Alexithymia and ADHD: the Most Common Overlappings
Are you an ADHDer who struggles with your emotions? Do you get overwhelmed by them or struggle to understand them? When stressed, do you go to emotional eating, drinking, or other unhealthy coping strategies? The connection between emotional sensitivity and ADHD is often poorly understood. Complicating matters further, alexithymia and ADHD often occur together. Having alexithymia can make it even more difficult to understand and regulate our emotions! Understanding the link between alexithymia and ADHD can help us to better learn how to work with our vulnerabilities.
As an ADHD Psychologist, I have learned how to work with my alexithymia and improve my relationship with emotions. The tools I learned in my training have helped me gain a greater sense of agency over my body and emotions. For this reason, I am passionate about passing along this knowledge and information to others. This article will provide an overview of:
What Alexithymia is
Alexithymia and ADHD
Impacts of Alexithymia and ADHD
Alexithymia, ADHD, and Impulsivity
Alexithymia and ADHD Support Needs
Alexithymia, ADHD, Depression and Anxiety
What is Alexithymia?
Alexithymia is a personality trait and not a mental health disorder. However, it co-occurs with many mental health conditions and forms of neurodivegence such as ADHD. Alexithymia is a broad term that means difficulty identifying and describing emotions. The term was coined by the psychiatrist Peter Sifneos in 1972. He used this term to describe his patients who struggled to perceive and describe their emotions. Sifneos, born on the Greek island of Lesbos borrowed from his native language to coin this term. In Sifneos' native Greek, the word means "without words for emotion." Alexithymia occurs on a spectrum, and a person can have mild to severe alexithymic traits.
Broadly speaking, there are three or four alexithymic traits that everyone agrees on; however, some researchers and some alexithymia tests include up to seven different alexithymic traits. For an in-depth view of all alexithymic traits, you can see my in depth-article on it here. For this article, I’ll just review the three foundational traits of alexithymia which include: difficulty identifying emotions, difficulty describing feelings, and an externally-oriented thinking style.
Difficulty Identifying Emotions: People who experience difficulty identifying emotions experience confusion about their internal experiences, including emotions. Their bodily sensations often cause confusion, and they struggle to distinguish between emotions and bodily sensations (for example, the difference between hunger and anxiety). Identifying emotions play a key role in our ability to regulate emotions. Difficulty in this area has been linked with depression, non-suicidal self-harm, and suicidal behavior (Cerutti et al., 2018).
Difficulty Describing Feelings: While difficulty describing feelings sounds similar to identifying feelings, it is slightly different. Difficulty describing feelings refers to difficulty 1) Finding words for your feelings and 2) Being able to express these feelings to others. People who struggle with this often experience difficulty labeling emotions and finding the right words to describe their feelings. Descriptors of emotions may be vague, general, and diffuse. Difficulty describing emotions is associated with more relationship difficulty.
Externally Oriented thinking: Externally oriented thinking occurs when a person's thought process is focused externally (vs. internally). An externally oriented thinker focuses their energy on external events and tends to avoid focusing on internal experiences. A person with high alexithymic traits in this area, has difficulty attending to their own emotions and inner states. Externally oriented thinking has been linked with a reduced ability to experience positive emotions, which can contribute to depression and other mood concerns.
Alexithymia and ADHD
Alexithymia is also more common among ADHDers (than the general population). Prevalence rates vary; some studies show 20%, while others report 44% or more. One study found that among those who didn't meet clinical levels of alexithymia, the average alexithymia score was much higher for ADHDers than people in the general population (Edel et al., 2010). Meaning even ADHDers who don’t have enough alexithymic traits to be considered Alexithymic have more alexithymia traits than the average person (remember, alexithymia occurs on a spectrum).
Alexithymia and ADHD are different in nature. Alexithymia is a personality trait, while ADHD is a neurodevelopmental difference. Alexithymia is characterized by difficulty identifying emotions, while ADHD is characterized by difficulty regulating attention, executive functioning disabilities, hyperactivity, and impulsivity.
While, on the one hand, they are very different, the impact they both have on how we experience and process emotions share a great deal of overlap.
Both ADHD and Alexithymia are associated with difficulty regulating emotions. For ADHD, this is due to executive functioning difficulties and impulsivity, which impacts the brain’s ability to regulate emotions. For alexithymia, this is due to difficulty registering emotions until they are too overwhelming to manage.
Both ADHD and Alexithymia have higher rates of disordered eating, substance abuse, and negative emotional coping. Negative emotional coping is a broad term that refers to strategies for coping with emotions that lead to emotional avoidance and unhealthy ways of managing emotion.
Given that both conditions result in more emotional difficulties, it is no surprise that people tend to struggle even more when you combine the two!
To learn more about the ADHD-Alexithymia connection and how to work with it therapeutically, check out the training I did with Therasmart. You can access the recording of the webinar for 30 days.
Impacts of Alexithymia and ADHD
Consistently the studies show that difficulties with alexithymia lead to increased difficulties with ADHD traits, social anxiety, and emotional processing.
When a person has both Alexithymia and ADHD, it tends to lead to more emotional difficulty, increased difficulties with impulsivity, more difficulty processing emotions, higher rates of depression and anxiety, and the need for more support around one’s ADHD.
This is important to understand because it is possible to work with alexithymia and improve our ability to detect and work with emotions in a more positive way. Working with alexithymia can be an important part of an ADHD person’s support plan.
Higher Rates of Impulsivity
Impulsivity is characterized by a tendency to act without planning and difficulty persevering in tasks, delaying gratification, and regulating emotions. ADHDers with alexithymia tend to have more impulsive traits. A study including 100 ADHDers found 41.5% had alexithymia. They found a link between alexithymia and ADHD impulsiveness (Kiraz et al., 2021).
This means that ADHDers with alexithymia are more likely to seek new and exciting sensations, experience more difficulty persisting in tasks, act rashly when in a positive mood, and are more prone to risky behaviors such as black-out drinking.
It’s important to consider the impact of alexithymia and ADHD. An ADHDer with combined or hyperactive ADHD and alexithymia may be particularly prone to substance abuse problems, and early support and education can help decrease a person’s risk.
Higher ADHD Support Needs
The above study involving 100 ADHDers found that people with ADHD and alexithymia had higher “severity of ADHD symptoms.” (Note, as a neurodivergent affirming clinician, I do not like the language of severity and prefer to talk about a person’s support needs). Essentially the research team found that people with alexithymia and ADHD were more negatively impacted by their ADHD traits and experienced more negative outcomes related to their ADHD (more difficulty in work and school, more interpersonal difficulties, and more behavioral struggles). People with alexithymia and ADHD benefit from more all around support.
Higher Rates of Depression and Anxiety
Edel et al., 2010 found a connection between ADHDers with alexithymia, social anxiety, and emotional processing difficulties. People who experience difficulty processing emotions are more negatively impacted by their emotions and more prone to go to negative emotional coping (emotional avoidance, emotional eating, substance use, etc.). For these reasons, it is no surprise that emotional processing difficulties are connected with higher rates of depression and anxiety.
People with alexithymia and ADHD have more difficulty processing emotions effectively, more likely to experience social anxiety, depression, and other mental health conditions. When an ADHDer has a co-co-occurring mental health condition, this is known as “complex ADHD” and creates unique stressors and complications for the ADHD person.
Summary: Alexithymia and ADHD
Supporting alexithymia (increasing emotional awareness) is integral to supporting ADHD people! When an ADHDer has Alexithymia, they have increased vulnerabilities. But the good news is that alexithymia can be worked with and improved!
Alexithymia can be improved by:
Increasing interoceptive awareness (through working with sensory-based OT or through interoceptive awareness exercises)
Increasing emotional literacy and
Practicing emotional identification
We can learn to better work with our alexithymia, increase our emotional awareness and gain more agency over our emotions.
To learn more about how to work with alexithymia, you can check out my workbook here. If your alexithymia is due to interoception difficulties, I recommend you check out the emotional awareness bundle, which includes a workbook for alexithymia and interoception.
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