Ep. 34 / Identifying Feelings: Alexithymia, Emotion and Autism

danielle sullivan emotional intelligence coach emotion and autismWelcome back to the Neurodiverging Podcast! Today, certified life coach Danielle Sullivan discusses the basics of what emotional intelligence is and why it can be difficult for neurodivergent people to develop emotional intelligence skills. We're also discussing alexithymia, how folks with autism process emotions differently than neurotypical people, and some easy interventions you can try at home to improve your own emotional intelligence skills, too!

Click here to learn more about "What Is This Feeling?" -  Danielle's introductory, self-paced course to increase your own emotional intelligence!


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Show Notes:

Further Reading:

Works Cited:

  • Samson AC, Phillips JM, Parker KJ, Shah S, Gross JJ, Hardan AY. Emotion dysregulation and the core features of autism spectrum disorder. J Autism Dev Disord. 2014 Jul;44(7):1766-72. doi: 10.1007/s10803-013-2022-5. PMID: 24362795.  https://med.stanford.edu/content/dam/sm/parkerlab/documents/Emotion_Dysregulation_and_the_Core_Features_of_Autism_Spectrum_Disorder.pdf
  • Sifneos PE. Short-Term Psychotherapy and Emotional Crisis. 1972, Cambridge, MA: Harvard University Press.
  • Gaggero, Giulia et al. (2020.) A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research. Front. Psychiatry, 10 December 2020. doi:10.3389/fpsyt.2020.611489https://www.frontiersin.org/articles/10.3389/fpsyt.2020.611489/full
  • Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European psychiatry : the journal of the Association of European Psychiatrists55, 80–89. https://doi.org/10.1016/j.eurpsy.2018.09.004
  • Surman CB, Biederman J, Spencer T, Miller CA, McDermott KM, Faraone SV. Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study. Atten Defic Hyperact Disord. 2013 Sep;5(3):273-81. doi: 10.1007/s12402-012-0100-8. Epub 2013 Feb 15. PMID: 23413201; PMCID: PMC4009378.


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Transcript of Ep. 34: Identifying Feelings: Alexithymia, Emotion and Autism

Introduction

Hello everyone, and welcome back to the Neurodiverging Podcast. I'm Danielle Sullivan and I'm your host. Today you've just got me on the line with you to talk about emotional intelligence and specifically about alexithymia, which I'll be discussing further.

Before I get to that, I'd like to thank my patrons: Klara, Zach, Teresa L., Sara, Marti, Kristen, Galactic Fay, Theresa B., Claire and David. Thank you all so much for supporting this episode of Neurodiverging. If you like this podcast and you get something out of it, please check us out on Patreon at patreon.com/neurodiverging. You can pledge a dollar, five dollars, or ten dollars a month to support the podcast and keep it going. It's very appreciated!

If you're new here, I'm Danielle Sullivan. I'm the host of the Neurodiverging Podcast, and I am a certified life coach and an autistic person and parent. When we started off this podcast, I used to just do these by myself until we started getting guests, so this is kind of a roll back to the old days where you're just going to listen to me today. 

Emotional Intelligence for Autistic People

What I'd love to talk to you about today is emotional intelligence and alexithymia. Like I said, I'm a certified life coach and I often work on emotional intelligence skills with my clients. Emotional intelligence is basically a set of skills which allow you to understand what you are feeling and then to regulate your feelings. Regulating your feelings just means that you're able to amp them up or dial them down based on the situation and the environment you're in, and what you need in the moment.

Emotional intelligence is a whole variety of skills that all people need to build on over their lives. Most of us learn a little bit when we're kids but continue to develop those skills over our whole adulthood. And especially after we become parents, many of us become much better at emotional regulation! 

Some of us are born with or grew up in an environment where we develop better skills than others, but autistic and ADHD folks are often at a disadvantage when it comes to building emotional intelligence skills over time. There's lots of reasons for that, but some of it is because many of us process our emotions and we feel our feelings in very different ways compared to neurotypical people. That's part of what I want to talk about today because I feel like it doesn't get enough play in conversations about autism and ADHD, and that it is a really big piece of the puzzle for the mental health and well-being of neurodivergent people.

It’s also relevant to the way that neurodivergent and neurotypical people communicate with each other. We have different communication styles that come from different ways of interpreting the world. A very basic piece of being a human is our emotions, and we feel our feelings differently and we access them differently so that's important for me to talk about.

Emotional regulation is important for autistic people to practice for a lot of reasons. One big one is that according to the research autistic folks like us tend to choose emotional regulation strategies that aren't very effective. This might be because we're taught poor regulation strategies when we're younger. This might be something inherent, something in the way that our brains are built to see the world. It's probably a mix of the two. 

Because we don't choose effective emotional regulation strategies we struggle later with things like self-harm, anxiety, impulsivity and aggression. This is according to some good research and I put the links in the show notes so if you're interested in looking at those papers I highly recommend it.

Autistic people are already struggling with so many issues that we definitely don't want to add things like a higher risk of self-harm, anxiety, impulsivity and aggression to those piles. So, supporting emotional regulation skills and emotional intelligence skills in general is really important for our autistic friends and family. We also know that generally a lack of emotional regulation skills in autistic children and adults are linked to poorer mental health and physical health later in life.

The good news is that you can develop these emotional intelligence skills anytime you want with a little bit of work. I'll talk a little bit more about that later but it is something that we do want to be paying attention to. 

Alexithymia in ADHD and Autistic Folks

Now, one important aspect of emotional intelligence (and what I want to talk a little bit more about today) is called alexithymia. Alexithymia is a difficulty in recognizing and distinguishing between different emotions and bodily sensations. Sometimes it's also a difficulty in expressing emotions, or a lack of imagination or interior fantasy life. It can also be that your thoughts are focused on external rather than internal experience. So, alexithymia is composed of a set of criteria.

The main one that I'm going to talk about today is that difficulty recognizing and distinguishing between different emotions and bodily sensations, because that's the piece that a lot of autistics and ADHD-ers struggle the most with in my experience.

Alexithymia is interesting and kind of weird because it's not a disorder or an illness, but it seems to be a personality trait, which I think is just so interesting. It's a personality trait that occurs in something like 10% of the general population. 

I do want to say up front that the research on alexithymia is scarce and is all over the place so the numbers I'm throwing out are pulled together from a couple of different sources and averaged together, but different studies say different things. I'm trying to give you good information that I filtered through but if you do want more information, please check out the links in this article, because they're much more specific. 

So, we think that something like 10% of the general population has some range of alexithymia. There's disagreement between researchers- some folks think that alexithymia is part of the profile of autism. But, it seems to me and some other researchers that it's more likely to be a general population trait that somehow is linked to autism - not caused by autism, but linked to it. 

The reason I think that is because, first, we do know that there are plenty of neurotypical people who also have alexithymia. Second, we also know that alexithymia co-occurs with autism way more frequently than it does with being neurotypical. Something between 30 and 80 percent of autistic people also have alexithymia. This number obviously is really murky;  there's a huge difference between 30% of people and 80% of people. That's because we don't have quite enough studies to really get into the ballpark. But,  average those together and we're talking roughly half of autistic people also have this alexithymia trait, so that's a huge portion of autistic people. 

I've been talking about autism a lot so I just want to jump in here and say that alexithymia also seems to be linked a little bit less directly (but still there) with ADHD. I've talked about this before a couple of times: ADHD and autism co-occur very frequently. Roughly 50% of autistic folks are also co-diagnosed with ADHD. So, alexithymia is in this mix of traits that is common in neurodivergence in general, though we don't have quite enough information to know why it's linked or how it's linked exactly. But, it comes up a lot, and so if you are an autistic, ADHD or neurodivergent person, or you work or live with folks who are, it's important to be familiar with alexithymia and aware of it.

I'm speaking as from my perspective as a life coach, somebody who works with emotional intelligence very often and is trained in emotional intelligence, and also somebody who is autistic with alexithymia myself.

What I think is most important to know is that someone with alexithymia like me, maybe like you, we obviously have emotions! Every human has emotions. What happens is that often we have physical reactions to emotions just like everybody else, but what often happens is we skip the part where the emotion goes into your head and through your brain. 

So, you feel a feeling, you have a reaction to something that happened to you, and your muscles tense, your breath rate might change, you might get hot or cold, you might sweat -  you'll have some kind of physical reaction. But, it's not always clear to us how to name the emotion we're having. Are we happy? Are we stressed? Are we anxious? Are we frightened? No one knows -  it's a mystery! 

You have the physical reaction of, say, saliva pooling, sweat, feeling hot, but you don't have the ability to identify in your mind what that emotion is. That's what I mean when I say that people with alexithymia  might have a physical reaction to an emotion, but not be able to notice that. 

What can often happen to us is that we misinterpret the emotional reaction to an illness or an injury so, for example, and something that is very common in the alexithymia literature, someone with alexithymia might feel very severely anxious, and some of the physical reactions to anxiety include things like tightness in the chest. Then instead of realizing that we're anxious, we instead believe that we're experiencing a heart attack or a panic attack, and so we go to the ER and the folks at the ER can't help us, because we are not in fact experiencing a heart attack. We are anxious and stressed. So, the emotional reaction in us is less mental and less going through our heads, and much more physical. 

A lot of autistic folks and ADHD-ers have some degree of alexithymia, and again that degree can range, and so experiences can differ. What I want to get through to you today is that, in my experience, a lot of us do not realize that we are alexithymic. Especially if you are a late-identified autistic person, you may have gotten through a large portion of your life without realizing that this is a space where you need to keep skill-building, without realizing that your emotional intelligence is suffering in this way.

I have talked to a lot of people who are late-identified autistics, and worked with a lot of clients who are late-identified autistics (and I'm also naming myself in this as a late-identified autistic) who felt like we were pretty in touch with our emotions, that we had pretty good concept of what was going on inside our heads, and that we're able to name emotions relatively quickly and identify what we're feeling. However, what often is actually happening is that we have developed some skill with emotions but we are not very quick. Our processing time around emotions is very slow, as in, the example I just gave of having a physical anxiety symptom like tightness in the chest and not immediately linking that to anxiety. 

How to Know If You Might Have Alexithymia

So [here are] some ideas around how to identify if you have alexithymia or not. Again alexithymia can range greatly in severity, but: 

 - If you're somebody who feels a feeling and doesn't know how to name it...

 - If you're somebody who gets physically upset: you start breathing heavily, you're crying, you shake, you have these physical reactions, but you don't know why that's happening and you don't know what you're reacting to, that's a a missing link between the emotion and the physical reaction that could be a symptom of alexithymia.

 - If you notice that your muscles are tense and it's hard to breathe all the way into your diaphragm, but you don't realize you're upset, or you don't realize you're happy ...

I talked to somebody the other day who said that they spent years believing that they were anxious in social situations because they had a bunch of physical reactions that, to them, indicated anxiety, but actually what it was (and it took them years to realize) is they were excited! They were excited to see people but the reality is that our physical reactions to happiness and excitement versus anxiety can be really similar: you breathe more shallowly, your palms sweat, you feel kind of up and jittery, and that can be anxiety or that can be excitement.

If any of this is ringing true to you, then this might be something you just want to look into further.

How to Improve Emotional Intelligence for Autism and ADHD

As I was talking about before, emotional intelligence skills make up a bulk of the different ways of being able to name your emotions, and being able to modulate them, modify them, amp them up or bring them back in depending on what you need.

Now, if you have alexithymia, if you're one of the maybe 50% of autistic people and ADHD-ers with this trait, then it's really difficult to do either of those pieces: to name the emotion you're feeling, and then to figure out how to modify it. If you don't even know if you're anxious or excited, how are you supposed to know whether you're amping that up or reining that down, right?

It's a really challenging situation! So, there are a couple of things that we can do that are evidence-based interventions to increase emotional intelligence. I'm going to go through them very quickly, and these are just some suggestions: there are so many great evidence-based approaches to improving emotional intelligence, and I'll be talking about them in future episodes too. Here are a couple of ideas for now. 

Delayed Reactions Can Be Due to Slow Processing 

The first one is mindfulness. If you're new to the podcast, we had a great guest speaker a couple of months ago, Dr. Rabia Subhani, and Rabia has created some really good content, both free and paid. That's just a suggestion to go back and look at that episode, give it a listen for some discussion of mindfulness and mindfulness practices that you can use as an adult, or you can share with your children.

Mindfulness is just about paying attention to your body in the moment - reining in that urge to think about the future, or perseverate around the past. Instead, [you’re] just focusing on what's right here, right now. Paying attention to what your body is doing and when it is reacting to things can give you a better sense of the time lag between whatever stimulus happened and your reaction to it.

Again, it is really common for neurodivergent folks like us to have a processing delay. Basically, we get an input from the outside world (that can be someone says something to us, something surprises you, anything that happens in your external environment) and then you have a reaction to it. That might be an emotional reaction or a physical reaction. For us, often there is a time delay between what happens in the external environment and us having an internal reaction to it.

Mindfulness can help because if you're paying more attention to what's happening outside of you and inside of you, you can figure out, “Oh, something happened to me this morning and now it's afternoon, but now I'm having a physical emotional reaction. I bet it's related to the thing that happened this morning!”

Because our reactions are so delayed, often the reason we can't link our physical reactions to our emotions with a stimulus is because it happened a while ago, and it's just sort of now percolating through all of our nervous system things and getting to a physical reaction.This is really common, and mindfulness approaches can be helpful for some neurodivergent folks to recognize the links between cause and effect. 

I do want to say that mindfulness is not for everybody. Some neurodivergent folks find mindfulness physically painful. So, if it's not for you it's not for you, and there's nothing to be ashamed of there, I wouldn't encourage trying it if you've tried it before and you know it's not for you. But, for a lot of us it is extremely helpful in getting a better grip on what's going on in our minds and bodies. I'm certainly one of the folks that doesn't take to it easily but finds it really helpful. So, I always encourage people to try it if you haven't before. Check out Dr. Rabia’s resources if you haven’t before.

Name Your Emotions

Another intervention that can be really helpful is learning to name your emotions. This is really great to do with kids too, but it works for kids, youth, teens, young, adults, older adults everybody on up. There's been a lot of research done on feelings and emotions and it can get very complicated, but basically there are six or seven main emotions. They're often called the universal emotions and whether they are actually universal or not is up for heated debate. For our purposes, I really don't think it matters if they're universal or not. What is important about them is they are the most common and maybe the clearest examples of emotion that are important to know for most people living in a Western world today. 

Your six basic emotions are happiness, sadness, disgust, fear, surprise and anger. The reason that these were chosen as the six basic emotions is that they are somewhat universal. A lot of different cultures, if not all of them, have examples of this emotion. They are meant to be somewhat pure emotions.

What I always recommend folks do is find or make a chart for yourself that shows faces of these six emotions: 

  • You can take pictures of yourself making the faces. 
  • You can draw a little cartoon. 
  • You can print stuff out from online

It depends what is most useful to you. If you are not someone who does well with visual prompts, another thing you can do is just write the words: happy, sad, disgust, anger, etc.

Then, when you are feeling a feeling and you're not sure what it is or how to identify it, go back and look at the words for the six basic emotions. Look at the definitions of the six basic emotions and see if you can pin down your feeling to one of those emotions. Over time, it helps you build a vocabulary of your feelings.

Even if your brain still doesn't really want to get involved in immediately naming the emotion, you can get used to saying, “Oh, when my shoulders tense this way, it means I'm excited. When I'm breathing this way, it means I'm anxious.” You can start to develop your own personal dictionary of your emotions. That can be really helpful, and again, very useful for kids too.

Some people use this as well to teach children or adults ways to read emotion on other people's faces. You can also choose to do this. It is very challenging, I would say, as an autistic person I find it very challenging to read other people's faces. I also notice that when I'm feeling something, my face doesn't match what another person's face might be doing for the same emotion. So, if I feel happy my face being happy might not look like somebody else's face being happy. It  just depends on whether you find it useful for you. It can be helpful to get a gist of what happiness might look like, but it might not be exact one-to-one correspondence, so it's really up to you.

Those are two approaches that I think are really helpful: the mindfulness approach and making an emotion cheat sheet for yourself of the six basic emotions.

About the Course: What's This Feeling?

Before we wrap, I want to talk to you about some further resources I have for folks who are interested in learning more about emotional intelligence. As you may have heard, I am part of the Autastic community. If you go to that community, you can join, it's free, our community for late-identified autistics. In that community, I have a course that is available for purchase that is a 101 emotional intelligence course. If you have found this podcast interesting and you feel like you could use some more support with emotional intelligence, you can go check out my course on Autastic.com. 

The course takes you through some basic information about emotions and then gives you several more in-depth, detailed exercises that you can do at home to help improve your emotional intelligence, and that of your family and friends. These exercises are ones that you can use as an adult, but you can also share with children, and I've included  ways to modify these exercises for kids of various ages. Some folks have done them with their teenagers and had success. Adults have done this course and reported great success.

Obviously, everything in the course is built upon my experience working one-on-one with clients on emotional intelligence for several years. I honestly think it's a fantastic resource for you and the feedback on it has been great so far. If you're interested go to Autastic.com, check out the community, and sign up for my course. It's called What's This Feeling? because identifying feelings is hard!

Conclusion

Thank you for being here with me today. If you've enjoyed this podcast, please let me know! Leave a comment or email me: neurodiverging.podcast@gmail.com. I would love to hear from you. Thank you again to my patrons for supporting this podcast and everything we do at Neurodiverging - you guys are wonderful! Join us at patreon.com/neurodiverging, and I hope to see you there. Please remember, we are all in this together.

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