Alexithymia and Emotional Processing in Autism Spectrum Disorders

Alexithymia, a personality construct denoting difficulty in identifying, describing and reflecting on one’s own emotions, co-occurs frequently with autism spectrum disorders (ASD) and has been proposed to underlie many socio-emotional differences observed in autistic individuals. While autism is characterised by social-communication challenges, repetitive behaviours and sensory sensitivities, alexithymia contributes specifically to diminished emotional self-awareness, reduced empathy and atypical facial emotion expression. Research over the last decade has shown that, rather than being intrinsic to the autistic condition, many recognised emotional processing deficits—such as impaired facial emotion recognition or limited emotional reciprocity—may be better explained by co-occurring alexithymia. Estimates suggest that around half of autistic adults meet clinical thresholds for alexithymia, forming a distinct subgroup whose emotional experiences and mental health trajectories differ significantly from those of autistic individuals without alexithymia. Emerging work has highlighted the predictive role of different alexithymia facets—for example, difficulties in identifying versus describing feelings—in shaping long-term social-communication outcomes, anxiety and depression. Advances in measurement, including refined questionnaire scales and item response theory, are improving the precision of alexithymia assessment in ASD, informing targeted psychological interventions aimed at enhancing emotional awareness. Understanding the interplay between autism traits and alexithymia holds global significance for tailoring support, reducing mental health comorbidity and refining diagnostic pathways in neurodevelopmental research and clinical practice.

Research from Nature Portfolio

Recent studies have employed large clinical cohorts of adults referred for autism diagnostics to disentangle the relative contributions of autism and alexithymia traits to affective outcomes. Using dominance analysis, researchers demonstrated that difficulties in identifying one’s own feelings—a core aspect of alexithymia—outweigh core autism traits as predictors of depressive symptomatology in individuals with confirmed ASD. This pattern of association was not confined to autism but extended to clinical controls without an ASD diagnosis, indicating a general psychopathological mechanism. These findings underscore the importance of routine alexithymia assessment within ASD diagnostic pipelines to better anticipate and address comorbid depression.

Alexithymia and Emotional Processing in Autism Spectrum Disorders publication trend

The graph below shows the total number of articles in alexithymia and emotional processing in autism spectrum disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Alexithymia: A trait characterised by difficulties in identifying, describing and reflecting on one’s own emotional states, often measured by standardised self-report scales.

Autism Spectrum Disorder (ASD): A neurodevelopmental condition defined by atypical social-communication, restricted and repetitive behaviours, and sensory processing differences.

Emotional processing: The cognitive and neural mechanisms by which emotions are perceived, interpreted, regulated and expressed.

Emotional self-awareness: The capacity to recognise and understand one’s own emotional experiences, foundational for effective social interaction and mental health.

Item Response Theory (IRT): A psychometric approach that models the probability of specific questionnaire responses as a function of underlying latent traits, enhancing measurement precision.

References

1. Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory. Molecular Autism (2021).
2. Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychological Medicine (2020).
3. Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry (2019).
4. Alexithymia, but not autism spectrum disorder, may be related to the production of emotional facial expressions. Molecular Autism (2016).
5. Facial emotion recognition in autistic adult females correlates with alexithymia, not autism. Autism (2020).
6. Alexithymia traits outweigh autism traits in the explanation of depression in adults with autism. Scientific Reports (2021).