Alexithymia: Why Some Children and Adults Struggle to Put Feelings Into Words

Sep 9

7 min read

Alexithymia in children and adults showing difficulty identifying and describing emotions — Alexithymia can make it difficult for children and adults to identify, understand and put their emotions into words, even when those feelings are strongly experienced.

Have you ever known that something feels wrong but struggled to explain exactly what you are feeling?

Perhaps you ask your child, partner or family member how they feel and repeatedly hear, "I don't know." Or your partner can explain exactly what happened during an argument but seems completely stuck when you ask how it made them feel?

Difficulty putting emotions into words doesn't necessarily mean someone is avoiding the question, doesn't care or doesn't experience emotions.

One possible explanation is alexithymia.

What Is Alexithymia?

Alexithymia describes difficulties identifying, distinguishing and describing emotions. Research commonly describes difficulties identifying feelings, difficulties describing feelings and a tendency towards more externally focused thinking.

In everyday life, this might sound like:

"I know something is wrong, but I don't know what."
"I just feel bad."
"I don't know how I feel."
"My stomach hurts."
"I need some time to work it out."

Importantly, alexithymia does not mean having no emotions. Someone can experience emotions strongly while finding it difficult to recognise exactly what they are experiencing or translate that experience into words.

An Important Note Before We Go Further

Difficulty talking about feelings does not automatically mean someone has alexithymia.

Children and adults can struggle to describe emotions for many reasons, including anxiety, feeling overwhelmed, developmental stage, communication or language differences, depression, trauma or neurodivergence.

Alexithymia is also not the same as autism. A systematic review and meta-analysis found alexithymia was substantially more common among autistic participants, but importantly, it was not present in every autistic person. Alexithymia can also occur in people who are not autistic (Kinnaird et al., 2019).

A single behaviour, including frequently answering "I don't know", should therefore never be used to label or diagnose somebody.

What Can Alexithymia Feel Like?

For some people, the body seems to speak before the words arrive.

Someone might notice a racing heart, tense shoulders, nausea, a tight chest or feeling hot without immediately recognising, "I'm anxious" or "I'm embarrassed."

Research has explored links between alexithymia and interoception, our perception and interpretation of internal bodily signals. The relationship appears complex rather than being a simple case of one causing the other (Van Bael et al., 2024).

Someone may also be able to describe the facts of an upsetting experience in considerable detail but become stuck when asked:

"And how did that make you feel?"

This can happen in children, teenagers and adults.

Why Does My Child Always Say "I Don't Know" When I Ask How They Feel?

Sometimes "I don't know" genuinely means "I don't know yet."

A child might know they feel uncomfortable or overwhelmed without being able to distinguish between anxiety, embarrassment, anger, disappointment or several emotions happening at once.

Rather than repeatedly asking "How do you feel?", it can sometimes help to make the question more concrete:

"What did you notice in your body?"

"Did you want to leave, hide, cry, shout or stay?"

"Was it more like worried, cross, embarrassed or something else?"

Visual emotion scales and allowing additional processing time can also be useful.

For some children, difficulties understanding emotions may occur alongside ADHD, autism and emotional regulation difficulties. However, research into alexithymia in children reminds us to be cautious about simply applying adult concepts and measures to younger people.

Why Can't My Partner Tell Me How They Feel?

When a partner struggles with emotional conversations, it can easily be interpreted as "They won't tell me" or "They don't care."

Sometimes a more accurate possibility is:

"They can't identify it yet."

Someone may know they are distressed without being able to distinguish whether they feel hurt, anxious, ashamed, disappointed or angry.

Alexithymia is only one possible explanation. Anxiety, depression, trauma, neurodivergence, communication styles, relationship experiences and how emotions were discussed while someone was growing up can all be relevant.

Giving somebody time to process can sometimes be considerably more productive than asking the same emotional question six different ways and hoping version seven finally unlocks the vault.

Is Alexithymia Linked With Autism or ADHD?

The strongest evidence currently concerns autism.

A systematic review and meta-analysis found substantially higher rates of alexithymia among autistic participants than non-autistic comparison groups. Approximately half of the autistic participants met criteria for alexithymia, which also means approximately half did not (Kinnaird et al., 2019).

Research involving autistic children and adolescents also suggests an association between autistic and alexithymic traits, although research involving younger populations is less developed than the adult literature (Vaiouli et al., 2022).

Alexithymia has also been studied in relation to ADHD and other psychological difficulties. However, we should not assume that difficulties identifying emotions are simply "part of ADHD".

At Prior Mindset, neurodiversity support is individualised rather than assuming everyone with the same diagnosis experiences the same difficulties.

Can Alexithymia Affect Anxiety and Social Situations?

It can make understanding emotional experiences more complicated.

For example, someone experiencing social anxiety may initially recognise physical symptoms, an urge to escape or feeling intensely uncomfortable before being able to identify fears about embarrassment, judgement or negative evaluation.

Similarly, a child struggling with separation anxiety, OCD or sleep difficulties may find it harder to communicate what is driving their distress if identifying emotions is already difficult.

This matters in psychological therapy because we shouldn't assume everyone can immediately answer questions about thoughts and feelings simply because we've asked them.

What Can Help Someone Who Struggles to Identify Emotions?

Support should be individualised. Depending on the person's needs, it might include:

developing emotional vocabulary gradually
connecting situations, thoughts, bodily sensations and emotions
using visual emotion tools or scales
noticing patterns and triggers
allowing additional processing time
distinguishing thoughts, emotions and physical sensations
developing emotional regulation strategies
adapting Cognitive Behavioural Therapy (CBT) to the person's communication style and neurodivergent profile

Encouragingly, a 2026 systematic review and meta-analysis involving 59 studies found an overall moderate reduction in alexithymia following psychological interventions compared with control conditions, while also highlighting limitations in the evidence and the need for further high-quality research.

A separate systematic review examining 18 randomised controlled trials, an especially valuable form of treatment research, reported promising findings across psychological interventions, including CBT-based approaches. However, substantial variation between studies means there is currently no single standardised psychological treatment for alexithymia.

Frequently Asked Questions About Alexithymia

Can you have alexithymia without autism?

Yes. Alexithymia and autism are not the same thing. Alexithymia occurs in autistic and non-autistic people.

Does alexithymia mean someone doesn't have emotions or empathy?

No. Difficulty identifying or describing your own emotional experience should not automatically be interpreted as an absence of emotions, caring or empathy.

Why can't I identify or explain my emotions?

There isn't one explanation. Stress, anxiety, depression, trauma, communication differences, neurodivergence and alexithymia are among the possibilities. If the difficulty is persistent or significantly affecting everyday life or relationships, exploring it with a suitably qualified professional may be useful.

Why do I feel emotions in my body but not know what I'm feeling?

Sometimes physical changes such as tension, nausea, heat or a racing heart become noticeable before someone consciously identifies the associated emotion. Exploring connections between situations, bodily sensations, thoughts and emotions can therefore be useful.

Is there an alexithymia test?

Measures such as the 20-item Toronto Alexithymia Scale (TAS-20) are widely used in research. However, completing a questionnaire is not the same as receiving a clinical assessment, and measurement is particularly complex in children and adolescents.

Can therapy help with alexithymia?

Research suggests psychological interventions may help some people develop their ability to identify and describe emotional experiences. Support may include emotional awareness, recognising body signals, communication work and emotional regulation, with adaptations based on the individual.

How Prior Mindset Can Help

Prior Mindset supports children, young people and adults experiencing mental health and neurodiversity-related difficulties.

Support includes CBT for children and adults, ADHD, autism and emotional regulation support, anxiety and social anxiety treatment, executive functioning support and work with parents and families.

The aim isn't to teach somebody the "correct" way to experience emotions. It is to understand the individual and develop strategies that are useful and meaningful in everyday life.

If you are unsure what support might be appropriate, Prior Mindset also offers a free 15-minute consultation.

You can also access the free Prior Mindset Resources library, covering ADHD, autism, emotional regulation, social anxiety, separation anxiety, OCD, sleep, depression and other areas of mental health and neurodiversity.

Final Thoughts

If somebody can't tell you how they feel, try not to assume they don't feel anything or they are being awkward.

Sometimes the emotion is there before the language is.

Whether you are a parent trying to understand your child, an adult wondering why emotional conversations feel so difficult, or a partner trying to understand someone you love, curiosity is usually a more useful starting point than assumption.

Alexithymia is one possible explanation, not a conclusion that should be drawn from a blog post or a handful of familiar-sounding characteristics.

With Warm wishes,

Miss Jerri Prior, CBTDip, BSc (Hons)

BABCP Accredited Cognitive Behavioural Psychotherapist

Registered Social Worker | Children and Adults

Founder and Director, Prior Mindset

Winner, Neurodiverse Mental Health Clinic of the Year 2026, Greater Manchester

NHS People's Star Award Winner

Priormindset.com

Prior Mindset is not a crisis service and does not provide emergency mental health support. If you or somebody else is at immediate risk of harm, call 999, attend your nearest A&E, contact NHS 111 or your local urgent mental health service.