Alexithymia: meaning, signs, causes, the TAS-20 and how to practice naming feelings

CareOps editorial team · October 28, 2026 · 10 min read

Mental wellness information and service guidance published by CareOps.

When someone asks “How are you feeling?”, do you usually end up saying “I don't know”? Your chest feels tight and your body feels heavy, but you can't tell whether it's hurt, worry or anger, and people close to you may say they can't read you. The word for this pattern is **alexithymia**. The name sounds heavy, but it is not a malfunction; it is a trait that varies from person to person, and noticing feelings and putting them into words can be practiced.

What does alexithymia mean? Is it an illness? #

Alexithymia joins Greek words meaning “no,” “word” and “emotion,” so it literally means having no words for feelings. Psychiatrist Sifneos (1973), who studied patients seeking care for physical symptoms and noticed how hard it was for them to put feelings into words, is known as the person who first used the term.

Despite the medical-sounding name, alexithymia is not a psychiatric diagnosis. A study of 1,285 people from the general population of Finland (Salminen et al., 1999) found that scores followed a bell-shaped (normal) distribution, confirming that it is not an all-or-nothing illness but a personality trait that varies in degree. So it is closer to “I find it harder than most to notice and express my feelings” than to “I have a disorder.”

The three features of alexithymia #

The most widely used questionnaire, the Toronto Alexithymia Scale (TAS-20; Bagby, Parker & Taylor, 1994), looks at alexithymia in three parts.

The three don't always come together. In the same Finnish survey, men scored higher than women on difficulty describing feelings and on externally oriented thinking, but there was no gender difference in difficulty identifying feelings. Knowing which part is harder for you shows you where to practice.

Signs of alexithymia in daily life and relationships #

Alexithymia can look like indifference from the outside, but it doesn't mean having no feelings. It is closer to having feelings but a narrow path to noticing and naming them. In daily life it can show up like this.

• You feel it in your body instead of your mind: a day of hurt or tension registers only as “I have a headache” or “I'm tired.”
• “I don't know” and “I'm fine” are your default answers: when asked how you feel, words get stuck and you keep it short.
• Feelings build up and burst out at once: small hurts slip by unnoticed, then one day you feel a surge of anger or tears without knowing why.
• In relationships, partners say they can't read you: they want to share feelings while you answer with solutions or facts, so it's easy to feel you're missing each other.
• Reading other people's feelings can be hard too: it may be difficult to guess why someone is upset, which can make conversations awkward. See low empathy and how to build it for how this connects to empathy.

Some research connects with feeling things in the body first. Brewer and colleagues (2016) reported that alexithymia is linked not only to emotions but to difficulty noticing body signals in general, such as hunger, tiredness and temperature, and suggested seeing it as part of a broader difficulty reading the body. If physical symptoms last a long time, don't put them down to emotions alone; have your body checked by a doctor too.

What causes alexithymia? #

There is no single known cause of alexithymia. Research so far suggests several factors working together.

• How you read body signals: as in the study above, if body signals are hard to notice, it may also be hard to tell feelings apart from them.
• Growing up where feelings weren't discussed: if feelings were rarely talked about at home, or showing them led to being scolded or ignored, there may have been few chances to learn words for them.
• Having had to switch feelings off: some people got through very hard times by not feeling. That protected them then, but it can make noticing feelings harder now.
• Social conditions: in the Finnish survey, scores tended to be higher among men, older people and those with less education or lower socioeconomic status. In a later study, however, these links disappeared once depression was taken into account.

How is alexithymia related to depression and autism? #

Alexithymia is closely tied to depression. In a study of 2,018 people from the Finnish general population (Honkalampi et al., 2000), 32.1% of those with higher depression scores had high alexithymia scores, compared with 4.3% of those without depression. The researchers concluded that depression must be considered whenever alexithymia is studied. If your mood has been low for a long time, also see early signs of depression.

It also often appears alongside the autism spectrum. A meta-analysis of 15 studies (Kinnaird et al., 2019) found high alexithymia scores in about 50% of autistic participants and about 5% of non-autistic participants. The researchers concluded that alexithymia is common, but not universal, in autism. Having alexithymia doesn't mean you are autistic, and being autistic doesn't mean you have alexithymia.

Is there an alexithymia test? About the TAS-20 #

The most commonly used tool is the TAS-20, a 20-item self-report questionnaire that Bagby, Parker and Taylor revised from an earlier version in 1994. It gives a score for each of the three features above, and its reliability and three-factor structure have been confirmed across several groups.

Many “alexithymia tests” circulating online have unclear sources or scoring. Rather than letting one number define you, use a questionnaire to see which of the three parts is hardest for you. If the result worries you, you can go over it with a mental health professional.

The CareOps emotion regulation check (ERQ) is not an alexithymia test. It is a 10-item check on how often you use reappraisal (changing how you think) and suppression (holding back expression) when handling feelings. You can use it alongside this article to reflect on how you tend to handle emotions.

Five ways to practice noticing and expressing feelings #

Noticing and naming feelings grows stronger with use, like a muscle, and putting feelings into words has power of its own. In one brain imaging study (Lieberman et al., 2007), simply labeling feelings reduced the amygdala's response to negative images.

1. Grow your feeling vocabulary: instead of just “good” or “bad,” collect words such as hurt, wronged, deflated or proud, one at a time. See naming your emotions for how.
2. Start from body signals: when a feeling is hard to catch, start with your body. Note whether your shoulders are tight, your chest feels heavy or your stomach hurts, then ask, “If this sensation were a feeling, what would it be closest to?”
3. Keep a one-line emotion diary: each day, write one line each for what happened, what your body felt and the closest feeling word. At first it's fine to write “not sure.” See how to keep an emotion diary.
4. Separate thoughts from feelings: “They ignored me” is a thought; the hurt or anger you felt then is the feeling. Writing them separately makes the feeling a little clearer.
5. Tell one trusted person, briefly: even if you're unsure, try “I think I felt a bit hurt today.” Expressing feelings isn't about getting the answer right; it's practice in sharing.

Once you notice a feeling, you can continue with how to regulate emotions to work with it. If you've had many days of feeling nothing at all, as if you were hollow inside, also see feeling empty.

If you want to keep practicing through conversation #

On your own, it's easy to get stuck at “What am I feeling right now?” CareOps Maeumi is an AI counseling app that runs sessions with approaches such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT), goes through what happened that day with you to put names to the body sensations and feelings you had, and remembers past sessions so the next one picks up where you left off. Get the app

This guide shares mental wellness information. If you are in immediate danger, contact emergency services where you are. Support and contact information.