When it's hard to know what you feel: alexithymia and autism
Someone asks how you're feeling, and you don't know what to say. You might notice your chest is tight or your stomach is churning, but you can't tell whether it's worry, anger or hunger. Or you only realise days later that something upset you.
If this happens a lot, other people may have told you that you're cold, unemotional or not trying hard enough. You may have started to believe it. It can be very tiring to keep being asked for an answer you don't have.
This article is for autistic adults, and for anyone who thinks they might be autistic, who finds feelings hard to name. If you're not autistic, or you're not sure, you're still very welcome here, and much of it may still fit. I'll look at what this can be like, why it might happen, and some other ways of working with feelings, including how I work with it in counselling.
A note on the word: I've used "alexithymia" in the title because it's the word many people search for. It comes from Greek and roughly means "no words for feelings". It isn't a diagnosis, and you don't need to have it, or be sure you have it, for this to be useful. If the word doesn't fit, you can read this as being about finding feelings hard to name. It doesn't mean you don't feel things.
What it can be like day to day
For some people, feelings show up first in the body. You might notice a racing heart, a heavy tiredness or a sudden need to leave a room, without having a word for what's behind it. Hunger, tiredness and worry can all feel much the same.
For others, the feeling arrives late. You might get through a hard conversation feeling fine, then find yourself exhausted or tearful the next day without knowing why. Some people say "I'm fine" by default, because it's the only answer that's quick to give.
It can also mean things seem calm until suddenly they aren't. If the smaller signals are hard to read, you might not notice stress building until it's already a lot. This can make anxiety especially confusing, because the physical signs don't come with a clear label. Autistica has a helpful page on how alexithymia and anxiety can affect each other, and if anxiety is part of this for you, there's more on my anxiety counselling page.
"Cold", "unemotional", "not trying hard enough"
Many people who find feelings hard to name have been described in ways that don't match what's going on for them. You might have been called cold because you didn't cry at a funeral, or been told you don't care because you couldn't say how something affected you. Some people have been asked "why can't you just say what's wrong?" so often that they stop trying.
Finding a feeling hard to name isn't the same as not having it. Plenty of autistic people describe feeling things very strongly. The difficulty is often in noticing, sorting or putting words to what's there. Some researchers think that the emotional differences often put down to autism may have more to do with alexithymia.
If you've heard those words about yourself for years, it makes sense if some of them have stuck. You don't need to prove anyone wrong here. You're welcome to come exactly as you are, with or without the words.
Why it can happen
Researchers are still working this out, and there's probably more than one reason. One idea is that some people find it harder to notice signals from inside the body, like heart rate, breathing or tension. This is sometimes called interoception. If those signals are faint or muddled, it makes sense that the feelings linked to them are harder to pin down.
Masking may play a part too. If you've spent years watching other people closely so you can fit in, most of your attention has been pointed outwards. Your own reactions may have been pushed aside because there wasn't room for them. Stress and difficult experiences can also make feelings harder to reach, sometimes as a way of getting through.
Research suggests alexithymia is much more common in autistic people, with many studies putting it at around half. So it's common, but it's by no means everyone. Most studies rely on questionnaires that ask people to rate their own emotional awareness, which is a tricky thing to measure, so it's worth treating any figures as rough.
It isn't only an autistic experience. It has also been found in people with ADHD, people living with PTSD or depression, and people with no diagnosis at all. If you're AuDHD, or unsure where you fit, you don't need to work that out first. What matters is how it is for you.
If therapy has asked you to name feelings on the spot
A lot of talking therapy leans on questions like "how did that make you feel?" For someone who finds feelings hard to name, that question can bring up a blank, and then a sense of having failed at something. Some approaches also expect you to rate or record your feelings between sessions.
Many autistic people I've worked with have said that previous support didn't take their needs into account. When a structured way of working isn't adjusted to the person, it can leave them feeling that the problem is them.
If that was your experience, it doesn't mean you're bad at therapy, or that therapy can't help. It may mean that way of working didn't fit you. There are other ways in.
Other ways in
Naming a feeling is only one way of working with it. Some people find it easier to start with facts: what happened, what you noticed, and what you did next. A feeling can sometimes be spotted from what it makes you do. Going quiet, leaving the room or needing to be alone can all tell you something.
Others find it easier to start with the body, noticing where something shows up without having to explain it. Images and metaphors can help too. Describing something as a fog, a storm or a low hum is still describing it.
Something you know well can also become a reference point. If there's a film or series you know really well, a feeling might be "like the quiet bit just before something goes wrong" or "like a character who's just realised they've been left out". Some people also find writing things down afterwards much easier than talking in the moment. None of these is the right way. They're options, and you can use whichever suits you.
Gentle ways to notice, if you'd like to try
If you'd like to try noticing a little more, here are a few questions. This is completely optional. It's best tried when you're feeling fairly settled, not when you're already overwhelmed. Pick one question and give it a minute, no more.
What do I notice in my body right now?
What happened just before this?
If this were weather, what would it be?
If you start to feel dizzy, numb or shut down, or your thoughts start racing, that's a sign to stop. You could look around and name a few things you can see, feel your feet on the floor, or do something ordinary with your hands, like making a drink. There's no need to come back to it.
And if you'd rather not try any of this, that's fine too. Even reading this far is enough.
How counselling with me can help
I'm a Level 4 BACP-registered counsellor, and autism is one of my main areas of interest. When feelings are hard to name, I change the way I ask about them. We don't need to label emotions in the way you may have been expected to before. Instead, we can look at what you're thinking, or what's coming up for you, as plain fact.
If metaphors help, we can use them. If you have an interest you know inside out, we can use it as a reference point for particular feelings. If words come more easily on paper, you're welcome to write things down in sessions, and some people find it helpful to record sessions so they can listen back later. Eye contact isn't expected, and there's no homework.
This is one way of working, and it won't suit everyone. On our free 15-minute call, I'll explain how I work so you can decide whether it feels right. If it doesn't, I'll help you find someone who may be a better fit. There's more about how I work with autistic adults on my autism counselling page, and about my approach more broadly on my neuro-affirmative counselling page.
You're welcome to bring feelings you can't name yet. We'll go at a pace that feels manageable.
Making sense of it
Finding it hard to know what you feel can touch a lot of everyday life, from conversations and relationships to noticing when you need a rest. It can also be hard to explain to other people, especially if you've been misunderstood before. If you take a few things away from this article, I hope they're these:
Finding a feeling hard to name isn't the same as not feeling it.
It's common in autistic people, and it also shows up with ADHD, PTSD and depression, and in people with no diagnosis.
If therapy has asked you to name feelings on demand and it didn't help, that doesn't mean therapy can't. That way of working may not have fitted you.
There are other ways in, like starting from facts, the body, images, or something you know well.
If you'd like to talk about how this is for you, the first step is a free 15-minute telephone call. It's a friendly, no-obligation way to see if it feels like the right fit. You don't need a diagnosis, and you don't need to know what you're feeling to get in touch. Sessions can be face to face in Whitefield, by video or by telephone.
You can book your free 15-minute call whenever you feel ready. You don't have to work it out alone.
If you're struggling right now: in England, you can call NHS 111 and choose the mental health option, or see the NHS page on where to get urgent help for your mental health. If you or someone else is in immediate danger, call 999.
