Alexithymia and Autism

Everyone will, at some point in their lives, find themselves at a loss for words when describing how they’re feeling. When it occurs on occasion, it’s human nature. However, if the challenge to name or express emotions is a prevailing theme in someone’s life, it may be a sign of alexithymia. While primary alexithymia is relatively uncommon, the odds of having alexithymia traits are much higher in autistic people.

Alexithymia is a condition where an individual has difficulties identifying and describing emotions they experience. For example, they may have trouble identifying a feeling as “anger” or “sadness,” leading to poor emotional regulation. Previously, it was believed that difficulty naming or expressing emotions was an autistic trait. However, it is becoming clear that this is more likely a trait of alexithymia. 

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Alexithymia traits include:

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• Difficulty identifying emotions in oneself
• Trouble recognizing emotions in others
• Struggling to express emotions in a socially expected way
• Challenges with emotional regulation

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On top of difficulty with emotional expression, people with alexithymia may also have difficulties identifying bodily sensations. For example, they may struggle to get in tune with their body’s hunger or thirst cues.

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In my own life, as someone with both autism and alexithymia, I will often miss my body’s hunger cues. It’s only when I find myself feeling suddenly queasy or experiencing symptoms of low blood sugar that I’ll realize it’s been several hours since my last meal or snack. I can become dysregulated, sometimes to the point of an impending meltdown. While I once chalked this up to just one of many autism symptoms I'd been living with, I know now that it’s an alexithymic trait.

Alexithymia and autism tend to go hand in hand. Alexithymia occurs in about 5-13% of people in the general population. Autistic people, however, experience alexithymia at a rate of about 50%, ranging from mild to severe alexithymia.

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It is paramount for caregivers and mental health professionals to be aware of the impact of co-occurring alexithymia and autism on emotional regulation. With appropriate therapy approaches and support strategies, caregivers and professionals can foster emotional growth and emotional intelligence in those with autism and alexithymia. 

Individuals with autistic and alexithymia traits likely struggle with maintaining a state of emotional regulation. Existing in a dysregulated state can lead to negative outcomes, such as meltdowns. 

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What is emotional dysregulation?

Emotional dysregulation occurs when a person is not successfully or comfortably controlling their emotions. It can feel like having an intense emotional reaction that’s disproportionate to the current situation. Examples of emotional dysregulation include tantrums, withdrawal or even laughing fits. While any person can experience emotional dysregulation, it’s far more common in autistic individuals. Extended or recurrent bouts of emotional dysregulation can lead to meltdowns or burnout. 

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An autistic person who experiences alexithymia is prone to emotional difficulties. Put simply, an emotion can’t be processed until it’s properly named and expressed. Expressing an emotion is a key first step to emotional regulation. When someone cannot express or has great difficulty expressing their emotion, they’re at risk of emotional dysregulation. In individuals with autism, dysregulation and other emotional difficulties can lead to meltdowns.

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Which techniques are most effective for teaching emotional regulation?

Emotional regulation and emotional awareness, especially for neurodiverse individuals with alexithymia, is a skill. This means that it can be taught and practiced. 

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Self-awareness

Self-awareness is the cornerstone of teaching emotional regulation. When presented with a stressor or sensory stimulation, individuals with alexithymia should take a moment to recognize that they are having a reaction. Though naming the emotion will be difficult, they should feel empowered to accept that a feeling is occurring and that they should respond proportionately.

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Mindfulness

Mindfulness is also a useful technique that relies on grounding oneself to calm the mind and body when confronted with something overwhelming. Mindfulness is the awareness and acceptance of one’s current physical and mental state. It’s the practice of being fully present in the current moment. There are many ways to achieve mindfulness, like meditation or deep breathing exercises.

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Self-compassion

Self-compassion is also a key aspect of emotional regulation. Alexithymia is frustrating and hard to navigate. Neurodiverse individuals should be encouraged to give themselves grace as they learn how to regulate themselves. Self-compassion involves treating oneself with kindness and recognizing that struggles are part of the human experience. 

While mindfulness, self-compassion, and self-awareness are great in-the-moment interventions, several therapy approaches and emotional coaching methods can also help in the long term.

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Many therapy modalities may improve emotional development for autistic people, particularly those with co-occurring alexithymia. 

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Cognitive behavioral therapy

Cognitive behavioral therapy helps individuals learn:

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• How to identify and change negative thought patterns
• How to break problems down into more manageable parts
• How their actions impact their thoughts
• How to cope with stress healthily

All of these skills lead to healthy emotional development in autistic people.

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Speech therapy

On top of CBT, speech therapy can help clients build a vocabulary of appropriate emotional terms and learn when to use them. A speech therapist can help clients build the vocabulary and communication skills necessary for expressing their emotions. Being able to express emotions more easily is an important part of improving self-regulation skills. 

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Sensory-based therapy

Sensory-based therapies help clients recognize the signs of emotional engagement and employ strategies to help them maintain the appropriate amount of emotional engagement for a given situation. When someone is emotionally engaged, they are aware of and content with their current emotions. To achieve emotional engagement, someone may listen to soothing white noise to settle in at bedtime or engage in stimming to release excess energy when an emotion is overwhelming. Sensory integration helps the body stay balanced, contributing to emotional regulation. 

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Emotional regulation therapy

Emotional regulation therapy (ERT) combines aspects of mindfulness and CBT to help clients feel the physical signs of emotions in their bodies and then name and express them.

ERT also focuses on teaching clients more effective decision-making and critical thinking skills. These skills will allow them to avoid making impulsive decisions that may harm their well-being and impede emotional growth. Radical self-acceptance is at the heart of ERT, helping foster a safe space for neurodiverse individuals.

Autistic individuals are just that… individuals. As with mental health conditions or mental disorders, therapy is rarely a one-size-fits-all solution. Even though autism spectrum disorder is not, on its own, a mental health condition, the same is true of therapy for autism and autism-related struggles, like alexithymia. 

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Some support strategies will resonate more for some people than others, and some will thrive in therapy approaches that leave others feeling stunted. As a hyperverbal autistic woman, speech therapy simply isn’t the right modality for me. However, starting cognitive behavioral therapy with a compassionate therapist changed my life. I was able to put my hyperverbal tendencies to good use and talk through the thought processes that were contributing to my anxiety. My therapist then taught me how to reprogram those thoughts into a healthier mindset, and my overall feelings of anxiety lessened. 

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Being shoehorned into a rigid prescription of therapies would have left me feeling frustrated and even more chronically dysregulated than I already was. An individualized approach to therapy allows not only for increased positive outcomes but also for a sense of agency, which can be especially important for autistic individuals.

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Autistic individuals are at greater risk of facing emotional challenges, especially when coupled with the unique challenges of alexithymia. Supporting an autistic person usually involves a well-rounded team of informed loved ones and professionals. Therapists and families must be willing and able to work together to provide meaningful support.

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What support strategies are available for managing emotional challenges in autism?

Families and caregivers can do several things to support their autistic loved one. For example, they can:

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• Model effective reactions and behavior
• Communicate expectations calmly and clearly
• Provide sensory-friendly spaces that encourage emotional regulation
• Acknowledge and validate feelings
• Help practice skills at home that they’re learning in therapy, such as deep breathing

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What role do therapists play in guiding families through emotional challenges?

A good therapist will not only keep their client’s best interests at the forefront, but they will also serve as a guidepost for families and others involved in their lives.

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Therapists will work in tandem with autistic individuals and their support systems by engaging in the most appropriate therapy approaches and emotional coaching methods. On top of engaging in support strategies during sessions with their client, therapists will also involve family members or other supportive people in the process if the client chooses. If the client wishes to include their family members or other supportive people in their lives in the therapy process, they can discuss the possibility of having those people attend sessions. Alternatively, their therapist can work directly with members of the client’s support system, so that they may better learn how to understand and support the client’s needs.  

Interpersonal skills and emotional resilience will help autistic individuals live more regulated, well-balanced and fulfilling lives. 

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What is emotional resilience, and how does it benefit neurodiverse individuals?

Emotional resilience is the ability to cope with and recover from unexpected situations and stressors. As previously mentioned, an autistic person with co-occurring alexithymia will be more easily distressed when confronted with emotions or triggers. Emotional resilience will allow them to work through initial distress more seamlessly and remain regulated, even when dysregulation is looming.

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What techniques help foster emotional resilience in neurodiverse individuals?

Emotional resilience can be improved with coping skills and therapeutic intervention.

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Coping skills include things like:

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• Journaling to help understand and process emotions
• Practicing mindfulness
• Sensory activities (like aromatherapy or yoga) 
• Engaging in hobbies
• Exercise
• Spending time with friends and family

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What is cognitive empathy, and why is it important?

Cognitive empathy is the ability to understand another person’s thoughts, feelings and perspectives. It is a building block for fulfilling interpersonal relationships. When autistic people have access to larger support systems and meaningful interpersonal connections, they will naturally become more regulated and have increased emotional resilience. 

Sensory integration is an innate neurobiological process referring to the integration and interpretation of sensory stimulation from the environment by the brain.

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How do sensory integration techniques aid in emotional and cognitive development?

Sensory integration relies on three major sources of input:

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• Tactile, or the sense of touch
• Vestibular, or the sense of balance and positioning
• Proprioceptive senses, or the sense of force and pressure

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These sources of input help autistic people interpret and respond to their environments.

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Sensory integration or sensory processing deficits manifest in many ways. Chief among them is a disproportionate response to stimuli––either too extreme or too muted. 

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For an individual with alexithymia and autism, when difficulties understanding and responding to stimuli are already present, sensory integration is even more important. Occupational therapists can use sensory integration techniques to help soothe an individual's nervous system and help them respond to their environments in ways that are more regulating and appropriate.

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Sensory integration therapy can include things like:

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• Repetitive movements like bouncing or rocking
• Playing with fidget toys
• Deep pressure stimulation
• Using sensory deprivation tools like earplugs 

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What are the benefits of sensory integration techniques, and how can others involved in autistic adults' lives and educators implement them?

Sensory integration techniques help individuals with autism and alexithymia self-regulate. Caregivers and educators can implement sensory integration techniques at home and in classrooms. They can do so by allowing and encouraging safe movement, such as rocking or stimming. Families and caregivers can also provide those spaces at home, as well. Further, autistic adults should be encouraged to use tools like noise-canceling headphones and weighted vests or blankets to cultivate a less overwhelming sensory experience. 

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How Prosper Health can help with alexithymia and autism

Alexithymia and autism co-occur at high rates. While autism spectrum disorder already presents unique difficulties with emotional and cognitive development, those difficulties are often worsened by alexithymia. It’s common for autistics with alexithymia to feel disconnected from their environments and their peers or even from their own bodies. With proper support and therapies, those same individuals can thrive. 

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If you are struggling with alexithymia and autism, Prosper Health is here to help. Prosper Health’s virtual diagnostic evaluations and therapy provide mental health support for autistic and neurodivergent adults, covered by insurance. Our expert clinicians incorporate evidence-based therapies into our sessions, tailoring all care to the unique needs of autistic adults. With Prosper’s support, you can learn to manage alexithymia and improve your overall emotional well-being.