Has anyone ever asked you 'how do you feel?' and you've gone completely blank? Not because you don't want to answer, but because, honestly, you don't know. You notice something is off —a knot in your stomach, tension in your shoulders, a sudden urge to leave— but putting a name to it (is it sadness? anger? fear?) feels like speaking a language you never learned. If this happens to you often, you may have a high degree of alexithymia.
Alexithymia is the difficulty identifying, understanding and expressing your own emotions. It doesn't mean you don't feel; it means you find it hard to know what you feel and to translate it into words. In this article I'll explain what it is, why it appears, how it relates to the body and to autism, and what you can do to learn to connect with what's going on inside you.
What alexithymia is
The word alexithymia comes from Greek and literally means 'no words for feelings'. Psychiatrist Peter Sifneos described it in the 1970s to refer to people who found it very hard to name what they felt. The American Psychological Association defines it as the difficulty recognising and describing your own emotions. It isn't a closed diagnosis, but a trait that comes in degrees: some people have a little and others live with it in a very marked way.
Alexithymia doesn't mean coldness or a lack of feelings
Here's the biggest misunderstanding. A person with alexithymia isn't cold and doesn't 'have no feelings'. They have them, often strongly; what fails is the bridge between what they feel and their awareness of what they feel. It's like having the radio on but with so much interference that you can't make out the song. That's why others sometimes see them as distant or overly rational, when inside they may be going through a storm they can't even name. Understanding this difference changes everything, both for the person and for those who love them.
Signs and symptoms of alexithymia
Alexithymia doesn't draw attention the way other difficulties do, because the person who has it usually functions well at work and in practical life. Where it shows up is on emotional ground and in relationships.
How alexithymia shows up day to day
- You go blank when someone asks how you feel.
- You confuse emotions with physical sensations: you notice your heart racing or that you're tense, but you don't realise it's anxiety.
- You have little imaginative life, few dreams you remember or little tendency to daydream.
- Others tell you you're cold or distant, even though you don't feel that way inside.
- You approach problems through logic and avoid talking about feelings.
- You find it hard to understand others' emotions and to know how to comfort them.
- Relationships get complicated because sharing what you feel is a real challenge.
The three components of alexithymia
Specialists tend to describe alexithymia through three pieces that often go together. The first is the difficulty identifying emotions and telling them apart from bodily sensations. The second is the difficulty describing them to others, finding the words. And the third is a thinking style very oriented outward, toward concrete facts and tasks, rather than toward the inner world. When all three coincide, emotional life is left like a room in the dark.
Causes of alexithymia
There's no single cause. Temperament and possibly genetics play a part, but so does what we learned (or didn't learn) as children. Growing up in a family where emotions weren't named, where crying was frowned upon or where no one helped you understand what you felt leaves a person without the basic emotional 'dictionary'. A harsh or traumatic environment in childhood can also contribute: in the face of pain that was too big, disconnecting from emotions was, at the time, a way of surviving.
Alexithymia and the body: when emotion is felt as a symptom
If you can't read an emotion in your mind, you often read it in your body. That's why alexithymia goes so hand in hand with somatization: headaches, digestive discomfort, tension or tiredness that appear with no clear medical cause. The unnamed emotion doesn't vanish; it looks for another way out. Learning to tell 'my stomach hurts' apart from 'I'm anxious' is, very often, the first big step toward feeling better.
Alexithymia and autism
Alexithymia is considerably more common in autistic people than in the general population, though they're different things and don't always go together. Many autistic adults describe exactly this difficulty knowing what they feel, something that's sometimes mistaken for a lack of empathy when it's nothing of the sort. The UK National Health Service (NHS) lists difficulty saying how you feel among the signs of autism in adults. Having alexithymia doesn't mean being autistic, nor the other way around: they're two realities that can overlap.
Alexithymia and relationships
Sharing what you feel is the glue of intimacy, and this is where alexithymia makes things hard. A partner can feel alone or read the silence as indifference, when in fact the other person isn't shutting down on purpose: they can't find the words. Often the attachment style each person carries comes into play too. The good news is that, when both understand what's happening, they stop trading blame and start building a shared language, even if slowly.
Primary and secondary alexithymia
Not all alexithymia is the same. We speak of primary alexithymia when it's a stable trait of the person, present all along and often linked to biological or developmental factors. And we speak of secondary alexithymia when it appears later, as a response to depression, strong anxiety, trauma or illness; in these cases, it usually improves when what's underneath is treated. Telling them apart helps you know what to work on and with what expectations.
How alexithymia is treated
Identifying and naming emotions is a skill, and like all skills it can be trained. Treating alexithymia isn't about 'forcing yourself to feel', but about learning to read the signals that are already there. We work on the connection between body and emotion, widen your emotional vocabulary and rehearse how to express what's going on inside in a safe setting. It's a slow, gentle process, not a race.
Strategies to connect with your emotions
These practices, simple but steady, help to gradually open up that room in the dark.
- Start with the body. Several times a day, pause and ask yourself what you notice physically (tension, warmth, weight in your chest). It's the clue that leads you to the emotion.
- Widen your vocabulary. Keep a list of emotions handy and look for the word that comes closest. Going from 'I feel bad' to 'I feel disappointed' is already a huge step forward.
- Write. Putting down on paper what's happening to you, unfiltered, trains the muscle of translating sensations into words; it's part of emotional regulation.
- Train the inward gaze. Strengthening your emotional intelligence and having coping strategies gives you tools not to freeze when a strong emotion arrives, as happens with anger.
When to seek professional help
It's worth seeking help when the difficulty understanding what you feel starts to take its toll: if your relationships suffer, if you pile up physical symptoms with no clear medical cause, or if you notice you live a little disconnected from yourself. Also if you suspect alexithymia may be linked to depression, anxiety or trauma worth looking at. Emotional awareness can be developed at any age; it's rarely too late to begin.
How therapy helps
In therapy we work on alexithymia without rushing: we learn to listen to the body, to connect those sensations with specific emotions and to find the words to say them. We also look at what's underneath (experiences, relationship style, a possible trauma) and rehearse, situation by situation, how to express what you feel so relationships stop being a minefield. I do this through emotional management therapy and, if it suits you, with online therapy, in English, Spanish or Catalan.
If you've recognised yourself here, get in touch for a first assessment with no obligation. And hold on to this: feeling nothing isn't the problem; the problem is not knowing what you feel, and that can be learned to read, like someone learning a new language.