Having spent most of my professional career working with autistic individuals and their families, I still find myself frequently having to correct misconceptions regarding autism and empathy. Empathy is the ability to sense another person’s emotions and it is still widely and mistakenly assumed to be a trait lacking in autistic people. However, we now know that alexithymia, or impairment in the ability to recognize one’s own emotions, can in fact be the reason why this misconception persists.
Alexithymia occurs in about half of autistic people, compared with 5 percent of neurotypicals. It confounds how autism is diagnosed and understood. It is a term coined in 1972, which means “lack of emotions for words.” We currently view it as difficulty identifying and describing one’s own feelings as well as a thinking pattern that is more focused on the external world rather than the internal one. Alexithymia affects recognition of facial expressions related to emotions in addition to many other elements of emotion-processing.
Alexithymia by itself and apart from autism traits, has been found to predict eye-gaze patterns, response to facial expressions, and even certain behaviors that are considered prosocial. Without adequate instruments for measuring and accounting for alexithymia, we unfortunately cloud our understanding of autism, including how it is diagnosed. For example, if an autistic child does not have alexithymia and subsequently does not have emotion-processing difficulties, they are unlikely to be diagnosed with autism using the measures that are currently widely used. In addition, alexithymia traits in and of themselves can push someone over the clinical cutoff on the most widely used gold-standard test for autism, the Autism Diagnostic Observation Scale (ADOS). As a result, a non-autistic person with alexithymia can be diagnosed as having autism.
A better understanding of alexithymia is also crucial for improved mental health services for autistic people. Alexithymia itself is associated with increased difficulties in social- communication as well as anxiety and depression. People with high levels of alexithymia are also less likely to benefit from the traditional cognitive behavioral therapy approach to treating depression and anxiety.
This research is shedding light on ways in which we continue to be challenged to find the right way to evaluate and support autistic individuals. It is important to recognize that our tools at this time are not perfect. Consequently, working with a clinician who is experienced in this specialized area is crucial when it comes to diagnosis and intervention.