Alexithymia: The Emotion Blindspot You Didn’t Know You Had

Clinically Reveiwed
April 21, 2025

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What is Alexithymia?

Have you ever been asked, “How are you feeling?”—and genuinely not known the answer? Not because you’re shy, numb, or trying to hide something—but because the answer simply isn’t there.

That might be alexithymia—a condition often described as “emotion blindness.” People with alexithymia struggle to identify and describe their own emotions. They may feel sensations in their body, like tension or restlessness, but can’t connect those feelings to an emotion like sadness, anger, or anxiety.

The term comes from Greek roots: a (without) + lexis (word) + thymos (emotion)—literally, “no words for emotions.” And that’s exactly how it feels for those living with it.

Alexithymia isn’t a mental illness in the traditional sense. It’s more of a personality trait or neurological profile that can exist on its own or alongside other conditions like autism, PTSD, or depression.

Why It’s Often Misunderstood or Misdiagnosed

Alexithymia doesn’t look dramatic. It doesn’t involve panic attacks or outbursts. In fact, it often shows up as the absence of expected emotion.

This can lead to major misunderstandings:

A partner might think you’re emotionally distant or cold.
A therapist might feel frustrated that you “won’t open up.”
You might believe you’re broken for not feeling what others seem to feel.

But the truth is: you’re not emotionless—you just have trouble accessing and expressing what you feel. And with awareness and the right tools, that can begin to change.

Defining Alexithymia

Origin of the Term and Its Clinical Definition

The word “alexithymia” was first used in the 1970s by psychiatrist Peter Sifneos to describe patients who had:

Difficulty identifying feelings
Limited imagination or fantasy life
A tendency toward logical, external thinking
Difficulty distinguishing between emotions and bodily sensations

Today, psychologists define alexithymia as a condition marked by impairments in emotional awareness and verbal expression. It’s not officially listed in the DSM-5, but it’s widely recognized in psychological literature and clinical practice.

An estimated 10–13% of the population may have some level of alexithymia—though it’s often missed because it doesn’t cause distress in the same obvious way as anxiety or depression.

Emotional Blindness vs. Emotional Numbness

Here’s a crucial distinction: alexithymia isn’t the same as emotional numbness.

Emotional numbness is typically a temporary shutdown in response to trauma, stress, or depression. People know something’s wrong but can’t feel it.
Alexithymia is a more consistent trait—often present from early life—and involves never having had strong access to internal emotional signals.

People with alexithymia may feel physical cues (tight chest, dry mouth, nausea) but can’t tell if it’s anxiety, hunger, or something else.

They might say:

“I just feel off.”
“I don’t really get emotional.”
“I don’t know how to describe what I’m feeling.”

It’s not that they’re avoiding emotion—it’s that the language and recognition for those emotions aren’t fully developed.

Core Symptoms of Alexithymia

Difficulty Identifying Emotions

This is the hallmark symptom. People with alexithymia often:

Can’t label what they’re feeling
Confuse emotions with physical sensations (e.g., “I feel weird” instead of “I feel anxious”)
Struggle with questions like “How do you feel about that?”

They might report feeling only “okay,” “fine,” “bad,” or “mad”—without nuance.

Trouble Describing Feelings to Others

Even when they do have an emotion, expressing it is hard. They may:

Go silent when asked about their inner world
Use overly logical explanations instead of emotional language
Rely on describing facts or behaviors rather than feelings

For example, instead of saying “I felt hurt when my friend ignored me,” they might say, “They didn’t respond. I went home.”

Limited Imaginative Thinking or Fantasy Life

Many people with alexithymia also report:

Not daydreaming often
Disinterest in fiction, metaphors, or symbolic thinking
Difficulty visualizing emotional scenarios or imagining outcomes

It’s as if their inner emotional landscape is underdeveloped or muted.

Logical Thinking > Emotional Insight

This isn’t always a bad thing. People with alexithymia often excel in:

Practical problem-solving
Technical, analytical, or rule-based environments
Remaining calm in crisis situations

But they may struggle in emotionally charged conversations, where nuance and vulnerability are needed.

They might appear robotic, distant, or uncaring—but that’s not the reality. It’s a mismatch between emotional input and internal processing.

Types of Alexithymia

Primary Alexithymia (Neurological)

Primary alexithymia is believed to be innate or neurologically based, meaning a person is born with the traits or develops them very early in life due to brain wiring differences.

This type is often:

Lifelong
Less influenced by environment or trauma
Common in individuals with neurodevelopmental conditions (like autism or ADHD)

People with primary alexithymia may have reduced connectivity between areas of the brain that control emotion and language, like the anterior insula and prefrontal cortex. As a result, even when emotions are felt, they may not reach the conscious, verbal parts of the mind.

This type tends to be stable over time but can improve with training and tools like emotion labeling and somatic therapy.

Secondary Alexithymia (Trauma-Induced or Situational)

Secondary alexithymia develops later in life, often as a response to trauma, emotional neglect, or overwhelming stress. It can also appear during certain mental health conditions such as:

Depression
PTSD
Burnout
Grief or emotional overload

In this case, alexithymia is more like a defense mechanism—a subconscious way to avoid painful emotions by disconnecting from them entirely. The brain shuts off access to feelings to protect itself.

The good news? Secondary alexithymia is often reversible with emotional processing work, therapy, and support.

Causes and Risk Factors

Genetic and Neurological Roots

Some studies suggest that genetics may play a role in the development of alexithymia. Certain brain structures responsible for emotion processing, such as the amygdala and anterior cingulate cortex, may function differently in those with alexithymia.

Additionally, lower connectivity between the limbic system (which handles emotion) and the language centers in the brain (like Broca’s area) can lead to the sensation of emotion without the words to describe it.

People with alexithymia often report feeling:

“Disconnected” from their body
Uncomfortable with physical affection or emotional expression
Emotionally neutral even in extreme situations

This neurological pattern tends to show up more frequently in those with autism, schizophrenia, or brain injury.

Trauma, Neglect, and Emotional Suppression

Emotional development is a skill we learn over time—often by watching caregivers label and regulate emotions in healthy ways. But if you grow up in an environment where:

Emotions are ignored or punished
Parents don’t model emotional language
You were shamed for crying or expressing anger

…you might learn to suppress or disconnect from your feelings entirely.

This kind of emotional “shutdown” can become permanent if not addressed. Many trauma survivors develop alexithymia as a survival adaptation, numbing out to avoid re-experiencing emotional pain.

Co-occurrence with Other Conditions (Autism, PTSD, Depression)

Alexithymia commonly appears alongside:

Autism Spectrum Disorder (ASD) – Over 50% of autistic individuals may experience alexithymia. It’s separate from autism but highly correlated.
PTSD – Trauma survivors often dissociate from their emotions, leading to secondary alexithymia.
Depression – Emotional blunting and reduced affect can mimic or cause alexithymia.
Eating Disorders – Difficulty identifying hunger, fullness, and emotions are often linked to alexithymia.

In these cases, addressing the underlying condition can help reduce alexithymia symptoms—but it often needs direct attention on its own as well.

How Alexithymia Affects Daily Life

Relationships and Communication

Imagine being in a relationship where:

Your partner says, “What’s wrong?” and you say, “I don’t know.”
You get accused of being cold or distant, but you truly don’t feel emotional shifts the way others do.
You struggle to comfort others because their emotional expressions feel confusing or overwhelming.

This is the daily experience of many people with alexithymia. While they may care deeply, their lack of emotional vocabulary makes it hard to:

Communicate needs and boundaries
Understand or mirror others’ feelings
Show affection or vulnerability in conventional ways

As a result, romantic, familial, and even workplace relationships can become strained.

Therapy Resistance and Miscommunication

Many people with alexithymia struggle in traditional talk therapy. Common challenges include:

Not knowing what to say during sessions
Struggling with “how do you feel about that?” questions
Feeling emotionally numb or confused when expected to reflect inward

Some therapists misinterpret this as avoidance or resistance, when it’s actually a neurological gap, not a choice.

This is why it’s important to find therapists familiar with alexithymia, who use structured, skills-based methods rather than open-ended emotional exploration.

Difficulty With Emotional Regulation and Empathy

If you don’t know what you’re feeling, you can’t regulate it.

People with alexithymia often:

Have emotional outbursts that seem out of the blue
Experience physical stress symptoms without understanding why
Struggle with empathy, especially emotional empathy (feeling what others feel)

This doesn’t mean they’re unkind or uncaring. It means they experience emotions in a nonverbal, internalized way that doesn’t match social expectations.

Diagnosis and Screening

How Alexithymia Is Diagnosed

Alexithymia isn’t formally listed in the DSM-5 as a stand-alone mental disorder, which means there’s no one-size-fits-all clinical process for diagnosing it. However, mental health professionals can identify it through structured interviews, questionnaires, and observed emotional processing patterns.

Key diagnostic steps include:

Evaluating how well a person can identify and describe their own emotions
Assessing emotional vocabulary and self-awareness
Looking at patterns in relationships and emotional responses

A skilled therapist or psychologist may notice alexithymic tendencies if a client:

Consistently struggles to answer emotion-based questions
Seems disconnected from their internal states
Responds to emotional prompts with logic or confusion

It’s important to remember: a diagnosis isn’t a judgment—it’s a map. It helps clarify what kind of support you need and how to work with your emotional world more effectively.

The Toronto Alexithymia Scale (TAS-20)

One of the most widely used tools for assessing alexithymia is the Toronto Alexithymia Scale (TAS-20). It’s a 20-question self-report assessment that measures three key areas:

Difficulty identifying feelings
Difficulty describing feelings
Externally oriented thinking

Examples of TAS-20 items include:

“I am often confused about what emotion I am feeling.”
“I prefer to analyze problems rather than just describe them.”
“When I am upset, I don’t know if I am sad, frightened, or angry.”

Scoring high on the TAS-20 doesn’t confirm a diagnosis, but it can guide deeper reflection and therapeutic exploration.

You can find free, unofficial versions of the TAS-20 online—but interpretation is best done with a therapist.

Alexithymia vs. Other Emotional Disorders

Difference from Emotional Suppression

It’s easy to confuse alexithymia with emotional suppression, but they are fundamentally different:

Suppression: You feel the emotion but choose to push it down.
Alexithymia: You don’t recognize the emotion clearly in the first place.

A person who suppresses their feelings might say, “I’m mad but I’m going to pretend I’m not.”
A person with alexithymia might say, “I don’t know what I’m feeling. I just feel off.”

This distinction matters because suppression can be reversed with emotional permission, while alexithymia requires building entirely new emotional awareness skills.

How It’s Distinct from Depression, Anxiety, or PTSD

Many people with depression or trauma report feeling emotionally flat or numb—but that’s often temporary and emotion-related, not a lifelong trait.

Here’s how they differ:

Depression causes reduced interest or pleasure in life, but the person can still label emotions like sadness or guilt.
Anxiety causes heightened emotional states and a flood of emotions, even if the person is overwhelmed.
PTSD may include alexithymia as a symptom, especially in dissociative subtypes.

Alexithymia, by contrast, tends to be consistent across mood states, and the emotional difficulty is present even when the person is physically well or socially supported.

Alexithymia in Children and Teens

Developmental Red Flags

Children aren’t expected to be emotional experts—but certain red flags may point to alexithymic traits in youth:

Difficulty naming basic emotions (happy, sad, angry)
Describing emotions as physical complaints (“my tummy hurts” instead of “I’m nervous”)
Emotional outbursts that seem out of nowhere
Not engaging in imaginative play
Flat affect or seeming indifferent to emotional events

It’s important not to label a child too quickly—many kids need time to develop their emotional skills. But if these patterns persist past early development, early intervention can make a big difference.

How to Support Young People With Emotion Processing Issues

If you suspect a child or teen may have alexithymia, focus on building their emotional vocabulary and self-awareness:

Use feeling charts and mood wheels during daily routines
Narrate your own emotions around them (“I feel a little frustrated, so I’m going to take a break”)
Encourage body awareness with questions like “Where do you feel that in your body?”
Read books together and pause to ask, “How do you think this character feels?”

The goal isn’t to force emotions, but to model and scaffold emotional literacy—so they can learn it at their own pace.

Coping Strategies and Treatment Options

Emotion Labeling and Feeling Charts

One of the most effective tools for alexithymia is emotion labeling—literally learning the language of feelings. Think of it as a dictionary for your inner world.

Try these tools:

Feeling wheels with basic and nuanced emotions
Daily emotion check-ins using words and emojis
Journals that prompt “How did this make you feel?”

This might feel silly or foreign at first, but with practice, you begin to build emotional fluency—connecting body sensations with words like “frustrated,” “overwhelmed,” or “hopeful.”

The brain needs repetition and structure to form new emotional pathways. Emotion charts aren’t just for kids—they’re powerful adult tools, too.

Mindfulness and Somatic Awareness

Mindfulness helps bridge the gap between body and emotion—especially when words are hard to find.

Try:

Body scans to notice where you hold tension
Breathwork to connect with physical and emotional states
Movement therapies (like yoga or dance) to explore nonverbal emotion release

Somatic techniques (like tapping, grounding, or cold exposure) teach you to tune into your body and use it as a guide to your emotional state.

Over time, your body becomes a translator for what your mind can’t quite say.

CBT and Emotion-Focused Therapy

Therapies that help with alexithymia include:

CBT (Cognitive Behavioral Therapy) – great for building awareness of how thoughts, feelings, and behaviors connect. Especially useful if you tend to over-intellectualize emotions.
Emotion-Focused Therapy (EFT) – designed to increase emotional expression and help you safely explore feelings.
Somatic Experiencing – focuses on how trauma and emotions live in the body.
Psychoeducation – learning about emotions as a subject, like learning a language.

If traditional talk therapy hasn’t worked for you, ask for skills-based or trauma-informed approaches. You need structure, not just open-ended questions.

Living With or Loving Someone With Alexithymia

How to Communicate With Compassion

If someone you care about has alexithymia, you might feel frustrated. You might hear:

“I don’t know how I feel.”
“I don’t care” (when they actually do)
Silence when you need a response

Here’s how to bridge the gap:

Use concrete, specific language (“Did that make you sad, mad, or worried?”)
Don’t pressure them to “open up”—offer options and wait.
Be patient with emotional silence—it’s not rejection.
Celebrate small wins (like when they express a feeling clearly).

They’re not broken. They’re learning a new emotional language—and your patience helps.

Supporting Growth Without Pushing Too Hard

Growth happens gradually. Help by:

Suggesting tools like journals, emotion charts, or somatic apps
Modeling healthy emotional expression yourself
Encouraging therapy—without forcing it
Offering praise for emotional honesty, even when it’s clumsy

Sometimes, just being a safe presence is the greatest gift you can give.

Self-Reflection Tools and Resources

Journaling Prompts and Emotion Vocabulary Building

Use prompts like:

“What happened today, and how did it affect me?”
“Where do I feel stress in my body right now?”
“What word best describes my current mood?”
“What might someone in my shoes feel?”

Keep a daily “emotion log” where you:

Write the event
Label a physical sensation
Guess the emotion (even if you’re unsure)
Rate it 1–10

Pair this with a growing list of emotion words—start with 10, aim for 100 over time.

Books, Apps, and Videos That Help

Books:

“Running on Empty” by Jonice Webb – for emotional neglect
“The Language of Emotions” by Karla McLaren – a deep dive into emotional meaning
“Emotionary” by Eden Sher – humorous but educational

Apps:

Moodnotes – mood tracking and CBT reflections
Daylio – daily emotion check-ins with no typing
Insight Timer – guided meditations for emotion and body connection

YouTube:

Search “Alexithymia Explained” or “How to Feel Your Feelings” for visual learning

Conclusion

Alexithymia doesn’t mean you’re cold, broken, or incapable of emotion. It means your emotional signals are harder to detect, interpret, and express—and that’s not your fault.

Whether it’s neurological wiring, trauma history, or emotional skill gaps, there are ways to reconnect with your inner world. With the right tools, support, and time, you can begin to feel more, express more, and connect more—on your terms.

Your emotions are there. They’re just waiting for you to learn the language.

FAQs

Can alexithymia go away with therapy?

It can improve significantly, especially if it’s secondary (trauma-induced). Therapy helps build emotional vocabulary and awareness, even for those with lifelong patterns.

Is alexithymia a mental illness?

No, it’s considered a personality trait or emotional processing style. It’s not a disorder in the DSM-5, but it can cause challenges worth addressing in therapy.

Do people with alexithymia still feel emotions?

Absolutely. They feel emotions but struggle to identify, name, or express them. The emotions exist—just often beneath conscious awareness.

How is alexithymia different from being emotionally “cold”?

“Coldness” implies a lack of empathy or care. Alexithymia is more about difficulty accessing and expressing emotions—not a lack of feeling altogether.

Can you have alexithymia and still be empathetic?

Yes. Many people with alexithymia have strong cognitive empathy (understanding others’ emotions logically), even if they struggle with emotional attunement or verbal empathy.