Interoception, Alexithymia, and Autism: Understanding Body Signals and Emotions
Interoception and alexithymia can be helpful concepts for understanding experiences that many autistic people describe. They can help explain why someone might not recognize that they are hungry until they suddenly feel shaky, realize they are overwhelmed only after reaching their limit, or know that something feels wrong without being able to identify exactly what they are feeling.
Autistic people can experience internal body signals in very different ways. Someone may notice certain sensations intensely while barely noticing others until they become difficult to ignore. Understanding these patterns can help autistic people and those supporting them make sense of experiences that might otherwise feel confusing or unpredictable.
Understanding Interoception and Alexithymia
What Is Interoception?
Interoception refers to how we sense and make sense of signals coming from inside our bodies. These signals provide information about things such as hunger, thirst, heart rate, breathing, body temperature, pain, muscle tension, fatigue, nausea, and the need to use the restroom. They also contribute to our awareness of emotions.
Interoception involves both noticing a sensation and making sense of what it means.
For example, someone might notice that their heart is beating quickly. Depending on the situation, they might interpret that sensation as anxiety, excitement, physical exertion, too much caffeine, or something else entirely.
Someone can be very aware of a sensation without knowing what it means. Someone else may recognize a bodily need once it becomes strong but have difficulty noticing the earlier signals leading up to it.
Interoception and Autism
Research on interoception in autism has produced mixed findings. Autistic people do not seem to have one consistent pattern of interoceptive differences. Findings vary depending on what researchers measure, and there is considerable variation among autistic people themselves (Williams et al., 2023; Klein et al., 2025).
In everyday life, these differences can show up in several ways.
Some body signals may be difficult to notice. A person might realize they are hungry only after becoming weak, irritable, nauseated, or lightheaded. They may continue working long after they are exhausted because the earlier signs of fatigue did not register clearly.
Other sensations may feel unusually intense. Someone may be very aware of their heartbeat, digestion, body temperature, pain, or other internal sensations.
Signals can also be difficult to interpret. A person may clearly recognize that something is happening in their body while having difficulty determining what it means. Hunger, anxiety, excitement, nausea, and stress can sometimes feel surprisingly similar.
Awareness can also change depending on the situation. Someone may notice hunger easily on a quiet weekend but miss it completely while intensely focused on work. Stress, sensory overload, attention, illness, sleep, and environmental demands can all affect how noticeable internal signals feel.
How Interoceptive Differences Can Affect Daily Life
Interoceptive differences can have very practical effects.
A person who does not reliably notice hunger or thirst may go much longer than intended without eating or drinking. Someone who has difficulty recognizing fatigue may repeatedly push past their limits and realize how exhausted they are only after they stop.
Interoception can also affect how someone recognizes stress and overwhelm. They may notice that they are becoming tense, uncomfortable, or cognitively overloaded without immediately recognizing the experience as stress. In other situations, the first clear sign of overload may come when thinking becomes difficult, emotions become intense, or they urgently need to get away from what is happening around them.
For some autistic people, internal sensations also add to an already demanding sensory environment. Noise, bright lighting, movement, clothing, temperature, social demands, and sensations inside the body may all be competing for attention at the same time.
An autistic child may get through a busy school day and then become significantly overwhelmed shortly after getting home. An adult might remain focused and productive through a demanding workday and only realize that evening how depleted they are.
Sometimes the earlier signs were unclear, were competing with other information, or did not become recognizable until the person was already significantly overwhelmed.
What Is Alexithymia?
Alexithymia describes difficulty identifying and describing one's emotional experiences. It can also involve difficulty distinguishing emotions from physical sensations.
Alexithymia is not specific to autism, but it is much more common among autistic people. Research has found that about half of autistic people experience significant alexithymia, compared with about 5% of neurotypical people (Kinnaird et al., 2019).
Someone with alexithymia might:
Know that something feels wrong but have difficulty determining whether they are anxious, sad, angry, embarrassed, overwhelmed, or something else.
Understand their emotions more clearly hours or days after an event than while it is happening.
Find it easier to describe what happened than how the experience felt.
Experience strong emotions while having difficulty putting those experiences into words.
A person can also have an extensive vocabulary for emotions while still having difficulty identifying their own emotions in the moment. Knowing the words and recognizing the internal experience are different skills.
How Interoception and Alexithymia Can Interact
Interoception and alexithymia are related, although the relationship is complex (Van Bael et al., 2024).
Our bodies provide information that can help us recognize emotions. A racing heart, muscle tension, changes in breathing, nausea, heaviness, restlessness, or changes in energy can all provide clues about what we are experiencing emotionally.
When those bodily signals are difficult to notice, inconsistent, unusually intense, or hard to interpret, identifying an emotion can become more complicated.
Someone may know that their body feels different without knowing why. They might notice a headache, muscle tension, nausea, restlessness, or difficulty thinking clearly before recognizing that they have been anxious or overwhelmed for several hours.
Emotional understanding can also develop slowly. During an interaction, someone may know only that something feels uncomfortable. Later that evening, they may realize that they felt embarrassed. The next day, after having more time to think, they may recognize that they were actually angry about how they were treated.
That delayed understanding is still meaningful emotional awareness. Some people simply need more time and less pressure to make sense of what they are experiencing.
Alexithymia, Emotion, and Empathy
Alexithymia can sometimes be mistaken for emotional detachment or reduced empathy. A person with alexithymia may experience emotions intensely while having difficulty recognizing, organizing, or communicating those experiences.
Alexithymia does not tell us how deeply someone feels or how much they care about other people. Research has also found that difficulties recognizing emotional facial expressions, which have sometimes been associated with autism, may be more closely related to co-occurring alexithymia (Cook et al., 2013).
Supporting Interoception and Emotional Awareness
Start With Curiosity and Compassion
Although the specific strategies that help will differ from person to person, a useful starting point is developing a more open, curious, and compassionate relationship with internal experiences. This can involve becoming aware of emotions and body sensations as they arise, approaching them without judgment, and allowing uncomfortable experiences to be present without immediately trying to change or get rid of them.
At times, taking a break, shifting attention, or distracting oneself can be an intentional and helpful response, especially when sensations or emotions have become overwhelming. The broader aim is flexibility: being able to recognize what is happening internally and respond in a way that fits the situation, instead of routinely needing to suppress, avoid, or disconnect from difficult internal experiences.
For someone who has difficulty noticing internal signals, this may involve gradually becoming more aware of subtle bodily sensations and learning what they tend to mean. For someone who experiences internal sensations very intensely, it may involve noticing those sensations with less judgment, widening attention beyond them, and learning ways to remain present without becoming consumed by the experience.
Uncomfortable internal experiences can also be approached with compassion. Hunger, anxiety, pain, anger, sadness, sensory overwhelm, and other difficult sensations or emotions often carry useful information. A helpful response is to recognize that the experience is difficult, allow it to be there, and become curious about what it might be telling us about what we need.
Use External Supports When Body Signals Are Unreliable
A person does not need to reliably feel hunger before they are allowed to eat or recognize exhaustion before taking a break.
External supports can reduce the need to depend entirely on interoception. These might include regular meals and snacks, keeping water nearby, reminders to use the restroom, scheduled breaks, predictable routines, or opportunities to step away from sensory and social demands.
These supports can be especially useful when someone becomes deeply absorbed in an activity or tends to notice bodily needs only after they become intense.
Notice Patterns Without Needing an Immediate Explanation
It can help to begin with concrete observations.
Someone might notice that their shoulders feel tight, their stomach feels strange, everything suddenly seems louder, or they no longer want anyone talking to them.
They do not need to immediately decide which emotion goes with the sensation.
Over time, these observations can help someone understand their own patterns. They may notice that certain sensations tend to occur before they become overwhelmed, when they have gone too long without eating, or when they are worried about something.
Help Children Explore What They Are Experiencing
A child who cannot explain why they are overwhelmed still deserves support. Adults can respond to what they observe, reduce demands when possible, and remain curious about what the child may be experiencing.
Parents and other supportive adults can also help children develop language for internal experiences without assuming they already know what those experiences mean. For example:
“I noticed you’re holding your stomach. Do you notice anything happening there?”
“I wonder if your body is telling you it needs something.”
“We don’t have to know exactly what you’re feeling yet.”
Adults can also model this kind of curiosity about their own experiences. A parent might say, “I noticed my shoulders are tight and I’m having trouble concentrating. I think I need a break.”
This gives children examples of how bodily sensations, emotions, and needs can connect while leaving room for their own interpretations. Over time, this can help them develop a clearer understanding of their own patterns and what helps.
This kind of curious, connection-focused approach can also be helpful more broadly when supporting neurodivergent children.
Allow Emotional Understanding to Take Time
Some people identify emotions easily in the moment. Others understand them through reflection.
Writing, drawing, talking with someone trusted, listening to music, moving their body, reviewing what happened, or simply having time alone can help someone make sense of an experience.
It can also help to ask more concrete questions. "How do you feel?" requires someone to identify and name an internal state immediately.
Questions such as "What part of that was hardest?" or "What would help right now?" may provide useful information without requiring someone to find the right emotional word first.
Understanding what happened and what the person needs can be enough.
Respect Different Ways of Communicating Emotions
Emotional communication does not have to happen through conventional emotional language.
Some autistic people communicate their internal experiences more clearly through writing. Others use metaphors, numbers, colors, body sensations, music, images, movement, or descriptions of situations.
Someone might have difficulty saying "I'm overwhelmed" but be able to say "everything feels too close," "my brain isn't working anymore," or "I need everyone to stop talking."
Those descriptions provide meaningful information and can help others understand what the person needs.
For Teens and Adults: Making Sense of Patterns Over Time
For teens and adults, learning about interoception and alexithymia can provide language for experiences that may have been confusing for years. Someone may realize that they routinely recognize exhaustion only after reaching their limit. Another person may discover that they understand their emotions best after having time alone. Someone else may begin to recognize that physical discomfort they had previously understood as anxiety also tends to occur when they are hungry, overstimulated, exhausted, or drained by social demands.
Understanding these patterns can make it easier to plan ahead, communicate needs, and make changes to routines or environments. Helpful supports might include regular breaks, predictable schedules, written communication, reduced sensory demands, access to quiet spaces, or additional processing time during emotionally demanding conversations.
When exhaustion and overwhelm become more persistent, it can also be helpful to understand the difference between ordinary depletion, autistic burnout, and depression.
Be Thoughtful With Body-Focused Practices
Mindfulness, body scans, yoga, breathing exercises, and other body-focused practices can be helpful, but they do not feel calming for everyone. For someone who has difficulty noticing internal sensations, gently bringing attention to the body can help them become more aware of subtle cues. For someone who already experiences bodily sensations very intensely, focusing on them too closely can increase discomfort or anxiety.
Mindful awareness does not require sustained or intense focus on a sensation. It can simply mean noticing what is present with curiosity and without judgment, then allowing attention to widen again. These practices are most helpful when they are flexible, optional, and adapted to the person's experience.
When Professional Support May Help
When interoceptive or emotional awareness differences are contributing to significant distress or making daily needs difficult to manage, working with a neurodiversity-affirming therapist can help someone better understand their patterns and identify supports that fit their needs.
Understanding Your Own Internal Experience
Interoception and alexithymia can provide useful language for experiences that otherwise feel confusing or disconnected. Someone may notice emotions only after the fact, miss early signs of hunger or exhaustion, or experience strong bodily sensations without immediately knowing what they mean.
Understanding these patterns can make it easier to recognize needs, communicate experiences, and build supports that fit the person. There is no requirement to become perfectly aware of every body signal or to always find the right word for an emotion. What matters is developing a better understanding of your own patterns and what helps.
References
Cook, R., Brewer, R., Shah, P., & Bird, G. (2013). Alexithymia, not autism, predicts poor recognition
of emotional facial expressions. Psychological Science, 24(5), 723-732.
Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic
review and meta-analysis. European Psychiatry, 55, 80-89.
Klein, M., Witthöft, M., & Jungmann, S. M. (2025). Interoception in individuals with autism
spectrum disorder: A systematic literature review and meta-analysis. Frontiers in
Psychiatry, 16, 1573263.
Van Bael, K., Scarfo, J., Suleyman, E., Katherveloo, J., Grimble, N., & Ball, M. (2024). A systematic
review and meta-analysis of the relationship between subjective interoception and
alexithymia: Implications for construct definitions and measurement. PLOS ONE, 19(11),
e0310411.
Williams, Z. J., Suzman, E., Bordman, S. L., et al. (2023). Characterizing interoceptive differences
in autism: A systematic review and meta-analysis of case-control studies. Journal of
Autism and Developmental Disorders, 53, 947-962.
