Alexithymia: what it is, and why my partner thinks I have it

Nathan Chadwick · October 31, 2026 · 7 min read

TLDRRead the short version

Alex thinks I might have alexithymia. I had never heard the word, so I went and read the research.
Alexithymia means difficulty identifying your own feelings, difficulty describing them, and a habit of looking outward instead of inward. It does not mean you feel nothing.
It is a trait, not a formal diagnosis. Roughly one person in ten sits above the usual questionnaire cut-off, and about half of autistic people do.
It tends to show up as a body-signal problem. The feeling is there, but the translation into words is the part that fails.
I do not have a diagnosis. I have a word, a partner who has been paying attention, and a reading list.

On this page

How this came up
What it means
What it is not
The body part
How common it is
Alexithymia and autism
How it is measured
What helps
Where I am with it
References

How this came up#

Alex thinks I might have alexithymia.

I had never heard the word. It sounds like a medication or a Pokémon. It is neither. It is a description of something that, once I read it properly, I could not stop recognising pieces of.

I am not writing this to announce a diagnosis, because I do not have one. I am writing it because I went looking for what the word actually means, and most of what I found online was either too thin or too confident. This is the version I wish I had read first.

What it means#

The word comes from Greek: roughly "no words for feelings". The idea was developed by psychiatrists in the early 1970s, and Peter Sifneos's 1973 paper is the one usually cited for it. He was describing patients who struggled to put emotional experience into words.

Today the description is usually split into three parts. These are the same three factors that the standard questionnaire measures, which I will get to below.

Difficulty identifying feelings. Something is going on, but you cannot tell what. It might be anger, tiredness, hunger, nerves, or sadness. From the inside they can all feel like "off".
Difficulty describing feelings. Even when you know something is happening, finding the words for it, or finding words someone else would recognise, is hard.
Externally oriented thinking. Your attention goes to events, facts, and practical details rather than to your inner states. Ask how you felt about something and you answer with what happened.

That last one matters more than it sounds. It is why alexithymia is easy to miss from the inside. If your mind is always pointed outward, you do not notice that you are not looking in.

What it is not#

This is where most of the confusion is, so I want to be clear.

It is not having no emotions. People with alexithymia feel things, often strongly. The problem is the identification and the translation, not the feeling itself.

It is not not caring. Alex does not think I do not care, and that is not what this is about. The gap is between feeling something and being able to say what it is.

It is not a formal diagnosis. It is not a mental health condition in the DSM-5. Research treats it as a dimension that is spread across the whole population, with some people near the bottom, most in the middle, and some at the top. It can sit alongside other conditions, but it is its own thing.

It is not the same as being stoic. I wrote about why feeling more is not the same as emotional intelligence, and the stoic in that post feels the thing, names it, and chooses not to let it run the room. Alexithymia is a step before that. If you cannot tell what the feeling is, there is nothing yet to hold.

The body part#

The part that changed how I understood it is interoception, which is your sense of what is going on inside your body: heartbeat, hunger, tension, temperature, tiredness.

Feelings are not only thoughts. They arrive as body signals first. A tight chest, a hot face, a heavy stomach. Part of how most people work out "I am anxious" or "I am angry" is by reading those signals and matching them to a label.

Research suggests that for people with alexithymia that reading step is where things go wrong. Brewer, Cook and Bird found that alexithymia was associated with self-reported poor interoception generally, not only for emotions. That covers signals like hunger, tiredness, and temperature. Their suggestion was that it is better described as a general failure of interoception than as a specific emotional impairment.

That is a more useful way to see it than "bad at feelings". It is closer to "the dashboard is hard to read".

How common it is#

More common than I expected.

In a representative German sample of 1,859 people, about ten percent were above the standard TAS-20 cut-off of 61.
In a Finnish sample of 1,285 people, the prevalence was 13 percent, and men were affected almost twice as often as women at 17 percent against 10 percent.

The same Finnish study found that alexithymia was normally distributed, meaning a bell curve across everyone rather than a group of "has it" and "does not". A later follow-up found it behaves like a stable personality trait over five years. It is not usually a passing mood.

Alexithymia and autism#

This is the part that made me sit up, because I am autistic and wrote about that in my post on bullying and social anxiety.

A systematic review and meta-analysis by Kinnaird, Stewart and Tchanturia found that alexithymia was far more common in autistic people, at about 50 percent compared to about 5 percent in non-autistic people. Their conclusion was that it is common but not universal in autism.

There is a further idea that I find interesting, and it is still being tested. Geoffrey Bird and Richard Cook argued that some of the emotional differences traditionally attributed to autism may actually come from co-occurring alexithymia. An fMRI study from Bird's group found that empathic brain responses tracked alexithymia levels rather than autism, and that once alexithymia was accounted for, the difference between autistic and non-autistic groups disappeared.

I would not hang too much on one hypothesis. But it fits something I have long suspected: that "autistic people do not feel empathy" is a lazy summary of something more specific and more fixable.

How it is measured#

The standard tool is the Toronto Alexithymia Scale, or TAS-20. Bagby, Parker and Taylor developed it in 1994. It is a 20-item self-report questionnaire with the three factors above, and a score of 61 or more is the usual cut-off for alexithymia.

Two honest caveats.

It is a self-report. If part of the difficulty is noticing your own inner states, a questionnaire that asks you about your inner states has an obvious limit. I think that is part of why Alex's view matters. Someone watching from outside sees patterns that I do not.
A score is a screening result, not a diagnosis. The German researchers who tested the cut-off even suggested that 61 might be too strict for some research purposes. If you think this applies to you, a professional who knows the area is the right next step, not a web quiz.

What helps#

I want to be careful here, because I am not a clinician and I do not want to sell a cure.

What I can say is that the common thread in the advice I found is to build the skills that are missing rather than to try harder at the ones that are not working. In practice that tends to look like:

Learning more emotion words, so there are more options than "fine" and "annoyed".
Checking the body on purpose, at set times, and noticing tension, breathing, and heart rate before trying to name anything.
Treating a feeling wheel or word list as a menu, not a test.
Asking people you trust what they see, and treating that as data rather than as criticism.
Working with a therapist who understands both neurodivergence and emotional awareness, if that is available.

None of that is a fix. It is the sort of slow, boring practice that works by repetition.

Where I am with it#

I do not know yet whether Alex is right.

What I do know is that the description fits more than I expected, and that "I do not know what I am feeling, I only know something is off" is a more common experience than I had realised. That alone is a relief.

The word has at least given Alex and me something to look at together instead of something to argue about.

I will treat this the way I try to treat everything now: curious first, conclusions later.

If any of this sounds familiar, you do not need to decide anything today. Read about it, notice what lands, and talk to someone qualified if it keeps landing.