What Is Alexithymia? Exploring Sensory Processing, Interoception and Masking
Alexithymia is often described as difficulty identifying and describing emotions. The word itself roughly translates to “without words for emotion.” This description is technically accurate, though it leaves considerable room for misunderstanding.
A person with alexithymia is sometimes imagined as disconnected from emotion altogether: emotionally flat, unaware or lacking emotional depth. Yet many people with alexithymia experience emotions intensely and with great complexity. They may know that something significant is happening inside them while having difficulty identifying exactly what it is. They may be able to write about an experience in considerable depth and still become stuck when asked how they feel in the moment.
Alexithymia is common among autistic people, though it is neither universal to autism nor exclusive to autistic people. Some autistic people do not experience alexithymia, and some non-autistic people do. One large review found that about 50% of autistic participants met the threshold for alexithymia, compared with about 5% of non-autistic participants (Kinnaird et al., 2019). The researchers suggested that some emotional processing differences often assumed to be inherent to autism may be better explained by co-occurring alexithymia.
This distinction matters. Treating alexithymia as an inherent part of autism can feed into inaccurate assumptions about how autistic people experience and understand emotions. It can also make alexithymia seem far more uniform than it is, flattening complex and varied experiences into a single explanation.
The goal of this article is to highlight the different mechanisms that may be involved in alexithymia for autistic people, with the aim of developing a fuller understanding of the experience and more informed ways of working with it.
Alexithymia and Interoception: When Body Signals Are Difficult to Detect
Interoception is the process through which the nervous system senses, interprets and integrates signals from inside the body. These signals include hunger, thirst, temperature, pain, breathing, heart rate, fatigue and digestive sensations.
Interoception is often spoken about as though it were one ability that a person either has or does not have. Research draws finer distinctions. Interoceptive accuracy refers to how accurately a person detects bodily signals. Interoceptive sensibility refers to their subjective sense of being aware of those signals. Interoceptive awareness involves knowing how accurate their perceptions are. A person can be highly aware that something is happening in their body while remaining uncertain about what they are detecting or how to interpret it (Proff et al., 2022).
For some people with alexithymia, internal signals may be faint, delayed or difficult to detect. Hunger may become noticeable only once it has progressed to nausea, shakiness or a headache. Fatigue may remain outside conscious awareness until keeping the eyes open becomes difficult or the person can no longer continue a task. Emotional distress may become recognizable only after it reaches the intensity of panic, shutdown or meltdown.
This is one possible relationship between interoception and alexithymia. It is not the only one.
Autistic sensory processing frequently includes both heightened sensitivity (hypersensitivity) and reduced sensitivity (hyposensitivity), sometimes within the same person and even at the same time. Someone might perceive a quiet electrical hum that no one else notices while missing signals of thirst. They might have little awareness of conventional hunger cues yet feel the movement of water through parts of their digestive tract with striking accuracy. They may be highly attuned to their heartbeat and have little access to hunger, notice subtle changes in muscle tension while struggling to recognize temperature or notice pain only once it becomes severe while finding clothing seams unbearable. They may also perceive other people’s emotional states quickly and accurately while taking much longer to understand their own.
Findings on the accuracy of interoceptive perception are mixed. Some studies have found lower accuracy among autistic participants, while others have found little or no difference between autistic and non-autistic participants (Proff et al., 2022). In some studies, differences in interoceptive perception between autistic and non-autistic participants disappeared once the groups had similar levels of alexithymia. This suggests that some interoceptive differences previously attributed to autism may be better explained by alexithymia.
Taken altogether, these examples and findings show that, in some situations, alexithymia does involve difficulty detecting certain internal signals. Even when that’s the case, the picture is rarely all-or-nothing, on-or-off. It is time to retire the myth that autistic people with alexithymia are simply disconnected from their bodies or unaware of what they feel.
Let’s turn to another way alexithymia may operate: situations where detecting internal signals is not the main difficulty. At times, awareness may already be quite strong. The difficulty may instead lie in determining which signals belong together, what they mean in context and how they combine into an emotional experience.
Alexithymia and Sensory Processing: When the Signals Are Vivid but Difficult to Interpret
The body does not usually send a neatly labelled message announcing “You are anxious,” “You are angry” or “You need to leave this room.” It sends information, or data, to be interpreted as a whole.
A person might experience pressure in the chest, warmth in the face, shallow breathing, tightening through the shoulders and difficulty concentrating. Those sensations could accompany fear. They could also relate to anger, excitement, exertion, overheating, low blood sugar, caffeine intake, illness or sensory overload.
Making sense of an emotional state requires more than detecting what is happening inside the body. The person also has to consider what is happening around them. What occurred immediately beforehand? Has the room become louder? Did someone make a comment that brought up an earlier experience? Is there conflict in an important relationship? Has the person eaten recently? Are they in pain? Did the bodily sensations begin before or after the interaction? Are several things happening at once?
This process involves integrating interoceptive information from inside the body with exteroceptive information from the surrounding environment. It also draws on memory, language, timing, relationship history and expectations about what different sensations are likely to mean.
Research on autistic sensory processing has explored a concept called weak stimulus binding (Proff et al., 2022). The terminology reflects older, more deficit-based language. The underlying theory remains useful when translated with greater care. It suggests that sensory information may sometimes arrive as several separate pieces rather than as one immediately recognizable whole, and that bringing those pieces together may require more time, context or active processing.
Autistic people may notice individual features, discrepancies and patterns that others filter out or rapidly blend into an overall impression. This can support strengths in areas such as visual search, auditory segregation and the detection of inconsistencies. It can also make complex environments more demanding when several forms of information need to be integrated quickly.
Consider walking into a crowded room. One person may rapidly register the scene as “a busy gathering.” Another may initially perceive many elements separately: several simultaneous conversations, music playing through a speaker, fluorescent lighting, movement in the corner of their vision, the smell of food, pressure from their clothing, uncertainty about where to stand and the facial expression of the person approaching them. The overall meaning has to be actively constructed from a large amount of detailed information.
A person may notice a tight chest, pressure behind the eyes, heat in their skin, a churning stomach and the urge to move. They may also know that the day has been demanding, the room is loud and someone recently said something unsettling. All the information is available, consciously perceived and felt. However the meaning has not yet taken shape.
The details may be present like points on a map before the route between them has been drawn.
This provides a different way of understanding alexithymia. The person may have strong awareness of bodily sensations while finding it difficult to determine which signals belong together, which ones are background information and what the combined pattern means. The body can feel loud and unclear at the same time.
This distinction has important implications for therapy.
Therapists commonly invite clients to notice where an emotion appears in the body. This can be useful when bodily signals are faint, delayed or habitually outside awareness. It can miss the mark when the person already perceives a great deal of internal information and instead need support in the meaning making stage of sensory processing.
Someone may be aware of ten different sensations and still have no idea what they signify. Asking them to notice more closely may produce additional data without producing greater understanding. It may even increase overwhelm.
A person can experience alexithymia without needing greater interoceptive awareness. They may already be hyperaware. Their difficulty may involve sorting sensations, comparing possible meanings and identifying how internal information relates to the environment.
In this situation, more helpful questions might include:
Do you know what changed first: the body, the environment, the interaction or the task?
Can you tell which sensations appeared together?
Did the experience begin suddenly or build throughout the day?
What possibilities fit the available information? (offer options and hypotheses)
Could this involve hunger, fatigue, pain or sensory overload?
Does the person need to know exactly what the emotion is before responding to the discomfort?
That last item is one place where therapists can lose sight of the forest for the trees. Our training may lead us to treat emotion identification as the highest form of experiential awareness. Yet people can often respond meaningfully to discomfort, overload or a need for distance without first identifying the emotion involved. Who knows, I may eventually need to write a separate post about how much of our training on emotions is shaped by ableist and neuronormative assumptions, especially the tendency to treat certain parts of experience and certain ways of processing emotion as more valid or more advanced than others!
Emotional language may also work better when used as a hypothesis rather than a test with one correct answer. “Could this be disappointment?” creates room for comparison. “Tell me what you are feeling” may demand a level of certainty the person does not yet have.
Time matters too. Some people understand an emotional experience only after leaving the environment, reducing sensory input and allowing the separate details to settle. Recognition that arrives three hours later remains recognition. The delay reflects the amount of processing required rather than a lack of emotional awareness or psychological insight.
The same principle applies to emotional vocabulary. Learning more emotion words can be useful, though having more labels does not necessarily make the experience easier to understand. As I discussed in my earlier post on bottom-up processing and autism, autistic people may take in a large amount of detailed sensory information that requires time and effort to sort through. Knowing the words hurt, resentful, frightened and overwhelmed does not automatically reveal which one fits a particular combination of bodily sensations and circumstances.
Support may involve organizing information across several domains:
What is happening in the body?
What sensory input is present?
What occurred in the environment?
What is happening relationally?
What needs have gone unmet?
What has accumulated over time?
The goal is not always to isolate one “clean” emotion. A person may be hungry, overstimulated, angry and frightened. Human emotional experience rarely respects the clean categories offered by an emotion wheel.
This also connects with the predictive-processing ideas discussed in that earlier post. Some forms of sensory processing in autism may rely more heavily on incoming sensory information and less automatically on assumptions formed through previous experience. This can support precise perception that is less guided by expectation. In noisy or uncertain situations, it may also leave the person working with a large amount of information that has not yet settled into a clear meaning. These theories may describe two related parts of the same process: how separate sensory details come together and how the situation, past experience and expectations help us make sense of them.
Ultimately, autistic sensory profiles are highly individual, so no single theory will explain every autistic person’s experience. The usefulness of this framework lies in recognizing that difficulty naming an emotion does not tell us where the difficulty occurred. The signal may have been missed. It may have been detected with great intensity. The person may have perceived every component and needed more time, context or structure to understand what the combined data meant. Sensory processing, however, is only part of the picture. Access to internal experience can also be shaped by what happens when a person’s signals are repeatedly dismissed, overridden or made unsafe to express. The next section considers how trauma, autistic masking and repeated pressure to ignore one’s own signals may further shape the experience of alexithymia.
Alexithymia, Trauma and Autistic Masking
Emotional self-understanding develops within relationships and social environments. People learn what bodily signals mean partly through having those signals noticed, named and responded to by others.
A child feels something unfamiliar in their stomach and an adult wonders whether they are nervous. They begin crying after a long day and someone helps them connect the tears with exhaustion. They pull away from a painful sound and the people around them lower the volume.
These interactions help create links between bodily experience, context and language.
Many autistic people receive a different kind of feedback.
The sound is not that loud. The light is fine. The clothing does not hurt. They cannot still be tired. Their reaction is too much. They need to sit still. They should make eye contact. They should stay at the gathering. They need to stop being rude.
Repeated experiences of correction can shape a person’s relationship with their own body and interoception. They may learn that internal signals are unreliable, socially unacceptable or too inconvenient to act upon. They may become skilled at remaining in environments their body is asking them to leave.
Masking develops within this context.
Autistic masking involves suppressing, altering or replacing autistic ways of moving, communicating and regulating in order to meet neuronormative expectations. It can include forcing eye contact, suppressing stimming, copying other people’s expressions, rehearsing conversational responses and hiding signs of sensory distress.
A recent paper describes masking as a response to neurotypical mindshaping: the social process through which people are encouraged and pressured to think, behave and express themselves according to dominant neurotypical norms or neuronormativity (Grodniewicz & Urbanek, 2026). The authors introduce the term self-mask ambiguity to describe the difficulty some people experience in distinguishing their own preferences, needs and reactions from the responses they have learned to perform.
After years of smiling while uncomfortable, a person may have trouble knowing whether they are enjoying themselves. After routinely staying in overwhelming social environments, they may struggle to recognize the point at which they want to leave. After copying other people’s emotional reactions, they may become uncertain about which feelings belong to them.
The authors of this paper distinguish isolated self-knowledge from the broader process of self-understanding. Knowing that one’s chest is tight is a piece of information. Understanding how that sensation relates to the environment, one’s history, current needs and recurring emotional patterns requires coherence across many pieces of information. The authors argue that masking can interfere with the richness, accuracy and coherence of this self-understanding.
This offers another angle from which to consider alexithymia. The connection is interpretive rather than something directly tested in that paper, though it fits with many autistic accounts of losing access to their preferences, limits and emotional responses through prolonged masking.
For some people, reduced access to emotional and bodily experience may be shaped by trauma, chronic masking or repeated pressure to override their own signals.
As discussed earlier, alexithymia is also found among non-autistic people. Research has linked it with experiences such as trauma and chronic stress. A recent study examining traumatic experiences and alexithymia adds to evidence that a person’s access to and understanding of emotional experience can be shaped by relational and traumatic history, rather than arising solely from neurodevelopmental differences (Tofan & Curcă, 2026).
This does not establish trauma as the cause of alexithymia in every person. Some people describe alexithymia as a longstanding feature of how they process emotion. For others, it intensifies during burnout, stress or after traumatic experiences. Both may be present: an existing difference in emotional processing can become more pronounced within environments that require ongoing self-suppression.
It is important to acknowledge that distance from the body, including reduced access to interoceptive signals, may have served a purpose. It may have helped someone remain in the classroom, get through the workday, avoid punishment or preserve a relationship when responding to their internal signals was not treated as safe or possible.
This adaptation can carry costs without having been misguided. Disconnecting from a need may have been the most workable response when acknowledging it did nothing to help the need be met or created additional risk.
A neuro-affirming approach makes room for that history. It asks what the person learned about their body and emotions, whose comfort they were expected to prioritize and what happened when they expressed themselves authentically. It considers how sensory processing, trauma and social pressure may interact without reducing the whole person to any single explanation.
What Helps With Alexithymia?
Supporting someone with alexithymia requires curiosity about where the process becomes difficult for that particular person.
Some people may benefit from noticing subtle or delayed bodily signals earlier. Others need help reducing the volume of sensory information before emotional meaning can emerge. Some need language, visual structure or time to reconstruct an experience after it has happened. Others need relationships where discomfort is believed and responding to their own needs does not threaten acceptance.
The work may involve detecting signals, sorting them, connecting them with context and rebuilding trust in information that has repeatedly been dismissed.
A body check-in can be useful. So can turning off the overhead light, eating something, leaving the room or waiting until the next morning to discuss what happened. Emotional understanding does not always have to come before care. A person can respond to distress while the exact meaning remains uncertain.
It can also help to move away from open-ended questions that require an immediate emotional answer. A narrower set of possibilities may create a more manageable starting point:
Does this feel closer to exhaustion or activation?
Do you want more distance or more connection?
Did something feel painful, unfair or unpredictable?
Is your body asking for movement, quiet, food, warmth or rest?
None of these questions offers a complete interpretation. They help organize the field.
Alexithymia is not one uniform experience, and it does not mean that emotion is absent. It may involve signals that are faint, many signals that arrive all at once or a long history of learning that internal experience cannot be safely expressed. For many people, these processes overlap.
References
Grodniewicz, J. P., & Urbanek, A. (2026). Autistic masking, neurotypical mindshaping, and self-understanding. Review of Philosophy and Psychology. https://doi.org/10.1007/s13164-026-00811-5
Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80–89. https://doi.org/10.1016/j.eurpsy.2018.09.004
Proff, I., Williams, G. L., Quadt, L., & Garfinkel, S. N. (2022). Sensory processing in autism across exteroceptive and interoceptive domains. Psychology & Neuroscience, 15(2), 105–130. https://doi.org/10.1037/pne0000262
Tofan, C. M., & Curcă, R. (2026). The predictive role of traumatic experiences, attachment, and alexithymia on the somatisation process. Journal of Child & Adolescent Trauma, 19(2). https://doi.org/10.1007/s40653-026-00827-0
Dr. Jesse Bossé, D.Ps., C.Psych, is a clinical psychologist offering virtual therapy for LGBT, queer, trans, neurodivergent and autistic adults in Ontario, Québec, New Brunswick and Nova Scotia. Their work focuses on gender identity, autism, relational patterns, burnout, boundaries and building more sustainable ways of living and connecting.