Alexithymia and Autism

Hello Dazzle! Thanks for coming and hanging out with me today, I’m glad that you are here. Today I want to talk about alexithymia and how it is connected with autism. This connection is important because it has lead to many of the misunderstandings regarding those with autism. Many symptoms that are actually symptoms of alexithymia have become associated with autism even though the research shows that this correlation does not exist. So, how did this happen? Well, let’s get into it!

Let’s start with what alexithymia is since that will be important. First, it is important to understand that alexithymia is not a disorder, but rather a symptom that can be present in individuals who have various mental disorders and in those who have no mental disorder at all. [1] [3] It can also be present in neurological conditions or cases of traumatic brain injury. [6] This means that alexithymia is far from being exclusive to those who have a diagnosis of autism. The research suggests that there is a stronger connection with trauma then with autism. [7] [8] [9] [10] [11] [12]

Alexithymia is a disruption in emotional awareness. [3] There are 3 categories that a person with alexithymia can have deficits in:

1. Difficulty identifying feelings
2. Difficulty describing feelings
3. Impaired Interoception (or externally-oriented thinking) [3] [4] [5]

Someone with alexithymia can have difficulties in just one or in multiple areas with their emotional awareness. The symptoms that they experience can have different degrees of severity. Having alexithymia can impair a person’s ability to have healthy relationships with others since they struggle with emotional connection. When you cannot identify or describe your own feelings it is also difficult to identify the feelings of others. People with alexithymia have a difficult time reading the facial expressions and body language of others. There is even research that shows those with alexithymia have more difficulty identifying the emotions in others while they are making eye contact [13] which makes them more likely to look at other parts of a person’s face.

Research suggests that about 50% of people with autism also have alexithymia. [1] [2] Alexithymia occurs in the general population in about 5% of people. [1] This means that alexithymia occurs much more often in those who have autism then it does in the general population, by far. When autism was first researched, the relationship with alexithymia was not known and thus not researched. This led to researches including the symptoms of alexithymia into the list of symptoms for autism. This relationship has since become well established yet the symptoms of alexithymia have yet to be removed from the diagnosis symptom list of autism. [14] There are symptoms of alexithymia that are not included in the diagnostic criteria that are also strongly associated with autism, so much so that they are symptoms that are frequently discussed as being part of autism even within the autistic community.

If one looks autism up in the DSM 5, they will see that the diagnostic criteria still includes emotional reciprocity, reduced sharing of emotions, reduced affect, abnormalities in eye contact, deficits in understanding nonverbal communication, and deficits in developing, maintaining, and understanding relationships. [13] These symptoms are all things that are known symptoms of alexithymia [3] [4] [5] [15] [16] which can make it difficult to say how much of these symptoms are presenting in this population because autism and alexithymia overlap so frequently.

More recent research has begun to try to evaluate if these symptoms are part of autism or if they are, in fact, due to the high prevalence of alexithymia. What this research is revealing, is that many of the symptoms that were once considered part of autism are, in fact, solely caused by the high prevalence of alexithymia in the autistic population. [17] [18] [19] [20] [21] [22] This research demonstrates that those with autism have the same range of emotional competence as those in the general population. This means that autism itself doesn’t impact a person’s emotional functionality.

Since there is a stronger correlation to PTSD than to autism, I suggest that the reason that alexithymia presents so frequently in autistic individuals is because of the high prevalence of trauma in an autistic person’s life. Having the diagnosis of autism makes it more likely that you are also going to be diagnosed with PTSD. [23] [24] [25] The implications of trauma being the possible cause of the high prevalence of alexithymia in autism are rather profound. Especially so when one considers that one of the leading treatments for autism, applied behavior analysis, has a correlation for increasing PTSD rates in those with autism. [26]

If you are interested in how alexithymia is measured, you can look at the Toronto Alexithymia Scale. I myself score 72 which is considered high and is a result that indicates a person has alexithymia. You can also try the Online Alexithymia Questionnaire. I myself score 126 which is considered high and is a result that indicates a person has alexithymia. I like that the Online Alexithymia Questionnaire breaks down your results into the different symptom areas. You can take the tests yourself and see how you score for alexithymia.

Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like what you read, click on that like button. It really does help! Until we talk again, you take care of yourselves!

References and Additional Reading

1. Investigating alexithymia in autism: A systematic review and meta-analysis
2. Alexithymia and Autism Spectrum Disorder: A Complex Relationship
3. Alexithymia
4. What to know about alexithymia
5. The Emotional Blindness of Alexithymia
6. Alexithymia in Neurological Disease: A Review
7. Towards a teleological model of alexithymia: alexithymia and post-traumatic stress disorder
8. Childhood adversities as risk factors for alexithymia and other aspects of affect dysregulation in adulthood
9. Clinical and neural correlates of alexithymia in posttraumatic stress disorder
10. Meta-analysis of alexithymia in posttraumatic stress disorder
11. Impact of severe childhood sexual abuse on the development of alexithymia in adulthood
12. The Role of Early Emotional Neglect in Alexithymia
13. Looking at the eyes interferes with facial emotion recognition in alexithymia.
14. Autism Spectrum Disorder (ASD): Diagnostic Criteria
15. Toronto Alexithymia Scale
16. Alexithymia
17. Alexithymia, not autism, is associated with impaired interoception
18. Alexithymia, Not Autism, Predicts Poor Recognition of Emotional Facial Expressions
19. Facial emotion recognition in autistic adult females correlates with alexithymia, not autism
20. Expressive Incoherence and Alexithymia in Autism Spectrum Disorder
21. Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism
22. Investigating alexithymia in autism: A systematic review and meta-analysis
23. Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits
24. Are PTSD and autistic traits related? An examination among typically developing Israeli adults
25. Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions
26. Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis