Do you find it hard to put feelings into words, or feel unsure what you’re feeling at all? That’s the territory of alexithymia. I have alexithymia myself, and it can be confusing and easy to misunderstand.
Alexithymia isn’t one single thing. It’s a set of traits that show up differently from person to person. In What Is Alexithymia? I cover what it is and where it comes from. Here, I look at seven traits and what each one can look like.
Table of Contents
The Alexithymia Wheel of Traits
Alexithymia is a trait that sits on a spectrum, and researchers don’t fully agree on which traits belong in it. Most agree on a core three: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. The Online Alexithymia Test looks at seven areas.
The Alexithymia Wheel puts those seven areas side by side. It isn’t an official tool. My ADHD brain loves to mash ideas together, so I borrowed the idea of the Autistic wheel of traits and applied it to alexithymia. Seeing the traits as a wheel makes it easier to notice that someone can be high in some areas and low in others.
The Seven Alexithymia Traits
The first three are the core traits. The fourth is sometimes included. The last three often go along with alexithymia but aren’t usually considered part of it.
Difficulty identifying feelings
Difficulty describing feelings
Externally oriented thinking
Vicarious interpretation of feelings
Restricted imagination
Interpersonal difficulties
Sexual difficulties and disinterest
1. Difficulty Identifying Feelings
People who are high in this trait find it hard to make sense of what’s happening inside them, including both emotions and body sensations. Telling them apart can be tricky: is this hunger, or anxiety? This is often connected to differences in interoception, our sense of what’s going on inside the body.
In children, this can show up as frequent stomachaches or a general sense of not feeling well. When a child talks about physical complaints, they may be telling us something about their emotions. It can be hard for parents to tell the two apart.
This trait matters for wellbeing. In one study of adolescents, difficulty identifying feelings was linked with self-harm and suicidal thoughts. Naming emotions plays a big part in regulating them, which may be one reason this trait is tied to more emotional distress. The good news is that emotional awareness can grow with support and practice.
It’s common for Autistic people to be high in this trait.
2. Difficulty Describing Feelings
This sounds similar to the first trait, but it’s a little different. Identifying feelings is more internal. Describing them is more external. It involves finding words for feelings and expressing them to other people.
People high in this trait may describe feelings in vague or general terms. A question like “how are you?” can be surprisingly hard to answer. This trait is linked with more relationship difficulties.
Many Autistic people have different access points to their inner world. I don’t usually connect with people by talking about emotions directly. Instead, I let people into my inner world through my passions and interests, which often lead to conversations about feelings. When I was practicing, I found this was often how my Autistic clients let me into their inner world too.
Passions and interests can be a doorway into our inner world.
3. Externally Oriented Thinking
Externally oriented thinking means our attention naturally goes outward, toward facts, events, and the practical details of what’s happening, rather than inward toward feelings and inner states.
Here’s what it can look like:
Answering “how are you?” with what you did, rather than how you feel
Preferring to solve a problem over talking through how it feels
Little curiosity about why you feel a certain way
Finding conversations about feelings tiring or hard to follow
Feeling most at home with facts, systems, and concrete details
Externally oriented thinking can be a strength. People high in this trait are often practical, grounded, and good at focusing on what needs to happen next. Many are calm and useful in a crisis.
It can also come with costs. When our attention rarely turns inward, feelings can build up unnoticed until they show up all at once, or in the body. One 2026 study suggests externally oriented thinking may be the part of alexithymia that links autistic traits with lower cognitive and emotional empathy, though this research is still early.
If this trait sounds familiar, approaching feelings from the side can help: through interests, through the body, or through practical tools like the ones in Emotional Identification: 5 Ways to Name Your Feelings.
4. Vicarious Interpretation of Feelings
People high in this trait rely on others to help interpret feelings. They might ask someone, “How would you feel if this happened to you?” to figure out their own response, or lean on others to read the emotional side of a social situation.
This trait isn’t always considered a core part of alexithymia, but it often goes along with the core traits. It can also make relationships harder.
5. Restricted Imagination
Some people with alexithymia (but not all) have a less active fantasy life. They tend to be oriented toward the concrete world of facts and practical matters, with less interest in daydreaming or imaginative play.
Like the fourth trait, this one isn’t always considered core.
6. Interpersonal Difficulties
The last two traits aren’t part of the formal definition of alexithymia, but they often go along with it.
Alexithymia has been linked with differences in empathy: understanding other people’s perspectives, feelings, and intentions. That can make building and deepening relationships harder.
This has changed how researchers think about autism. In a 2010 brain-imaging study, empathy-related brain responses tracked with alexithymia rather than autism. This idea, sometimes called the alexithymia hypothesis, suggests that some emotional differences long attributed to autism may be better explained by alexithymia. For more, see Autism and Alexithymia.
7. Sexual Difficulties and Disinterest
This isn’t a primary feature of alexithymia, but the two are often connected. In one study of university students, higher alexithymia went along with more sexual shyness and nervousness, and among women, lower sexual satisfaction.
One possible reason is that alexithymia is associated with more negative emotions, which can affect how people feel about sex and intimacy.
A Few Closing Thoughts
Alexithymia looks different from person to person. Someone might be high in difficulty identifying feelings and low in externally oriented thinking, or the other way around. The wheel can help you map your own pattern.
If you’d like to measure your traits, Alexithymia Test compares three free tests and how to read your results.
Alexithymia Traits FAQs
What are the main traits of alexithymia?
The three core traits are difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. Some measures also include vicarious interpretation of feelings, restricted imagination, interpersonal difficulties, and sexual difficulties.
What is externally oriented thinking?
Externally oriented thinking is a tendency for attention to go outward, toward facts, events, and practical details, rather than inward toward feelings. It can be a strength, but it can also mean feelings build up unnoticed.
Is alexithymia a mental health condition?
No. Alexithymia is a personality trait that sits on a spectrum, not a diagnosis. It’s more common among Autistic people and often shows up alongside anxiety and depression.
Can you have some alexithymia traits but not others?
Yes. Alexithymia looks different from person to person. Someone can be high in one trait and low in another, which is why the wheel of traits can be helpful.
Additional Resources
What Is Alexithymia? What it is and where it comes from
Autism and Alexithymia How the two overlap
Alexithymia and ADHD How alexithymia shows up in ADHD
Alexithymia Test Free tests and what your results mean
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References
Bird, G., Silani, G., Brindley, R., White, S., Frith, U., & Singer, T. (2010). Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain, 133(5), 1515–1525. https://pmc.ncbi.nlm.nih.gov/articles/PMC2859151/
Bird, G., & Cook, R. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3, e285. https://pmc.ncbi.nlm.nih.gov/articles/PMC3731793/
Cerutti, R., Zuffianò, A., & Spensieri, V. (2018). The role of difficulty in identifying and describing feelings in non-suicidal self-injury behavior (NSSI): Associations with perceived attachment quality, stressful life events, and suicidal ideation. Frontiers in Psychology, 9, 318. https://pmc.ncbi.nlm.nih.gov/articles/PMC5859383/
Goerlich, K. S. (2018). The multifaceted nature of alexithymia: A neuroscientific perspective. Frontiers in Psychology, 9, 1614. https://pmc.ncbi.nlm.nih.gov/articles/PMC6124373/
Lyvers, M., Dallago, B. B., Montague, S., & Thorberg, F. A. (2026). The externally oriented thinking facet of alexithymia mediates the negative association of ASD symptoms with cognitive and emotional empathy. Scandinavian Journal of Psychology, 67, 867–873. https://pmc.ncbi.nlm.nih.gov/articles/PMC13159508/
Scimeca, G., Bruno, A., Pandolfo, G., et al. (2013). Alexithymia, negative emotions, and sexual behavior in heterosexual university students from Italy. Archives of Sexual Behavior, 42(1), 117–127. https://pubmed.ncbi.nlm.nih.gov/23007336/
