Anxiety on the Autism Spectrum, Part 1: Unpacking Alexithymia
- Lucy Wallace
- Sep 9
- 5 min read
Updated: Sep 11
As a 2e teenager, I was almost always anxious, but I didn’t always know I was anxious. I felt my rapid heart rate, my thoughts racing, the fluttering in my stomach, the dizzy spells–but these perceptions never cohered into an overarching sense of emotion, and I couldn’t connect them to anything that was happening in my life. If you asked me how I felt, I probably would have just said, “Fine,” “Bad,” or simply “I don’t know.”
This lack of emotional awareness wasn’t specific to anxiety. I couldn’t identify sadness, either, nor did I have a grasp of more nuanced gradations like disappointment, irritation, or envy.
Positive feelings were equally baffling. I couldn’t make sense of the bright, fizzing sensation that I now call joy. Even unambiguously positive emotions became too overwhelming to handle. In short, I was overwhelmed with emotions that I couldn’t quite put into words.
Scientists have a word for this. It’s called alexithymia.
Alexithymia, explained
Alexithymia isn’t a clinical diagnosis, although it shows up in many physical and psychiatric conditions. Instead, it’s thought of as a personality trait, akin to extraversion or neuroticism. Alexithymia has three facets, or core components:
Difficulty identifying one’s own emotions: “Am I angry, sad, frustrated, scared, or something else altogether?”
Difficulty describing one’s emotions: “How do I put this feeling into words?”
A tendency not to focus on one’s own emotions: “It’s weird for me to think about my feelings, so I try to avoid them.”
Someone who strongly agrees with these sample survey items would be said to have high alexithymia. High alexithymia is particularly prevalent in the autistic population, with 30% to 60% of autistic individuals exhibiting clinical levels of alexithymia.
I don’t know of any research on alexithymia in the 2e population, but I suspect that many 2e learners struggle to name and understand their feelings. As a result of asynchronous development, 2e kids’ intellectual abilities often outpace their emotional intelligence.
Until just a few years ago, I was the poster child for autism-alexithymia-2e crossover. These struggles made it challenging to cope with all emotions, but anxiety proved especially problematic, perhaps because I experience it almost constantly. Learning to identify anxiety was the first step to managing it, and I suspect this may be true for other 2e kids and teens, as well.
What causes alexithymia?
As with most questions in psychology, there are no definitive answers but lots of possibilities.
One explanation relates to interoception, the ability to perceive bodily sensations. These include hunger, thirst, and pain, as well as the physical feelings linked to emotions.
To understand our emotions, we need to pay attention to and interpret physical cues like a pounding heart, tingling hands, or fluttering stomach. Autism and alexithymia have been linked to a phenomenon researchers refer to as "interoceptive confusion," which is the difficulty in making sense of physical sensations. Does my stomach hurt because I’m anxious, or is that just hunger? Is the tightness in my chest a sign of sickness or dread? These types of questions can befuddle high-alexithymics and autistics.
Other studies suggest that autistic people and those with high alexithymia tend not to notice sensory input until it becomes overwhelming. Someone might go an entire day without eating, unaware of their hunger. They might not notice pain or injury, or they might not recognize anxiety until it escalates into full-blown panic.
Both of these interoceptive issues make it hard to interpret the physical sensations that signal our emotions. In my case, physical sensations were confusing enough that just thinking about them increased my anxiety, which made it even harder to understand my feelings.
A second explanation involves emotion knowledge. According to this hypothesis, kids start out with broad, undifferentiated emotional terms: good or bad, happy or sad, upset or calm. As kids get older, they flesh out these categories. “Happy” becomes “excited,” “content,” and “overjoyed.” “Sad” expands into “disappointed,” “lonely,” and “hurt.” These additional shades of nuance help kids describe their feelings more precisely and accurately.
It could be that people with high alexithymia, though, haven’t developed their emotional vocabularies in this way. They only have a few words to describe their feelings. If other people see the whole rainbow of emotions, high-alexithymia individuals live in grayscale.
A third possibility suggests that alexithymia might represent both a lack of ability to understand emotions and a coping strategy. When someone struggles to comprehend their feelings, they may push those emotions away and focus on more concrete matters. Psychologists call this avoidance alexithymia.
Over time, a long-term pattern of avoiding feelings can hinder a person’s ability to develop emotional awareness, as they miss valuable opportunities to practice understanding their emotions. Consequently, this reduced emotional awareness can drive the individual to continue ignoring or suppressing their feelings, perpetuating the cycle of alexithymia.
(I should clarify that this framing represents my hypothesis, not a scientific finding, though I wouldn’t be surprised if this speculation were borne out in the data.)
What do we do?
Scientists are still in the early stages of developing solutions for individuals with high alexithymia, so while I can’t offer a bulletproof, scientifically backed solution, I can share what worked for me.
I started tackling alexithymia by becoming more aware of physical sensations. The yoga classes I took throughout high school proved enormously beneficial. To follow an instructor’s directions, you have to attach words and concepts to physical sensations. I gradually learned to feel the difference between muscle tension and relaxation.
Later, I found a similar benefit in a very different activity: weightlifting. Every weightlifting session feels like an embodied anatomy lesson. I do a series of exercises, and I can feel exactly which body parts are working. Over time, this experience has built up and clarified my sense of physical sensations, teaching me to interpret these sensations by inducing them under controlled circumstances.
Most recently, I’ve started practicing mindfulness (or trying to) throughout the day. It turns out that all the mindfulness hype is well-deserved. In particular, progressive muscle relaxation has been a game-changer. By systematically tensing and relaxing each muscle group, I can calm myself down immediately, something I’d never managed to do before. If this video hits a million views, I think I deserve partial credit.
Alongside physical activity, I also experimented with outsourcing emotion recognition. I’d talk to people I trusted, people who had known me for most of my life, and they would help me put the pieces together. Gradually, I learned that dizziness in the context of stressful life events usually indicated anxiety; that heat and adrenaline signaled anger; and that the bright, effervescent, shaken-bottle-of-Kombucha feeling equated to joy.
If you or your child experiences similar struggles with recognizing emotions, the following tips may help:
-Take this questionnaire to measure your levels of alexithymia. Your responses can offer insight into specific challenges.
-Keep a feelings wheel on hand for easy access to emotion terms.
-Check out the following resources to learn about physical manifestations of emotion:
-Explore mindfulness activities such as body scans and progressive muscle relaxation. These practices are especially beneficial if done regularly. You’ll start to notice patterns and become more familiar with your feelings.
About Lucy: I graduated from Stanford in 2024 with a degree in psychology and Slavic Studies. I currently live in Boston and work as a writing tutor with a focus on supporting 2e/neurodivergent students. I've been involved in the neurodiversity world since I was diagnosed with autism at age 18. I hope to pursue a PhD in psychology and develop evidence-based interventions to help neurodivergent students write. For tutoring inquiries, please check out my website!
