What is alexithymia and its relationship to interoception?

This is a guest post by author Kelly Mahler, reprinted with her permission. 

What is alexithymia?

We know alexithymia is a term that’s used to describe when someone has difficulty identifying their feelings–or more specifically identifying and describing their emotions. Researchers have found that one in 10 people can experience this alexithymia and these rates are even higher in people that are neurodivergent, have experienced trauma and/or have a mental health diagnosis. Alexithymia does not mean that a person lacks emotions, it just alludes to the fact that they have a hard time figuring out exactly what emotion they’re experiencing and sometimes even putting words to that experience.

To me, alexithymia is pretty much a surface term. But what is causing alexithymia? What is the deeper reason? Seeing beneath the surface is what I’m always concerned with as an occupational therapist, because it is this insight that drives more effective supports. What researchers have been finding over the last few years is that interoception is the underlying neurobiological cause or foundation of this experience of alexithymia.

Interoception and Alexithymia

Let’s think about this connection. First what is interoception? Interoception is a sense and one of its biggest jobs is to allow us to feel our feels, to feel these internal sensations coming from the inside of our body. We know these internal sensations are what drive our emotional experiences and help us to understand exactly what emotion we’re feeling.

For example, when I notice a certain feeling in my stomach, it has this empty, gnawing feeling. I know that, for me, that feeling means I’m hungry. That sensation helps me clearly identify exactly how I’m feeling in that moment. Or, sometimes when my heart is racing and I have this tight feeling in my chest, I’ve learned over time that, for me, that means I’m feeling anxious. Those internal interoceptive sensations are what help me to identify and describe the way that I feel. And this inner experience is different for all of us!

So, interoception research clearly shows that it is an important factor to be considering and exploring when someone is experiencing alexithymia. This encourages us to think deeper, to think beyond just that surface term of alexithymia, and get to the deeper root cause. Considering a person’s interoceptive experience becomes much more helpful and drives effective alexithymia supports (more on this below!)

Interoception, Alexithymia & Emotion Words

A lot of people that experience alexithymia also talk about how there is a language difficulty; a difficulty in describing and putting words to your feelings or your emotional experience. Again, that has been tied back to our interoceptive sense, and how our internal sensations ground the concepts of emotions and emotion words. In other words our body signals help to give concrete definition to emotion words. So, conversely, without a clear interoceptive experience, emotion words can prove to be very abstract. Again interoception science shows that it is important to use interoception-based supports when someone is seeking to better understand their emotions and emotion words.

Using Interoception Supports to Improve Alexithymia

What can we do as professionals supporting someone that might be experiencing alexithymia (or if we are experiencing alexithymia ourselves)? Use interoception-based supports! Here are a few tips.

Tip #1: Get Interoceptively Regulated

Number one, get regulated. It’s really hard to want to pay attention to how your body feels or even have the resources to pay attention to the way your body feels when you are dysregulated. We need to consider a person’s inner stabilization and consider what can we do to help their nervous system to be as regulated as possible. We must also consider outer stabilization, or the environment, and what we can do to the environment to help that person feel safe and regulated so that they can shift their attention away from the environment and to themselves.

Tip #2: Evoke and Connect Interoception Sensations

Number two is to evoke and connect interoception sensations. Once you’re regulated, what we are having so much fun doing is using our interoception supports to evoke sensations within the body. We evoke stronger feelings in playful, fun, and safe feeling ways, and give a person practice noticing those internal sensations and connecting to themselves.

You can evoke sensations during lots of fun things, like when you’re playing games, or when you’re doing your daily activities, such as washing the dishes, or your hands, or getting a shower. All of those experiences are most likely evoking a stronger sensation in your body and you can take time to notice the way your body feels. We are also evoking many sensations while exercising, or doing yoga, or just silly things like holding an ice pack and noticing the way your hands feel. It’s important to evoke those sensations in safe feeling ways and give practice noticing and connecting to yourself.

Tip #3: Remember, There is No Wrong Way to Feel

Tip number three is remembering that there’s no wrong way to feel. I have so many clients that, when we’re starting to do this interoception work, are very anxious over giving the wrong answer or feeling the wrong way. That’s because a lot of the self-regulation programs out there teach people that there is really one way to feel–stress feels a certain way in your body; your heart races, your muscles tense, your skin gets clammy, etc. Well guess what? That is just not the case for every single person. For example, what my body feels like when I’m hungry is way different than what my husband’s body feels like when his body needs food. What my body feels like when I’m frustrated is different than what my husband experiences when he is frustrated. We really need to embrace the fact that we all have unique interoceptive and emotional experiences. There is no wrong way to feel. Hopefully, this begins to give people permission to explore their own inner experience and figure out exactly what their body feels like and what their interoceptive sensations mean uniquely for them.

Tip #4: Be Kind to Yourself

Tip number four is all about being kind to yourself and embracing the fact that it’s okay to not know how you feel. In fact, I’ve never met a person that is 100% clear on exactly how they feel at every given minute of every single day. Feeling your feels can be a really murky area for lots of reasons! Trying to connect with or understand our inner selves might go well some days, and some days it might not. Give yourself grace–if you’re really struggling to know how you feel, it is okay. Keep at it and keep trying and keep evoking those sensations to connect with yourself. Once you’re noticing those sensations, really try to find patterns and connect them to your emotions, because we know those interoceptive sensations are powerful clues to our emotional experience.