When you ask your teen how they’re feeling, and they say “I don’t know,” they might actually mean it. Usually, we’d associate this response with avoidance or maybe even defiance. But for some teens, they say it because they genuinely can’t put a name on what they feel.
For autistic teens in particular, this experience is far more common than most parents realize. It’s called alexithymia.
Research into alexithymia suggests that it’s present in around half of those with autism. That’s something every parent of an autistic teen should understand.
This page covers:
Alexithymia comes from Greek roots that literally mean “no words for emotions.” It’s not a diagnosis in itself, but rather a way to describe difficulty identifying and understanding your own emotions.
Alexithymia presents in different ways, meaning there isn’t one universal sign. These include:[1]
Here, the person feels a certain emotion but can’t name it. They might know they feel “bad” or “off” but can’t distinguish between the emotions linked with that feeling. For example, they might not be able to tell the difference between sadness and frustration.
The person struggles to communicate to others how they’re feeling. They might shut down when asked how they’re feeling or describe physical sensations instead. For example, a person might say they “feel weird” because it’s the closest they can get to describing the feeling.
This means someone focuses on outside facts and details rather than their own emotional state. It may be because they don’t naturally look inward, the way most people do.
A person with alexithymia still has emotions. They still react emotionally to the world around them. The key difference is they can’t translate what they’re feeling inside into something they can name or express.
Emotional dysregulation, on the whole, is well documented in autism, and there are many reasons for this. But one of the most researched areas is the overlap with alexithymia.
A meta-analysis found that nearly 50% of autistic people met the threshold for alexithymia. That’s compared to 5% of non-autistic people.[1]
Research focusing on autistic adolescents specifically found the rate was 55%, with 31 out of 56 autistic teens scoring above the clinical cutoff.[2]
To understand the link, researchers have been trying to work out whether alexithymia is built into autism itself, or whether it’s a separate trait that just happens to present alongside it.
For example, there’s an idea called the Alexithymia Hypothesis. It argues that many of the emotional difficulties that those with autism experience are actually driven by alexithymia.[3]
Studies supporting this found that once researchers controlled for alexithymia, autism itself no longer predicted difficulties recognizing emotions through facial expressions.[3]
Research on interoception has taken this idea further. Interoception is the ability to sense your body’s internal signals. The study found that impaired interoception was associated with alexithymia, not with autism.[4]
In other words, if you can’t accurately read your own body’s signals, you can’t easily build a vocabulary for the emotions those signals represent.
That’s an important distinction for you as a parent. If alexithymia is the driver of emotional difficulties in your child, it can be addressed directly. This cuts through the worry that many parents have that it’s one of the autism symptoms you have to accept as unchangeable.
Understanding the link between the two is important for understanding your teen, but it’s also worth exploring the areas in their lives that are affected. You may be able to see some of them on a day-to-day basis. But there are other things that you might miss, because they are internal difficulties.
If your teen has trouble with identifying their own emotions, understanding other people’s emotions becomes even harder. This then compounds the social communication difficulties that are already associated with autism and can make your teen appear disengaged from the people around them.
Research on adolescents found that alexithymia was associated with poorer emotion recognition and higher rates of parent-reported emotional difficulties.[3]
You can’t regulate an emotion that can’t be identified, and alexithymia removes the first step of that process. This means emotions can build without your teen realizing it.
As a parent, you might recognize the pattern. Sudden meltdowns or shutdowns that seem to come from nowhere are often a sign of emotions that have been building without being processed.
If your child seemed fine, then all of a sudden they are not fine, it could mean they’re experiencing a buildup they couldn’t manage because the emotional labeling system wasn’t available to them.
Alexithymia can also show up as physical symptoms. Some people express emotional distress through their body instead of words.
For example, your teen may complain of headaches or stomach pain rather than say they feel anxious. That’s often because physical symptoms are the only signals they can recognize and name.
The emotional side of anxiety stays hidden to them, but they’re aware of the physical symptoms like digestive issues or persistent headaches.
One line of research looked at children with medically unexplained physical symptoms. It found higher rates of alexithymia in this group.[5]
Mental health is another area parents of autistic children should be aware of.
One study found that difficulty identifying feelings predicted later anxiety in those with autism, and while the participants were adults, similar results were found in children.[6]
Regarding depression, it was also found that difficulty naming feelings was the strongest predictor of depression in autistic adults.[7]
Studies have also found that alexithymia could partially explain the heightened eating disorder risk associated with autistic traits.[8]
As we can see from these studies, the pattern that stands out the most is that alexithymia looks like a bigger driver of mental health risks than autism severity. This is why identifying alexithymia and then addressing it can make such a difference for your teen.
Mission Prep is here to help you or your loved one take the next steps towards an improved mental well-being.
The encouraging finding from the research is that alexithymia isn’t a permanent feature. Several therapeutic approaches and practical tools can help your teen.
Problems with verbally identifying emotions can be improved through building emotional vocabulary. This might include emotion charts and body mapping that connects physical sensations to emotional states.
These tools can give your teen a way to communicate intensity even when they can’t name the feeling.
You can support this at home by saying your own feelings out loud. For example, you could say “I’m feeling frustrated because the traffic was bad,” which gives your teen a template for connecting an experience to a named emotion.
Standard cognitive behavioral therapy (CBT) relies on identifying thoughts and feelings, which can be difficult for your teen to do if alexithymia is present.
Adapted versions of CBT exist for people with autism, which use more visual supports and plain language. These adaptations can help with your teen’s emotional well-being during treatment.
Therapists may also use tools like structured worksheets. These break the process of naming emotions into smaller steps.
Dialectical behavior therapy (DBT) has some of the strongest evidence in this area. Trials have found it reduces emotional dysregulation, which in turn improves alexithymia.
A separate trial found DBT reduced suicidal thoughts and suicide attempts in autistic adults, compared to standard treatments.[9] These results come from adult participants, but the approach may work for teens too, going forward.
Impaired interoception seems to be one of the main aspects that links alexithymia and autism. Some approaches focus on building your teen’s awareness of their own body’s internal signals.
For example, therapists are exploring body scan and mindfulness practices focused on physical sensations. They can be used alongside other therapy to build interoceptive awareness directly.[10]
It can be difficult to know when it’s the right time to seek professional help, especially if you’re unsure whether the behavior you’re seeing is autism based or alexithymia-based. That said, some signs strongly suggest that professional help should be sought.
For example, if your teen’s alexithymia seems to be contributing to frequent meltdowns or shutdowns, the next step would be to reach out for autism support.
The same also applies if you notice:
If your teen is expressing signs of suicidal ideation or attempts at suicide, call the 24/7 mental health crisis line at 988 or emergency services at 911.
Alexithymia isn’t something that resolves on its own. The longer it goes unaddressed, the more it compounds the difficulties your teen already faces because of autism. The research covered on this page suggests that alexithymia responds to intervention.
Autism, alexithymia, and co-occurring mental health conditions can be a lot to manage together. If outpatient therapy hasn’t been enough, it may be time to think about a higher level of support.
Residential treatment provides a safe and structured environment for your teen where they can build emotional awareness skills. Staff can work carefully on identification and labeling, adapting their approach based on how your teen responds.
A residential setting also lets the team treat any co-occurring mental health conditions. This happens alongside work on emotional regulation.
Mission Prep provides treatment for teens experiencing various mental health conditions. Mental Health support is a phone call away – call 866-901-4047 to learn about your treatment options.
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If anything on this page has resonated with what you’re seeing in your teen, support is available. At Mission Prep Teen Treatment, we use evidence-based therapeutic approaches and innovative interventions to foster sustainable change for adolescents and their families.
To best serve each teen, we offer tailored treatment programs at various levels, including residential and outpatient mental health programs.
Our team understands the unique challenges that come with neurodivergence. We know what it takes to support a neurodivergent teen through emotional difficulties. That’s why we adapt treatment to their needs.
Our facilities are an important part of the treatment process at Mission Prep Teen Treatment. We believe it’s critical for teens to have a safe and welcoming environment to build the tools they need to facilitate healing. We maintain modern and welcoming homes to provide stability to adolescents throughout treatment.
Mission Prep Teen Treatment accepts insurance and is in-network with most major providers. We are happy to help you check your insurance coverage for mental health care.
If you’ve been wondering whether your teen needs more support, trust that instinct and reach out. Contact us online or call 866-901-4047 to speak with a caring member of our team who can answer any questions you might have. Reach out for a free, no-obligation conversation.
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