tasks enliven you and which slowly drain you;
you confuse “I’m good at it” with “it suits me”;

Alexithymia and burnout

With alexithymia, a person often notices overload too late. For example: you rest only when you are already completely broken, and as soon as a little energy appears, you immediately try to catch up on everything you didn’t do, and once again go into the negative.

For example:

you don’t understand that you’re tired until you’re already flattened;
you don’t notice that after socializing you need silence until your eye starts twitching from notifications and a mountain of unanswered messages piles up and you disappear from life for a month;
you don’t register sensory overload until a shutdown/meltdown happens;
you call exhaustion laziness or procrastination and try even harder;

For many neurodivergent people, maintaining well-being means having to study and notice the bodily and behavioral symptoms of fatigue.

Where exactly to look?

Cognitive shifts (Thoughts): you may not “feel” stress at all, but if you are endlessly fixating on the same anxious thoughts, this is a sure sign of bodily overload. Watch for increased self-criticism, the appearance of a heavy sense of fear about the future, and intensified rumination.
Bodily indicators: alexithymia is associated with higher rates of somatic complaints and chronic pain. This may include increased stomach pain, migraines, and myalgia.
Behavior: Sometimes tension shows up first and foremost in what we do or stop doing. A sudden change in sleep schedule, avoiding contact, strong withdrawal, an increase in stimming frequency, or neglecting our interests (for example, I stop listening to music and playing games).

Ask yourself regularly: what changes in behavior appear when I am overloaded? What somatic signals usually arise as tension builds? What thinking patterns appear when I am exhausted? Over time, it becomes easier to recognize these signals. By noticing stress earlier, we can take necessary measures sooner: reduce obligations, increase the frequency and quality of rest, and prevent a fall to the bottom of burnout.