Alexithymia: When You Can’t Name What You Feel, and What Helps

Alexithymia is difficulty identifying and describing your own emotions. It does not mean you have no feelings. People with alexithymia have emotions like anyone else. What is hard is knowing which emotion is happening, putting it into words, and often telling a feeling apart from a body sensation such as tension, a racing heart or tiredness. It is a personality trait that everyone has to some degree, not a diagnosis, and it is fairly common. The research also suggests it can change with practice.

This article explains what alexithymia is and isn’t, how it shows up, how it relates to autism and to the body, and what the evidence says helps.

What alexithymia is (and isn’t)

The word was introduced by the psychiatrist Peter Sifneos in the early 1970s, in work with psychosomatic patients. It comes from Greek and means, roughly, “no words for emotions”. That literal meaning is the most accurate short description: the gap is in the words, not in the feelings.

Researchers usually measure it with the Toronto Alexithymia Scale (TAS-20), a 20-item questionnaire developed at the University of Toronto in 1994. It captures three related difficulties:

So the common internet description, “someone who can’t feel emotions”, gets it wrong. A better description is someone whose emotions arrive without clear labels.

Signs of alexithymia

There is no official symptom list, because it is not a diagnosis. But the three facets above show up in recognisable ways in everyday life:

• “I don’t know” is a genuine answer. When someone asks how you feel, you honestly can’t tell, rather than not wanting to say.
• Feelings show up as body sensations. A tight chest, a churning stomach or sudden tiredness, without a clear sense of what emotion goes with it.
• Emotions seem to arrive all at once. You can go from “fine” to overwhelmed with nothing in between that you noticed.
• Conversations about feelings are hard work. You may prefer to talk about what happened rather than how it felt, and other people may read that as coldness.
• Other people’s emotions can be confusing too, especially when they are not spelled out.

Recognising yourself in some of these does not mean you “have” alexithymia. Most people have some of these experiences some of the time. Alexithymia describes having them more often, and more strongly.

How common is it?

Quite common. In one study of 1,285 people representing the general population of Finland, 13% scored above the TAS-20 cut-off. Men were almost twice as likely as women to do so (17% vs 10%), and alexithymia was also linked to older age, less education and lower socioeconomic status. Interestingly, men and women did not differ in difficulty identifying feelings. Men scored higher on describing them and on externally oriented thinking.

That is one country and one point in time, so treat the exact numbers with care. The bigger point holds: this is not a rare condition. Many people you know probably have it to some degree.

Is alexithymia a diagnosis?

No. Alexithymia is not in the DSM, the manual used to diagnose mental health conditions. The same Finnish study found that scores were normally distributed, “confirming that it is a personality dimension”: a scale everyone sits somewhere on, like being more or less extraverted, rather than something you either have or don’t. Researchers describe it as “a sub-clinical construct”.

The TAS-20 cut-off is a research convention for grouping people, not a clinical verdict. That is why an online “alexithymia test” can tell you something interesting about yourself but cannot diagnose you with anything.

It is also fairly stable. In a group of 755 middle-aged Finnish men followed for 11 years, scores changed only a little over time, which supports the idea that it behaves like a trait. Stable does not mean fixed, though, as the section on what helps shows.

Alexithymia and autism

The two are often mentioned together, and the link is real, but it is often overstated. A 2019 meta-analysis of 15 studies at King’s College London found that about half of autistic participants (49.9%) scored in the alexithymic range, compared with 4.9% of neurotypical participants. The authors’ conclusion is worth quoting: alexithymia is “common, rather than universal” in autism.

That has two practical consequences:

• Not every autistic person has alexithymia, and the emotional difficulties sometimes assumed to be part of autism may partly reflect co-occurring alexithymia instead. That is the argument this research makes.
• Alexithymia is not a sign of autism. Most people with alexithymia are not autistic. If you are wondering about autism, that is a separate question for a proper assessment.

It may start in the body

One of the most interesting lines of research suggests that alexithymia is not only about emotions. It may be about reading the body’s signals in general, which researchers call interoception.

Emotions are partly physical: fear speeds up your heart, sadness can feel heavy, anger can feel hot. To name an emotion, you first have to notice those signals and make sense of them. In a 2016 study of about 200 people, higher alexithymia went with worse self-reported awareness of non-emotional body signals too, such as hunger, tiredness and temperature. People with higher scores also felt that emotional and non-emotional states were more alike: that being anxious and being hungry, for example, felt harder to tell apart.

The study used questionnaires the researchers designed for it, so it points in a direction rather than proving a mechanism. But it rings true for many people with alexithymia, and it suggests that body awareness is a sensible place to start. If you are interested in that side of things, our guide to nervous system regulation separates what is well established about the body’s stress response from what isn’t.

Alexithymia in men: “normative male alexithymia”

Some men keep their feelings to themselves because that is what they learned a man should do. The psychologist Ronald Levant calls this normative male alexithymia: limits in expressing emotion that come from gender socialisation, rather than from the trait itself.

The two overlap. In a study of 505 men, a scale measuring normative male alexithymia correlated moderately with the TAS-20, and it predicted “restrictive emotionality” beyond what the TAS-20 explained. In other words, a man who never talks about his feelings may have alexithymia, or he may have learned that talking about them is not allowed. Often it is some of both. The difference matters, because unlearning a rule and learning a skill are different kinds of work.

Can alexithymia change? What helps

The honest answer is that it can, and that the evidence is promising but not yet conclusive.

Psychological therapy. A 2024 systematic review gathered 18 randomised trials with 1,251 participants. Most of the treatments tested were from the CBT family, including acceptance and commitment therapy (ACT), behavioural activation, schema therapy and compassion-focused therapy. Most of them significantly reduced TAS-20 scores. The authors also say the studies were too different from each other to standardise any one treatment, and that larger, higher-quality trials are needed. So no treatment is “proven” for alexithymia, but there is good reason to think therapy can help.

Guided digital practice. A 2023 randomised trial at the Max Planck Society in Berlin tested two 10-week app-based trainings with 285 adults: a solo mindfulness programme and a partner-based practice called the Affect Dyad, done together with another person. Both trainings were supported by weekly coaching sessions, and both reduced TAS-20 scores. The partner practice did better on some measures of body awareness, and those gains helped explain the drop in alexithymia. Two caveats matter: the participants did not have a clinical diagnosis, and the published results compare the two trainings with each other. One author also disclosed that she advised a start-up developing a commercial version of the dyad practice.

What both strands have in common is practice in noticing and naming. You can start on that yourself:

• Start with the body. Several times a day, pause and notice what is going on physically: jaw, shoulders, chest, stomach, energy. You don’t need an emotion word yet.
• Then guess a word, and be specific. Not just “bad” but “disappointed”, “lonely” or “on edge”. A list of emotion words helps at first. Putting feelings into words seems to do something useful in itself: in a well-known brain-imaging study, labelling the emotion in upsetting images reduced the response of the amygdala, a brain region that responds to threat.
• Track it over time. A short daily note of the sensation, your best-guess word and what happened before it turns scattered moments into patterns. Our guide to mood tracking explains how to do it without it becoming a chore.
• Practise out loud with someone. Describing how you feel to another person, even badly, is the skill itself. That is the idea behind the partner practice in the Berlin trial.

These skills sit at the heart of emotional intelligence. If you want to keep building them, our guide to emotional intelligence coaching covers the next steps.

If you would like somewhere to practise putting feelings into words, aidx.ai, an AI coaching and therapy service, can help you reflect on what you notice and find the language for it, at your own pace. It is AI, not a clinician, and it does not diagnose or treat alexithymia.

Loving someone with alexithymia

If your partner has alexithymia, it is easy to read their “I don’t know” as avoidance, or their flatness as not caring. Usually it is neither. They may be feeling a lot and finding it hard to reach. A few things tend to make it easier for both of you:

• Ask about the body or the situation, not just the feeling. “What did that feel like in your body?” or “What went through your head when she said that?” is easier to answer than “How do you feel?”
• Offer options instead of open questions. “Were you more annoyed or more hurt?” gives them something to check against.
• Give it time. The answer may come hours later. Leave the door open.
• Notice care in actions. Many people with alexithymia show care in what they do more easily than in what they say.
• Look after your own needs too. If you need more emotional conversation than you are getting, say so plainly. Couples therapy can help you find a way of talking that works for both of you.

Common questions

How do you tell if you have alexithymia?

If you often can’t tell what you are feeling, struggle to describe it, or notice feelings mainly as body sensations, you may be higher on the alexithymia scale. Online versions of the TAS-20 can give you a rough sense of where you sit, but they are research questionnaires, not diagnoses. If it is causing you problems, a psychologist or therapist can help you understand it in context.

Do people with alexithymia feel love?

Yes. Alexithymia affects identifying and describing emotions, not having them. People with alexithymia fall in love, form close relationships and care deeply. They may find it harder to say so, or to recognise exactly what they feel, so their love may show more in what they do than in what they say.

Can a person with alexithymia cry?

Yes. Nothing about alexithymia stops someone crying. Some people with alexithymia find themselves in tears without being able to say why, which fits the core difficulty: the emotion is there, but the label is missing.

What can alexithymia be mistaken for?

Most often for coldness or a lack of empathy, for depression, or for emotional numbness. It overlaps with depression: in one Finnish study, depressive symptoms explained over a third of the variation in alexithymia scores, so when mood is low the two can be hard to tell apart. Numbness is also different. Feeling flat or cut off is an experience of its own, often temporary and often linked to stress or low mood, which we cover in feeling lost, numb or stuck. Alexithymia is a long-standing difficulty with putting feelings that are there into words.

Can you be born with alexithymia?

Partly, it seems. In a study of 729 Italian twins, genetic factors accounted for about 42% of the differences in alexithymia, and factors unique to each person’s own experience accounted for the rest. That suggests both nature and experience play a part. Exactly how is still an open question.

Can alexithymia be caused by trauma?

There is a link, but cause has not been established. A 2024 meta-analysis found that people who reported childhood abuse or neglect tended to score higher on alexithymia, with emotional abuse and neglect showing the strongest links. The correlation was modest (r = .26), and the studies relied on questionnaires, so they cannot show that trauma causes alexithymia. If trauma is part of your story, a trauma-informed therapist is the right person to help.

Is there a cure for alexithymia?

It is not an illness, so “cure” is not quite the right word. But it is not fixed either. Most therapy trials found that alexithymia scores went down, and practising noticing and naming feelings is something anyone can start.

What is the opposite of alexithymia?

There is no official opposite, but the closest idea is emotional granularity: being able to tell feelings apart in fine detail, such as “disappointed” versus “embarrassed” versus “lonely”. A 2022 review found that higher alexithymia goes with lower emotional granularity, though the association was small.

Last reviewed: October 2026

References

• Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32.
• Bagby, R. M., Taylor, G. J., & Parker, J. D. (1994). The Twenty-item Toronto Alexithymia Scale—II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38(1), 33–40.
• Brewer, R., Cook, R., & Bird, G. (2016). Alexithymia: a general deficit of interoception. Royal Society Open Science, 3(10), 150664.
• Honkalampi, K., Koivumaa-Honkanen, H., Lehto, S. M., et al. (2010). Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study. Journal of Psychosomatic Research, 68(3), 269–273.
• Kick, L., Schleicher, D., Ecker, A., Kandsperger, S., Brunner, R., & Jarvers, I. (2024). Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis. Frontiers in Psychiatry, 15, 1412229.
• Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: a systematic review and meta-analysis. European Psychiatry, 55, 80–89.
• Lee, K. S., Murphy, J., Catmur, C., Bird, G., & Hobson, H. (2022). Furthering the language hypothesis of alexithymia: an integrated review and meta-analysis. Neuroscience & Biobehavioral Reviews, 141, 104864.
• Levant, R. F., & Parent, M. C. (2019). The development and evaluation of a brief form of the Normative Male Alexithymia Scale (NMAS-BF). Journal of Counseling Psychology, 66(2), 224–233.
• Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., et al. (2007). Putting feelings into words: affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428.
• Picardi, A., Fagnani, C., Gigantesco, A., et al. (2011). Genetic influences on alexithymia and their relationship with depressive symptoms. Journal of Psychosomatic Research, 71(4), 256–263.
• Salminen, J. K., Saarijärvi, S., Aärelä, E., Toikka, T., & Kauhanen, J. (1999). Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. Journal of Psychosomatic Research, 46(1), 75–82.
• Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255–262.
• Silveira, S., Godara, M., Faschinger, A., & Singer, T. (2023). Reducing alexithymia and increasing interoceptive awareness: a randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice. Journal of Affective Disorders, 341, 162–169.
• Tolmunen, T., Heliste, M., Lehto, S. M., Hintikka, J., Honkalampi, K., & Kauhanen, J. (2011). Stability of alexithymia in the general population: an 11-year follow-up. Comprehensive Psychiatry, 52(5), 536–541.
• Tsubaki, K., & Shimizu, E. (2024). Psychological treatments for alexithymia: a systematic review. Behavioral Sciences, 14(12), 1173.

This article is general information about emotions and mental health. It is not medical or psychological advice, and it cannot diagnose any condition. If difficulties with emotions are affecting your relationships, work or wellbeing, a GP, psychologist or therapist can help. If you are in crisis or thinking about harming yourself, contact your local emergency services or a crisis line right away: in the US, call or text 988 (Suicide & Crisis Lifeline); in the UK and Ireland, call Samaritans on 116 123.