What is Alexithymia?
When feelings are hard to notice and name.
Alexithymia refers to difficulty noticing feelings, telling them apart, putting them into words, and working with them.
Higher severity usually means more trouble identifying, describing, and processing emotions, often showing up as confusion, irritability, numbness, or shutdown.
What it means
Alexithymia is best understood as a difficulty with emotional awareness and using emotion language. The common measures of alexithymia (PAQ, TSQ, etc.) are designed around these self-report items.
Difficulty identifying feelings
Noticing internal emotional cues and differentiating feelings from bodily sensations.
Difficulty describing feelings
Finding accurate words and sharing emotions effectively with other people.
Externally-oriented thinking
Attention goes to outside events and practical details more than inner meaning.
Alexithymia Scales:
TAS vs PAQ vs ALI
A quick, high-level comparison of the widely used self-report scales VS. our conversation-derived ALI approach.
TAS-20
Toronto Alexithymia Scale
- 20-item self-report checklist.
- Global alexithymia score plus three subscales.
- Widely used benchmark in research and clinics.
PAQ-24
Perth Alexithymia Questionnaire
- Self-report with positive and negative emotion facets.
- Richer profile of identifying and describing feelings.
- Still relies on people rating themselves on items.
ALI
Alexithymia Language Index (Feelpath)
- Conversation-derived indices from session language.
- Facet scores tied to concrete, labeled excerpts.
- Designed to complement TAS/PAQ, not replace them.
Feelpath Smart Emotion Wheel Example
Neurodivergences & Emotion Skills
Emotions show up differently across people and neurotypes. This table highlights a few commonly reported patterns.
| Profile | AlexithymiaEmotional awareness | RegulationEmotion regulation | EmpathyPerspective-taking | ExecutiveFunctioning |
|---|---|---|---|---|
| ADHD | ◐ | ● | ◐ | ● |
| Autism (ASD) | ● | ● | ◐ | ◐ |
| AuDHD | ● | ● | ◐ | ● |
| CEN* | ● | ● | ◐ | ◐ |
| HSP* | ◐ | ◐ | ● | ◐ |
| Trauma / CPTSD | ● | ● | ◐ | ◐ |
| Anxiety / Depression & Perfectionism | ◐ | ● | ◐ | ◐ |
Research references
Selected peer-reviewed sources supporting the main patterns summarized in this table.
- Kinnaird, Stewart, & Tchanturia (2019): Investigating alexithymia in autism: A systematic review and meta-analysis
- McDonald et al. (2024): Emotion dysregulation in autism: A meta-analysis
- Song et al. (2019): Empathy impairment in autism spectrum conditions from a multidimensional perspective: A meta-analysis
- Milton (2012): On the ontological status of autism: The “double empathy problem”
- Crompton et al. (2020): Neurotype-matching (not autistic status) influences ratings of interpersonal rapport
- Beheshti et al. (2020): Emotion dysregulation in adults with ADHD: a meta-analysis
- Edwards (2022): Posttraumatic stress and alexithymia: A meta-analysis of presentation and severity
- Khan & Jaffee (2022): Alexithymia in individuals maltreated as children and adolescents: a meta-analysis
- Somerville et al. (2024): Emotion controllability beliefs and young people’s anxiety and depression: A systematic review
- Acevedo et al. (2018): Sensory processing sensitivity brain circuits review
* CEN (Childhood Emotional Neglect) is an experience; HSP (Highly Sensitive Person) is a temperament trait. They’re included because support needs often overlap with neurodivergent profiles.
What Alexithymia looks like in real life
These are some general experiences of what alexithymia might look like in a therapy session conversation.
“I don’t know what I feel. I just know I don’t want to be here right now.”
Sometimes the strongest available signal is an urge to escape, with no clear emotion label attached yet. Building emotion language can help make the inner state more specific and workable.
How to interpret severity
Think of Alexithymia as a continuum.
No alexithymia
People in this range are unlikely to have meaningful difficulty recognizing what they feel, differentiating emotions, or expressing those feelings in words.
Possible alexithymia
People in this middle range may benefit from a closer clinical look at how reflection capacity affects daily life. They can run into difficulties with emotion awareness, telling similar emotions apart, expressing feelings, and regulating emotions once they arise.
Alexithymia
People in the high range often struggle to identify and describe feelings. Attention may be directed more toward external events than internal experience, and regulating and communicating feelings can be difficult.
Clear Awareness
Feelings are accessible and nameable.
Mixed Awareness/Foggy
Some clarity, some fog. It varies by context.
Confused/Unaware
Body sensations/stress are present; words are hard.
Want to build emotional clarity?
If emotions tend to show up as sensations or fog, we can help you strengthen awareness and language in a steady, compassionate way.