Autism or alexithymia?

Published: 24-02-2023

Alexithymia, or difficulties in recognizing and naming emotions, very often co-occurs with the autism spectrum disorder. So often that it is confused with it, which leads to incorrect stereotypes about autistic people.

First, read the article Alexithymia or emotional illiteracy, in which I described what this psychological construct is all about. It occurs, according to various studies, in about 50 – 85% of people with autism spectrum disorder. In the general population it is visible in about 10% of people.

The autism spectrum is characterized by difficulties with social interaction and communication, and repetitive behaviors. Autistic people are also often described as having problems with taking the perspective of others (poor theory of mind), recognizing the emotions of others, and having low empathy. Research in recent years, however, indicates that such problems are caused by co-occurring alexithymia and not autism itself.

What is alexithymia and not autism?

One trait often associated with autism is low empathy. It can be divided into two types: emotional empathy, which involves feeling the emotions of others, and cognitive empathy, which is understanding why another person feels what they feel.

In people with alexithymia, difficulties in recognizing their own emotional states cause problems with recognizing them in other people and less empathizing with the emotions of others. Therefore, people on the autism spectrum who also have alexithymia have lower both cognitive and emotional empathy than autistic people who do not have alexithymia.

Bird and colleagues used functional magnetic resonance imaging in 2010 to study brain activity in response to pain from a loved one. It turned out that the degree of brain activity (specifically the front part of the insula) correlated with alexithymia, but not with autism.

The same team of researchers studied the ability to recognize emotions based on facial expressions. Study participants with high alexithymia could not accurately identify emotions by looking at another person’s face, but people with autism without alexithymia had no problems with this. Similarly, recognizing emotions from another person’s voice turned out to be related to the degree of alexithymia, not the autism itself.

In 2016, the Ketelaars team studied the ability to recognize emotions from voice and face in women with high-functioning autism spectrum. They also showed that such people have no problem with it, unless they also have high alexithymia.

One of the studies conducted by Lerner in 2019 also showed that social isolation does not have to be the result of autism spectrum disorder. In his study, autistic people had as many social interactions as people not on the autism spectrum, while alexithymia was associated with limited social interaction.

What does autism look like without alexithymia?

Characteristic features of autism include: limited interests, repetitive behaviors, and a love of routine. People on the autism spectrum who do not have alexithymia, like those who have alexithymia, also have problems communicating with other typical people. Such problems are largely due to a different communication style (direct, specific communication, literal use of words), which makes it difficult for autistic and non-autistic people to understand each other. This does not mean, however, that all people with autism have problems with empathy and recognizing emotions in other people.