Autism and Alexithymia

Emotional regulation is a commonly acknowledged challenge for many autistic individuals, with the majority (67 to 79 percent) of children on the spectrum experiencing comorbid symptoms of anxiety and many (42 to 54 percent) depression (Mayes et al., 2010).

Autistic individuals’ experience of emotional regulation is impacted by numerous variables. Some variables relate to autistic individuals’ unique perception and information processing, including sensitivities to sensory information. Other variables include biological and neurological processes including atypical neurotransmitter activity, altered connectivity in prefrontal-amygdala pathway, or a decreased respiratory sinus arrhythmia (RSA) (Shuid et al., 2020).

Alexithymia is an additional variable associated with emotional processing challenges for many autistic individuals, especially “poorer regulation of negative affect” (Morie et al., 2019). The term alexithymia translates into English as "no words for emotions." it was first introduced by Sifneos and Nemiah (1970) to describe an emotional processing impairment characterized by: difficulty with identifying one’s own feelings and bodily sensations, difficulty with describing and expressing feelings, and an externally oriented thinking style with a preference for focusing on external vs internal stimuli (Morie et al., 2019). Apfel and Sifneos (1979) added that characteristics associated with an externally oriented thinking style may be higher levels of social conformity as well as a tendency towards behavioral action rather than reflection.

Additional components of alexithymia suggested by some researchers include limited imaginal processes with reduced daydreaming and fantasizing, or reduced emotional reactivity, however there is inconsistent factor analysis support to establish them as core components of alexithymia (and further research is required into their constituting elements) (Preece et al., 2020).

Preece et al. (2017) proposed an attention-appraisal model of alexithymia, suggesting that the core components of alexithymia reflect difficulties with focusing of attention on emotion, and difficulties with appraising emotion. Other models of alexithymia suggest a lack of integration of physiological arousal induced by an emotional state within conscious awareness.

Preece et al. (2017) suggested that individuals measuring high on alexithymia exhibit higher levels of negative reactivity and make use of avoidant regulatory strategies such as emotional suppression.

The rate of alexithymia is considerably higher in autistic population in comparison to neurotypical population, Kinnard et al. (2019) suggests that estimates of alexithymia in autistic population vary between 33 and 64 percent. In Kinnard et al.’s (2019) study autistic individuals scored higher in all key dimensions of alexithymia, especially on difficulties with identifying their feelings and describing them. Authors concluded that for a subgroup of the autistic population, alexithymia is associated with emotional processing challenges, which, in turn, is associated with higher rates of mental health diagnoses such as anxiety and depression (Kinnard et al., 2019). It makes sense that a limited understanding of one’s inner experience impact's on how it is regulated.

Costa et al. (2019) additionally found that alexithymia in autistic children is associated with reduced frequency of parent-child interactions, authors suggested that difficulties with communicating inner states within the child-parent relationship effects coregulation and negatively impacts parent-child interactions.

The elevated rate of alexithymia in autistic individuals may be due to similar underlying neural processes in both conditions, such as reduced activation of amygdala and insula (Kinnaird et al., 2019). However, due to the heterogeneity of individuals on the spectrum, alexithymia is not considered a key feature of autism, rather a frequently occurring condition associated with heightened emotional processing challenges.

The increased awareness of alexithymia and its impact on the wellbeing of autistic individuals points to the importance of interventions that support individuals in learning to identify their feelings and bodily sensations.