Alexithymia: when you can’t tell what you feel, what research says and what helps

Alexithymia describes difficulty noticing what you are feeling and putting it into words. The psychiatrist Peter Sifneos coined the term in 1973, describing patients with psychosomatic illnesses who showed constricted emotional functioning, a poor fantasy life and an inability to find the right words for their emotions, and calling these characteristics “alexithymic” (Sifneos, 1973). Literally, it means “no words for feelings” (Seo et al., 2009).

Research today looks at three facets: difficulty identifying what you feel and telling feelings apart from bodily sensations (difficulty identifying feelings), difficulty describing feelings to other people (difficulty describing feelings), and a style of thinking that focuses on outside events rather than inner experience (externally oriented thinking) (Seo et al., 2009). It does not mean having no feelings. One study found that the higher people scored on alexithymia, the more similar emotions felt to bodily states such as hunger or tiredness (Brewer et al., 2016).

Alexithymia is not a psychiatric diagnosis. It is a sub-clinical construct with no agreed diagnostic criteria (Brewer et al., 2016; Hemming et al., 2019), and researchers see it as a personality trait that people have to different degrees, not something you either have or do not have. A study of 1,933 community members, 1,948 university students and 302 psychiatric outpatients found strong evidence that alexithymia is a continuous dimension rather than a category (Parker et al., 2008). That is why this guide speaks of people with high alexithymia scores rather than of patients.

The short answer: in a survey of 5,454 adults in Finland, about one in ten (9.9%) scored above the commonly used cut-off (Mattila et al., 2006). Alexithymia often goes together with depression, physical symptoms and autism, but most of this research looks at associations, so it cannot be called the cause. It is a mostly lasting trait, yet scores can shift with someone’s current state, such as depression (Luminet et al., 2001), and studies of treatments that worked on alexithymia directly tended to report lower scores (Cameron et al., 2014).

This guide covers how alexithymia is measured and how common it is, its links with depression, physical symptoms and autism, the debate about body signals, whether it can change, what you can try on your own, and when to talk to a professional. mind.io has no alexithymia test, and this guide prints no scale items. Ways of handling emotions in general are covered in the emotion regulation guide.

The most widely used tool is the 20-item Toronto Alexithymia Scale (TAS-20), a self-report questionnaire. It has 7 items on difficulty identifying feelings, 5 on difficulty describing feelings and 8 on externally oriented thinking, each answered from 1 (strongly disagree) to 5 (strongly agree), so totals range from 20 to 100 (Seo et al., 2009). The development studies showed good internal consistency, good test-retest reliability and a three-factor structure that fits the theory (Bagby et al., 1994). The scale has been translated into 18 languages and tested in 19 countries, with strong support for its three-factor structure across languages and cultures, but in most cultures where English is not the main language the externally oriented thinking factor lacked internal reliability (Taylor et al., 2003).

A Korean version (TAS-20K) was developed and validated with adults in 1996 (Lee et al., 1996). A study of 290 middle school students in Daegu confirmed the same three-factor structure, with good internal consistency for the full scale (α = 0.87) and good test-retest reliability (0.87; 22 students re-tested after 4 weeks) (Seo et al., 2009).

For the English version, cut-offs were set empirically: a total above 60 (61 or more) indicates alexithymia, and a total below 52 indicates its definite absence (Seo et al., 2009). The percentages below are the shares of people above such a cut-off, so they depend on where the line is drawn. The TAS-20 does not measure a poor fantasy life, and its externally oriented thinking scale may lack reliability, so it has been recommended not to rely on the TAS alone (Kinnaird et al., 2019).

Other tools try to make up for the limits of a questionnaire. The Toronto Structured Interview for Alexithymia (TSIA) is scored by an interviewer using 24 questions and scoring criteria; it was developed with 136 community members and 97 psychiatric outpatients, and its correlation with the TAS-20 was significant but modest (Bagby et al., 2006). The Perth Alexithymia Questionnaire (PAQ) is a 24-item self-report questionnaire designed to measure negative and positive emotions separately (Preece et al., 2018). mind.io offers none of these, and has not made its own short quiz that claims to detect alexithymia either.

How common is it? In a study of 1,285 people from the general population of Finland, scores were normally distributed in both men and women, which supports seeing alexithymia as a personality dimension, and 13% scored above the cut-off. Men (17%) did so almost twice as often as women (10%), and high scores were more common with older age and with lower education and socioeconomic status (Salminen et al., 1999). In a larger study of 5,454 people aged 30 to 97, the figure was 9.9% (men 11.9%, women 8.1%), with a clear link to age (Mattila et al., 2006).

The gender gap differed by facet. In the Finnish study, men scored higher on difficulty describing feelings and on externally oriented thinking, but there was no gender difference in difficulty identifying feelings (Salminen et al., 1999). Among 290 Korean middle school students, 5.2% scored above the cut-off, with no difference between boys and girls (boys 5.4%, girls 4.9%), using an adult cut-off that has not been validated for adolescents (Seo et al., 2009). With no diagnostic criteria, prevalence is hard to pin down, and estimates from different studies range from 10% to 19% (Hemming et al., 2019).

Depression is what alexithymia has been studied with most. In a study of 2,018 people from the general population of Finland, 32.1% of those with higher depression scores (BDI 9 or more) scored above the alexithymia cut-off, compared with 4.3% of those who were not depressed. Once depression was taken into account, the links with several sociodemographic factors disappeared, and only depression and low life satisfaction were associated with alexithymia (Honkalampi et al., 2000). In a meta-analysis of 35 studies with 23,085 people, the correlation between alexithymia scores and depression severity was r = 0.455, a moderate one, and difficulty identifying and describing feelings were more closely linked with depression than externally oriented thinking (Liu et al., 2025). An earlier meta-analysis of 19 studies with 3,572 people likewise found medium relationships between depression and the TAS total, difficulty identifying feelings and difficulty describing feelings, and a weak one with externally oriented thinking (Li et al., 2015). These are pooled correlations, so they cannot show which comes first.

Physical symptoms show a link too. A quantitative review found a small-to-moderate relationship between alexithymia and the number of physical symptoms people reported; difficulty identifying feelings had the strongest link and externally oriented thinking almost none. With only one prospective study, though, it could not conclude that alexithymia predisposes people to somatisation (De Gucht & Heiser, 2003). In a meta-analysis of 77 studies with 8,019 people with chronic pain, people with chronic pain scored higher than people without a health condition (d = 0.81) and than people with other conditions that did not involve pain (d = 0.55), and alexithymia went with pain intensity (d = 0.20), depression (d = 0.46) and anxiety (d = 0.43). Once negative emotion was controlled for, however, the link with pain intensity was no longer significant (Aaron et al., 2019).

Autism has been studied a lot as well. In a meta-analysis of 15 studies that compared 366 autistic people with 348 non-autistic people on the TAS, the autistic groups scored higher on the total and on every facet, and in the 9 studies that reported how many people scored above the cut-off, the shares were 49.93% in the autistic groups and 4.89% in the non-autistic groups. The authors concluded that alexithymia is common in autism but not universal, and described the hypothesis that the emotion-processing difficulties seen in autism come from co-occurring alexithymia rather than from autism itself (Kinnaird et al., 2019). Alexithymia often co-occurs with autism and depression, but they are distinct constructs (Brewer et al., 2016). Signs of autism in adults are covered in autism in adults.

Alexithymia also connects with personality traits. In a study of 101 university students, TAS-20 scores were positively related to emotional sensitivity (neuroticism) in the Big Five, negatively related to extraversion and openness, and unrelated to agreeableness and conscientiousness (Luminet et al., 1999). But in a study of 51 university students who were also interviewed, difficulty identifying feelings measured by interview was unrelated to emotional sensitivity, which suggests the often-reported link may partly come from measuring with questionnaires. The links with low openness and low agreeableness appeared whichever method was used (Rosenberg et al., 2016). You can look at your own traits with the Big Five personality test.

Noticing an emotion depends on reading signals from inside the body, a sense called interoception. That led to the hypothesis that alexithymia is not limited to emotions but reflects a broader difficulty reading body signals. In a study of 105 people from the general population and 103 people who reported having had a psychiatric diagnosis, those with higher alexithymia scores also reported more difficulty reading non-emotional body signals such as hunger, temperature and arousal, and felt emotions and bodily states to be more alike. The authors suggested that alexithymia may be better described as a general failure of interoception (Brewer et al., 2016). These were self-reports on questionnaires the researchers made for the study. The questionnaire on non-emotional body signals also had low internal reliability (α = 0.53), and the authors said that result should be interpreted with caution.

The evidence is mixed. In a meta-analysis of 66 samples with 7,146 people, alexithymia had a small negative correlation with interoception (r = −0.162), and the size and even the direction of the link varied widely depending on whether accuracy on objective tasks or self-reported sensitivity was measured, and how. The link was moderate in samples with psychiatric or developmental conditions but not significant in healthy samples, and the authors noted that the way interoception is defined and measured is still confusing (Trevisan et al., 2019).

So although “I can’t tell whether I’m hungry or angry” is an experience often mentioned alongside alexithymia, it has not been shown that training yourself to read body signals reduces alexithymia. The authors of the first study also said that how useful interoceptive training is in clinical practice remains to be established (Brewer et al., 2016).

Researchers sometimes split alexithymia in two: primary (trait) alexithymia, a disposition thought to develop in childhood or early adulthood, and secondary (state) alexithymia, which may develop at any age after distressing events or trauma, as a defence against overwhelming emotion. Most research so far has treated it as a stable personality trait, but there is still no consensus on its types or causes (Hemming et al., 2019).

In the general population it is fairly stable. In a study that surveyed 3,083 Finnish adults aged 30 and over twice, 11 years apart, the average TAS-20 score stayed at 44.2, and the first score significantly predicted the score 11 years later. The authors concluded that both absolute and relative stability were high. In the group aged 75 to 97, however, the average rose from 49.1 to 53.1. Having had a depressive or anxiety disorder at the first survey was not associated with the score 11 years later, but having such a diagnosis at the later survey was associated with the score at that time (Hiirola et al., 2017). This suggests that current depression or anxiety can be reflected in the score.

Treatment for depression shows a similar picture. Among 46 outpatients with major depression treated with antidepressants for 14 weeks, alexithymia scores changed significantly, but people’s positions relative to one another were largely preserved. The authors concluded that scores can change when depressive symptoms change a lot, but that this relative stability supports the view of alexithymia as a stable personality trait (Luminet et al., 2001). So a score taken while you are very low is not enough to conclude that you are “just someone who doesn’t know their feelings”.

It can also decrease after treatment. A review of changes in alexithymia after psychological interventions concluded that alexithymia is partly modifiable. Interventions that targeted alexithymia directly tended to report significant reductions in scores, while results were inconsistent for treatments that did not (Cameron et al., 2014). In an analysis of 4 randomised controlled trials of mindfulness-based programmes (460 people), TAS scores were on average 5.28 points lower than in the control groups (95% confidence interval 1.28 to 9.28 points), but the authors said the finding needs to be replicated in larger samples (Norman et al., 2019). The evidence on meditation in general is covered in meditation and mindfulness.

One thing first: the ideas below are not treatments shown to reduce alexithymia, but practice ideas drawn from related research. If not knowing your feelings well does not bother you or get in the way of your life, there is no need to treat it as a problem to fix.

Build your emotion vocabulary. The ability to tell emotions apart in fine detail and put them into words, rather than lumping them together as “I feel bad”, is called emotion differentiation or emotional granularity. According to a review, people who differentiate their emotions more finely were less likely to fall back on harmful ways of coping, such as binge drinking or aggression, when in intense distress, and had less severe anxiety and depressive disorders. The review also reported evidence that interventions designed to improve emotion differentiation can reduce psychological problems and increase several kinds of well-being (Kashdan et al., 2015). Instead of “I feel bad”, for example, try picking whether you feel hurt, wronged, anxious or worn out, and if no word fits, look through a list of emotion words for the closest one.

It is fine to start with your body. Difficulty identifying feelings includes difficulty telling emotions apart from bodily sensations (Seo et al., 2009). A few times a day, first note a bodily feeling, such as tightness in your chest, tense shoulders, hunger or tiredness, then ask yourself “if this were an emotion, which one would it be?” and “what just happened?”. Whether this kind of practice lowers alexithymia scores has not been tested yet, so try it and watch whether it helps you.

Keep short notes. Writing one line each for the situation, the bodily feeling, the emotion word that came to mind and what you did next lets you look back later for patterns that repeat. The evidence and limits for naming emotions and for expressive writing about feelings and events are covered in the emotion regulation guide.

Telling the people close to you in advance can help too. Saying “It takes me a while to answer because I don’t recognise my feelings right away”, or naming what you need instead of the emotion, such as “I need a rest” or “I need a moment alone”, may help reduce misunderstandings. How to read and respond to other people’s feelings is covered in the empathy skills guide.

Not knowing your feelings well is not an illness in itself, but if it keeps leading to misunderstandings and conflict in your relationships, if your mood is low and you have lost interest in things, or if physical symptoms continue that tests cannot explain, talk to a professional. You can first look at your mood with the depression check-in (PHQ-9). A self-check is not a diagnosis. If you wonder whether autistic traits are part of the picture, see autism in adults.

If you start counselling or treatment, say from the beginning that you find it hard to put feelings into words. The review mentioned above wrote that alexithymia is generally accepted to work against a range of physical and mental health treatments, and found that interventions that worked on alexithymia directly tended to report lower scores (Cameron et al., 2014). In Korea, help is available from psychiatry clinics and city, county or district community mental health welfare centres, and from the mental health crisis line 1577-0199 (24 hours). What happens at a first visit is described in Seeing a psychiatrist for the first time. Elsewhere, start with your family doctor or local mental health service.

Studies have reported a fairly clear link between alexithymia and suicidal thoughts, and a weaker one with suicidal behaviour such as self-harm, but little is known about the nature of these links (Hemming et al., 2019). Even if feelings are hard to put into words, if you have thoughts of ending your life or of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services. In Korea, call 109 (24 hours, free).

Q. Is there an alexithymia test or self-check? A. Research and clinical work most often use the 20-item TAS-20 questionnaire (the TAS-20K in Korean); there is also the TSIA interview and the PAQ, which measures negative and positive emotions separately (Bagby et al., 2006; Preece et al., 2018). Questionnaire scores can also reflect current depression or anxiety (Hiirola et al., 2017). mind.io has no alexithymia test. The “checking in with feelings” score of the empathy & emotion style test does not measure alexithymia, but it can help you reflect on how often you check in with your own emotions.

Q. Does alexithymia mean feeling nothing at all? A. That is not how it is understood. Alexithymia is not an absence of feelings but a tendency to find it hard to notice, tell apart and put feelings into words (Seo et al., 2009). If feelings seem far away and you do not feel like yourself, see depersonalisation or derealisation; if your feelings seem dulled since starting a medicine, see antidepressants and psychiatric medication; and if your mood is low and nothing feels enjoyable, see depression symptoms as well.

Q. Is it more common in men? A. In Finnish population surveys, men more often scored above the cut-off (17% vs 10%, and 11.9% vs 8.1%) (Salminen et al., 1999; Mattila et al., 2006). But men scored higher on difficulty describing feelings and externally oriented thinking, with no difference in difficulty identifying feelings (Salminen et al., 1999), and a study of Korean middle school students found no difference between boys and girls (Seo et al., 2009).

Q. Can alexithymia be treated? A. It is a mostly lasting trait (Hiirola et al., 2017), but a review found it can partly change after psychological interventions, and interventions that targeted alexithymia directly tended to report lower scores (Cameron et al., 2014). The evidence for mindfulness programmes comes from 4 randomised controlled trials and needs further confirmation (Norman et al., 2019). Rather than trying to make it disappear, it may help to think of gradually building the skills of noticing and expressing feelings.

References: Sifneos, P. E. (1973), The prevalence of ‘alexithymic’ characteristics in psychosomatic patients, Psychotherapy and Psychosomatics 22(2), 255-262, https://doi.org/10.1159/000286529; Seo, S. S., Chung, U. S., Rim, H. D., & Jeong, S. H. (2009), Reliability and validity of the 20-item Toronto Alexithymia Scale in Korean adolescents, Psychiatry Investigation 6(3), 173-179, https://doi.org/10.4306/pi.2009.6.3.173; Brewer, R., Cook, R., & Bird, G. (2016), Alexithymia: a general deficit of interoception, Royal Society Open Science 3(10), 150664, https://doi.org/10.1098/rsos.150664; Hemming, L., Haddock, G., Shaw, J., & Pratt, D. (2019), Alexithymia and its associations with depression, suicidality, and aggression: an overview of the literature, Frontiers in Psychiatry 10, 203, https://doi.org/10.3389/fpsyt.2019.00203; Parker, J. D. A., Keefer, K. V., Taylor, G. J., & Bagby, R. M. (2008), Latent structure of the alexithymia construct: a taxometric investigation, Psychological Assessment 20(4), 385-396, https://doi.org/10.1037/a0014262; Mattila, A. K., Salminen, J. K., Nummi, T., & Joukamaa, M. (2006), Age is strongly associated with alexithymia in the general population, Journal of Psychosomatic Research 61(5), 629-635, https://doi.org/10.1016/j.jpsychores.2006.04.013; Luminet, O., Bagby, R. M., & Taylor, G. J. (2001), An evaluation of the absolute and relative stability of alexithymia in patients with major depression, Psychotherapy and Psychosomatics 70(5), 254-260, https://doi.org/10.1159/000056263; Cameron, K., Ogrodniczuk, J., & Hadjipavlou, G. (2014), Changes in alexithymia following psychological intervention: a review, Harvard Review of Psychiatry 22(3), 162-178, https://doi.org/10.1097/HRP.0000000000000036; Bagby, R. M., Parker, J. D. A., & 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, https://doi.org/10.1016/0022-3999(94)90005-1; Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (2003), The 20-Item Toronto Alexithymia Scale. IV. Reliability and factorial validity in different languages and cultures, Journal of Psychosomatic Research 55(3), 277-283, https://doi.org/10.1016/S0022-3999(02)00601-3; Lee, Y. H., Rim, H. D., & Lee, J. Y. (1996), Development and validation of a Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), Journal of Korean Neuropsychiatric Association 35, 888-899 [in Korean]; Kinnaird, E., Stewart, C., & Tchanturia, K. (2019), Investigating alexithymia in autism: a systematic review and meta-analysis, European Psychiatry 55, 80-89, https://doi.org/10.1016/j.eurpsy.2018.09.004; Bagby, R. M., Taylor, G. J., Parker, J. D. A., & Dickens, S. E. (2006), The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity, Psychotherapy and Psychosomatics 75(1), 25-39, https://doi.org/10.1159/000089224; Preece, D., Becerra, R., Robinson, K., Dandy, J., & Allan, A. (2018), The psychometric assessment of alexithymia: development and validation of the Perth Alexithymia Questionnaire, Personality and Individual Differences 132, 32-44, https://doi.org/10.1016/j.paid.2018.05.011; Salminen, J. K., Saarijärvi, S., Äärelä, 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, https://doi.org/10.1016/S0022-3999(98)00053-1; Honkalampi, K., Hintikka, J., Tanskanen, A., Lehtonen, J., & Viinamäki, H. (2000), Depression is strongly associated with alexithymia in the general population, Journal of Psychosomatic Research 48(1), 99-104, https://doi.org/10.1016/S0022-3999(99)00083-5; Liu, Z., He, S., & Hou, C. (2025), The effect of alexithymia on depression: evidence from meta-analysis, Frontiers in Psychology 16, 1465286, https://doi.org/10.3389/fpsyg.2025.1465286; Li, S., Zhang, B., Guo, Y., & Zhang, J. (2015), The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: a meta-analysis, Psychiatry Research 227(1), 1-9, https://doi.org/10.1016/j.psychres.2015.02.006; De Gucht, V., & Heiser, W. (2003), Alexithymia and somatisation: quantitative review of the literature, Journal of Psychosomatic Research 54(5), 425-434, https://doi.org/10.1016/S0022-3999(02)00467-1; Aaron, R. V., Fisher, E. A., de la Vega, R., Lumley, M. A., & Palermo, T. M. (2019), Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis, Pain 160(5), 994-1006, https://doi.org/10.1097/j.pain.0000000000001487; Luminet, O., Bagby, R. M., Wagner, H., Taylor, G. J., & Parker, J. D. A. (1999), Relation between alexithymia and the five-factor model of personality: a facet-level analysis, Journal of Personality Assessment 73(3), 345-358, https://doi.org/10.1207/s15327752jpa7303_4; Rosenberg, N., Rufer, M., Lichev, V., Ihme, K., Grabe, H. J., Kugel, H., Kersting, A., & Suslow, T. (2016), Observer-rated alexithymia and its relationship with the five-factor-model of personality, Psychologica Belgica 56(2), 118-134, https://doi.org/10.5334/pb.302; Trevisan, D. A., Altschuler, M. R., Bagdasarov, A., Carlos, C., Duan, S., Hamo, E., Kala, S., McNair, M. L., Parker, T., Stahl, D., Winkelman, T., Zhou, M., & McPartland, J. C. (2019), A meta-analysis on the relationship between interoceptive awareness and alexithymia: distinguishing interoceptive accuracy and sensibility, Journal of Abnormal Psychology 128(8), 765-776, https://doi.org/10.1037/abn0000454; Hiirola, A., Pirkola, S., Karukivi, M., Markkula, N., Bagby, R. M., Joukamaa, M., Jula, A., Kronholm, E., Saarijärvi, S., Salminen, J. K., Suvisaari, J., Taylor, G., & Mattila, A. K. (2017), An evaluation of the absolute and relative stability of alexithymia over 11 years in a Finnish general population, Journal of Psychosomatic Research 95, 81-87, https://doi.org/10.1016/j.jpsychores.2017.02.007; Norman, H., Marzano, L., Coulson, M., & Oskis, A. (2019), Effects of mindfulness-based interventions on alexithymia: a systematic review, Evidence-Based Mental Health 22(1), 36-43, https://doi.org/10.1136/ebmental-2018-300029; Kashdan, T. B., Barrett, L. F., & McKnight, P. E. (2015), Unpacking emotion differentiation: transforming unpleasant experience by perceiving distinctions in negativity, Current Directions in Psychological Science 24(1), 10-16, https://doi.org/10.1177/0963721414550708