Alexithymia · ADHD Harmony™

Alexithymia

For a long time, if you had asked me how I was feeling in the moment, I would have frozen. I could talk about ideas, theories, other people’s emotions, even write a long essay about my inner world, but in real time, I often had no words for what was happening inside me.

This showed up most starkly in therapy. I’ve spent years sitting across from well‑meaning therapists asking, “How are you feeling right now?” or “Where do you feel that in your body?”and feeling a sudden surge of irritation and shame.

The same thing happens with friendly check‑ins from family or the casual “How are you?” that most people seem to answer on autopilot. Few questions stump me as quickly, or make me feel as incompetent, as that simple one.

I now know that this isn’t “being bad at feelings” or resisting the work. It’s alexithymia: a very common trait among Autistic and ADHD people where emotional and body signals show up more like static than a clear radio station. The signals are there, but the translation layer is foggier.

In this article, we’ll explore what alexithymia is, why it’s so common for Autistic and ADHD people, and how it can shape everything from therapy to day‑to‑day life.

What Is Alexithymia?

Alexithymia literally means “without words for emotion.” It’s a term coined in the early 1970s by psychiatrist Peter Sifneos to describe people who struggled to notice and put words to their internal emotional states.

Alexithymia itself is not a formal medical diagnosis. It’s usually described as a trait — a fairly stable pattern in how a person takes in and works with emotional information. Like most traits, it exists on a spectrum from mild to more pronounced.

At its core, alexithymia is about having a hard time noticing and naming emotions. People with alexithymia often struggle to tell the difference between an emotion and a body sensation: is this anxiety or low blood sugar, sadness or fatigue, fear or just too much coffee.

Two features show up again and again in the research: difficulty identifying feelings and difficulty describing feelings. You may feel “off,” overwhelmed, or shut down, but when someone asks, “What are you feeling?” the answer is often “I don’t know” or a very broad word like “stressed.” Even when you can sense something is there, finding the specific words for it is much harder.

Alexithymia also influences how we regulate emotions. Research increasingly shows a connection between alexithymia and mental health problems, which makes sense because it disrupts emotional awareness and makes it harder to self‑soothe and manage feelings.

People with higher levels of alexithymia are more likely to experience depression, anxiety, self‑harm, substance use, and other difficulties, in large part because it is so hard to recognize what they feel and choose supportive coping strategies.

How Common Is Alexithymia?

Alexithymia is more common than many people realize. In general population studies, around 1 in 10 people meet criteria for alexithymia, although estimates vary depending on how it is measured.

Among Autistic people, the rates are much higher. A 2019 meta-analysis found that about 50% of Autistic participants scored in the alexithymic range, compared to roughly 5% of non‑autistic participants. That’s a big gap, and it helps explain why emotional differences are so prominent in autism spaces.

Alexithymia also shows up frequently in ADHD. Studies of adults with ADHD have reported alexithymia rates around 20–40%, with one study finding that about 41.5% of ADHD participants met criteria. This suggests that for a substantial subset of ADHDers, emotional awareness is part of the picture, not just attention and executive functioning, and it tracks with newer ways of understanding ADHD that highlight emotional dysregulation as a core feature rather than a side issue.

Most researchers now agree on a cluster of core features that define alexithymia.

Difficulty identifying feelings: It’s hard to work out what you’re feeling, or to tell emotions apart from body sensations. Hunger and anxiety, for example, can blur together into a vague sense that “something is wrong.”
Difficulty describing feelings: Even when you sense something is happening inside, finding words is another hurdle. Many people default to broad terms like “stressed” or “off,” or simply “I don’t know,” especially when put on the spot.
Externally oriented thinking: Attention tends to move toward facts, tasks, and what’s happening around you rather than toward your inner emotional world. This doesn’t mean you don’t care about feelings; it reflects a thinking style that runs outward more than inward.
Restricted imaginative processes: Many (though not all) people with alexithymia report a more limited fantasy life and a concrete, practical way of thinking. Newer models debate whether this truly belongs in the core alexithymia construct or reflects something closely related but separate.

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