Difficulty Noticing Emotions and Body Signals: Alexithymia and Interoception in ADHD and Autism

Bandai Choi
Clinical Psychologist | Board-approved supervisor
Breathe-n-Smile Psychology, Essendon North, Footscray and telehealth across Australia

Defining interoception and alexithymia

Plain answer: Interoception is the physiological perception of internal bodily sensations (like heart rate, breathing, bladder fullness, or hunger). Alexithymia is a personal trait characterized by difficulty recognizing, naming, and describing emotional states.

While interoception involves physical sensation awareness, alexithymia involves cognitive-emotional translation—attaching descriptive feeling words (like “anxious”, “grieving”, or “excited”) to visceral physical sensations. Someone may experience strong physical sensations (such as a heavy chest or a knot in the stomach) while feeling uncertain about what emotional state those physical sensations represent.

Distinguishing alexithymia from autism and ADHD

It is important to clearly distinguish alexithymia from ADHD and autism:

Key clinical distinctions

• Alexithymia is not a mental illness or diagnostic category: First identified by Dr. Peter Sifneos in 1973, alexithymia is a subclinical personality trait that occurs across neurotypical, neurodivergent, and clinical populations.
• Alexithymia is distinct from autism and ADHD: While some autistic adults and individuals with ADHD experience co-occurring alexithymia, many do not. Alexithymia is not part of the core diagnostic criteria for ASD or ADHD.
• Individual experiences vary widely: Some neurodivergent adults have heightened emotional awareness (hyper-interoception), while others experience delayed recognition (hypo-interoception).

Calm examples of late body-signal awareness

In daily life, variations in interoceptive processing and emotional naming can manifest in subtle, practical ways:

• Noticing Hunger or Thirst Late: Absorbed in an engaging activity or work task, an individual may not notice mild hunger cues, only realizing they need food when feeling sudden lightheadedness or fatigue.
• Recognizing Physical Stress Signals: Shoulder tightness, jaw clenching, or shallow breathing might build up gradually throughout a busy day before being noticed during quiet evening downtime.
• Describing Internal States: When asked “How are you feeling?”, an individual might describe physical sensations (such as “tired” or “heavy”) rather than categorical emotion words (like “overwhelmed” or “sad”).

These experiences are normal human variations and do not mean a person is broken or unfeeling.

What research shows about interoception in neurodiversity

Scientific literature exploring interoception and neurodiversity is evolving, and current findings are mixed:

Some studies, such as research by Shah and colleagues (2016) in Biological Psychology, suggest that observed differences in emotional identification among autistic participants may be accounted for primarily by co-occurring alexithymia rather than autism itself. Other systematic reviews by Murphy et al. (2018) in the Journal of Autism and Developmental Disorders highlight that interoceptive accuracy varies across different physical measures (such as heartbeat perception versus temperature awareness).

Research on interoception and alexithymia

A 2013 review in Trends in Cognitive Sciences by Bird and Cook highlighted the “alexithymia hypothesis,” proposing that emotional processing variations often attributed solely to autism may reflect co-occurring alexithymia instead.

Exploring mind-body patterns in therapy

Therapy can offer a gentle, non-judgmental space to explore personal patterns of bodily awareness and emotional expression without rigid prescriptions or treatment promises. In a supportive therapeutic environment, individuals may:

• Observe personal daily energy cycles, stress indicators, and rest preferences.
• Develop individualized ways of tracking comfort, noise limits, and physical boundaries.
• Explore neurodiversity-affirming therapy approaches that validate different communication styles and emotional expressions.

Clinicians work collaboratively, recognizing that what works for one person may not suit another.

Common questions about alexithymia and interoception

Is alexithymia the same as a lack of empathy?

No. Alexithymia involves difficulty identifying and describing one’s own emotional states. It does not mean a person lacks care, compassion, or concern for others.

Can interoceptive awareness change over time?

Personal awareness of bodily signals can fluctuate depending on stress levels, illness, environmental noise, and life transitions.

How can I explore this in therapy?

You can read about what to expect in therapy or contact our clinic to discuss whether an initial consultation fits your goals.

Suggested reading and helpful guides

• Adult Autism & AuDHD Assessment Services – Information on diagnostic assessment pathways in Melbourne.
• Adult ADHD Assessment Services – Exploring attention, focus, and executive function support.
• Neurodivergent-Affirming Therapy – Client-centred support respecting individual neurodivergent identities.
• What to Expect in Therapy – A clear guide to intake, pacing, choice, and collaborative goal setting.