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Alexithymia—the difficulty in identifying and describing one’s emotional experiences—has emerged as a critical yet underappreciated link between autism spectrum disorder (ASD) and atypical sensory processing. This connection is rooted in overlapping neurobiological mechanisms, shared genetic influences, and the interplay of self-awareness deficits that affect both domains [1]. Below are key insights into why alexithymia serves as this “hidden bridge” between ASD and sensory differences.
The Genetic Overlap: Alexithymia Mediates Autism-Sensory Correlations
Research has shown a strong genetic component to autism (heritability ~82%) and moderate heritability for both sensory symptoms (~57% [1]) and alexithymia. However, when studies controlled for the presence of alexithymia in autistic individuals, the previously observed significant association between ASD traits—such as social communication challenges—and sensory processing differences disappeared or weakened significantly (e.g., source 3). This suggests that some sensory symptoms may not be directly caused by autism itself but are instead mediated through the co-occurrence of alexithymia [1]. In other words, alexithymia might act as a confounding variable, masking direct genetic links between ASD and sensory processing.
Interoception: The Shared Neurobiological Mechanism
A central hypothesis linking autism to both emotional regulation (via alexithymia) and atypical sensory responses is the concept of interoceptive dysfunction. Interoception refers to awareness of internal bodily states, such as heart rate or stomach sensations. Studies indicate that both autistic individuals with high levels—and those without—as well as non-autistic people who are highly alexythemic show impaired interoception [3]. This deficit may explain why:
- Autistics often struggle not only in identifying emotions (alexithymia) but also interpreting sensory input, such as feeling overwhelmed by loud noises or tactile stimuli.
- Reduced awareness of internal states could lead to heightened sensitivity—or conversely hypo-responsiveness —to external environmental cues [6]. For example, an autistic person might not recognize the physical tension in their body (a sign of anxiety) until they are already overwhelmed by sensory input.
Alexithymia and Sensory Processing: A Bidirectional Relationship
Several studies highlight a direct relationship between alexithymia severity and atypical sensory processing. For instance:
- In autistic children, higher levels of alexythemia correlate with reduced brain activity in regions associated with empathy (e.g., the anterior cingulate cortex) [2]. This may explain why sensory differences—such as aversion to certain textures or sounds—are often accompanied by challenges understanding others’ emotions.
- Conversely, sensory processing difficulties might exacerbate alexithymia: if an individual is constantly overwhelmed (e.g., in a noisy environment), they are less likely to have the cognitive bandwidth needed for introspection and emotional labeling [8].
This bidirectional relationship suggests that alexythemia does not merely coexist with autism but actively shapes how sensory experiences influence—and vice versa—emotional processing.
Clinical Implications: A Subgroup of Autistic Individuals
Approximately 49.93% to as high as 75–80% [1] autistic individuals experience alexithymia, with some studies suggesting that up to half may have severe forms (source 2). This subgroup is particularly vulnerable:
- Emotional processing challenges linked to both autism and alexythemia are associated with higher rates of mental health diagnoses such as anxiety or depression. These conditions can be worsened by unmet sensory needs, creating a feedback loop [10].
- Tailored interventions that address both emotional regulation (e.g., mindfulness training) and environmental accommodations for sensory sensitivities may yield better outcomes than approaches targeting either issue in isolation.
Conclusion: A Call to Reimagine Autism Research and Support
Alexithymia’s role as a hidden link between autism and atypical sensory processing underscores the need for more nuanced models of ASD. Rather than treating these traits separately, researchers must consider how interoceptive deficits—and their downstream effects on emotional awareness—are central to both domains [3]. Clinically, this means that interventions targeting alexithymia (e.g., emotion labeling exercises) could also alleviate sensory-related distress in autistic individuals.
By recognizing the interplay between these factors, we move closer not only toward more effective support for autistics but a deeper understanding of how self-awareness shapes our relationship with both internal and external worlds.
Rethinking Sensory Sensitivities in Autism: The Overlooked Role of Alexithymia
https://research.aota.org/ajot/article/74/4_Supplement_1/7411505132p1/9688/Sensory-Differences-Alexithymia-and-Neural
https://neurodivergentinsights.com/autism-and-alexithymia/
https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2018.01196/full
https://www.tandfonline.com/doi/full/10.1080/00050067.2023.2174409
https://www.sciencedirect.com/science/article/pii/S1750946724001454
Autism and Emotions: How and Why Do Autistic People Process Emotions Differently?
https://aidecanada.ca/resources/learn/asd-id-core-knowledge/alexithymia-autism-when-you-don-t-know-what-emotion(s)-you-are-feeling
https://pmc.ncbi.nlm.nih.gov/articles/PMC6331035/
https://www.psychologytoday.com/intl/blog/nurturing-self-esteem-in-autistic-children/202307/autism-and-alexithymia
https://pmc.ncbi.nlm.nih.gov/articles/PMC6056680/
https://www.sciencedirect.com/science/article/pii/S1750946720300982
https://pmc.ncbi.nlm.nih.gov/articles/PMC9839896/
Alexithymia & autism guide
https://pmc.ncbi.nlm.nih.gov/articles/PMC11882979/
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