Emotions and empathy

Alexithymia is difficulty identifying and describing one's own feelings.² Across 15 studies using the Toronto Alexithymia Scale, autistic participants scored higher than non-autistic participants.¹ In the 9 studies that reported how many people passed the scale's cut-off, about half of autistic participants (49.93%, ranging from 33% to 63% between studies) scored in the alexithymic range, against about 5% (4.89%) of non-autistic participants.¹ The authors conclude that alexithymia is common in autism but not universal.¹

How alexithymia relates to sensing the body (hunger, heartbeat, temperature) is covered in Interoception.

Nearly all of this research rests on one tool, the Toronto Alexithymia Scale, usually its 20-item version (TAS-20), which people fill in about themselves.¹ That raises a problem: a person who has trouble noticing their feelings is asked to rate how well they notice them.

In 743 autistic adults and 721 adults from the general population, the TAS-20's intended structure did not fit the data adequately in either group. The two groups came from different studies, and the comparison group answered only 16 of the 20 items. The authors built an 8-item score from the scale (the GAFS-8) that measured alexithymia about equally well in both groups; in the autistic sample its scores went with autistic traits, repetitive behaviors and depression.³ The autistic sample was mostly women, diagnosed later in life and well educated, which limits how far the result generalizes. The paper is a revised version of an earlier article retracted over copyright.³

An older, smaller study found that autistic adults could report on their feelings by questionnaire. In 27 autistic and 35 non-autistic adults, scores on the TAS-20 and on a second alexithymia questionnaire were both stable when 19 of the autistic participants and 29 of the others were retested 4 to 12 months later. The TAS-20 separated the groups and the second questionnaire did not; the authors read this as a sign that alexithymia in autistic adults lies mainly in thinking about emotions rather than in feeling them. The autistic participants were also more depressed than the others.⁴ Alexithymia scores track depression in the larger study too,³ which makes a single score harder to read.

The scale's parts can behave differently. In 556 adults from the general population, one part, "externally oriented thinking" (a preference for concrete, outward-focused thought), was the only one that predicted lower accuracy once autistic traits were taken into account. It did so on emotion tasks and on a face-identity task, the second done by 325 of the participants.⁵

On average, autistic groups are less accurate at recognizing emotions in faces. One meta-analytic review, pooling subsets of 148 studies, found this for each basic emotion. It also found the difference was about as large for faces' non-emotional features, and for emotion shown in voices or bodies, so it is not specific to emotion in faces.⁶ In 2013, Bird and Cook set out the proposal, building on their group's earlier brain-imaging work, that the emotional differences seen in autism come from co-occurring alexithymia rather than from autism itself.^2,28 If so, autistic people without alexithymia should recognize emotions about as well as anyone. That earlier work was itself mixed: in a 2008 study, alexithymia scores tracked insula activity in both groups, while people rated their feelings about unpleasant pictures, but autistic participants still showed less activity in regions for self-reflection, whatever their alexithymia score.²⁸

Several studies fit this. In one experiment, alexithymia, not autism severity, went with how precisely people judged facial expressions; a second experiment suggested the difficulty lies in interpreting expressions rather than in seeing them.⁷ Autistic participants high in alexithymia recognized fewer expressions than non-autistic participants, while those low in alexithymia did not differ, even when the lower half of the face was covered.⁸ In 25 autistic and 45 non-autistic adults, less typical gaze at the eyes was best predicted by alexithymia.⁹ These three studies share authors, and the early supporting work was mostly with autistic men. Two studies from other groups agree: in 83 autistic women, a study set up to check whether the finding held for women, alexithymia, not autistic traits, went with lower accuracy at naming complex emotions,¹⁰ and in 247 adults from the community, measured on autistic traits rather than diagnosis, alexithymia fully accounted, statistically, for the link between autistic traits and emotion recognition.¹¹

Other studies do not fit. In 60 autistic and 60 non-autistic adults, autistic participants recognized facial emotions less accurately whether or not they had alexithymia; among the autistic participants, those with alexithymia showed different brain activity during the task but no difference in performance.¹² In 184 adolescents, 75 of them autistic, emotion recognition difficulties went with autistic traits and were not explained by alexithymia; both were rated by parents.¹³ In the 556-adult study, also of traits in the general population, autistic traits were the strongest predictors of emotion recognition, and people high in autistic traits recognized emotions less accurately whatever their alexithymia level.⁵ Most of these studies measure alexithymia with the TAS-20.

Researchers separate cognitive empathy, understanding what someone else feels, from affective empathy, being moved by it.^14,15 A 2025 meta-analysis of 226 studies found that autistic groups scored lower than non-autistic groups on cognitive empathy, by a large margin on average (g = −0.85). The difference in affective empathy was small (g = −0.17) and was no longer significant when only high-quality studies were counted.¹⁴ Results varied widely by measure. Tools that give empathy a single score showed the largest gap (g = −1.70), and that gap varied with the sex make-up of the samples. On one common questionnaire, autistic participants reported less concern for others in distress (g = −0.59) but more personal distress, feeling upset themselves (g = 0.67). In the same paper, a qualitative review of tasks closer to real life and of brain imaging found mostly minimal differences.¹⁴ Across studies, a sample's average alexithymia, its age, verbal IQ and study quality did not change the size of the differences.¹⁴ That comparison is between studies, so it cannot rule out a role for alexithymia within individuals.

Two early small studies of adults with Asperger syndrome, from one research group, found a similar pattern. On a photo-based test, 17 adults scored lower than 18 matched adults on cognitive empathy but no different on emotional empathy.¹⁵ On a questionnaire, 21 adults reported the same concern for others as 21 matched adults, and more personal distress.¹⁶ A small brain-imaging study from the group that later proposed the alexithymia hypothesis, on empathy for another person's pain, found that the response in the insula tracked alexithymia in both groups, and the groups did not differ in empathy once alexithymia was taken into account.¹⁷

In an editorial, two researchers, one of them a co-author of the alexithymia hypothesis, argue that flawed terminology, measurement and theory have helped portray autistic people as lacking empathy.¹⁸ For the view that difficulty reading each other runs both ways between autistic and non-autistic people, see Double empathy.

In 2009, Adam Smith proposed the empathy imbalance hypothesis: that autistic people have too little cognitive empathy and too much emotional empathy, and that this imbalance, with a tendency to be overwhelmed by others' feelings, might give rise to autistic behavior. He noted that too much empathy is a recurring theme in autistic people's own accounts.¹⁹

A later research group calls the gap between the two kinds of empathy "empathic disequilibrium". In 1,905 autistic and 3,009 non-autistic adults who completed the Empathy Quotient questionnaire online, a tilt toward higher emotional than cognitive empathy predicted an autism diagnosis and social autistic traits, and it was more marked in autistic women; the opposite tilt went with non-social autistic traits. Diagnosis was self-reported.²⁰ The tilt is within each person. In the average scores, autistic participants' emotional empathy was still lower than the comparison group's, though less reduced than their cognitive empathy.²⁰ In 163 children aged 4 to 10, rated by parents, a tilt toward emotional empathy went with more autistic traits; the children were not a diagnosed group, and the study comes from the same research group.²¹ A 2025 online study of 304 autistic and 289 non-autistic people, with authors from the same group, repeated the pattern: autistic participants were more likely to show the emotional tilt, and did not differ in overall empathy. In autistic participants the tilt went with more self-injury, through stronger emotional reactions; the study measured everything once, so the direction is unknown.²⁹

So the evidence supports a different balance between the two kinds of empathy, measured by questionnaire. It does not show that autistic people feel more emotional empathy than others, or that the imbalance produces autistic behavior.

In psychology research, rejection sensitivity is the tendency to defensively expect, readily perceive and react strongly to rejection, a concept from Downey and Feldman with its own questionnaire.²² "Rejection sensitive dysphoria" (RSD) is a different, newer term. It was introduced by the psychiatrist William Dodson from his clinical experience with ADHD clients and spread through social media among people with ADHD and autistic people. A 2026 critical review warns that it has limited empirical evidence and recommends the established concept of rejection sensitivity instead.²³ Its author also led the interview study below.

Research on rejection sensitivity in autistic people is thin. In interviews with 19 autistic adults aged 21 to 71, recruited through social media because they reported heightened rejection sensitivity, participants described it as overwhelming and exhausting, at times with physical tension, pain and reliving past rejections. They said it was often dismissed, including by health professionals, and linked it both to autistic traits and to a lifetime of rejection. The authors call for quantitative studies of how common it is.²⁴ In a non-clinical sample, people scoring high on autistic traits reported more hurt feelings after rejection in a lab task than low scorers and showed larger EEG responses to it. In a second sample, measured once, rejection sensitivity partly accounted for the link between autistic traits and depression and anxiety symptoms.²⁵ No study found as of October 2026 has measured how common rejection sensitivity is among diagnosed autistic people with a standard questionnaire.

Most of the related research is on ADHD. In 391 young adolescents from the community, more ADHD symptoms, as rated by mothers, went with a larger early brain response to peer rejection, higher self-reported rejection sensitivity, and a smaller brain response to acceptance. In the full analysis, the link with self-reported rejection sensitivity was no longer significant once anxiety, low mood and aggression were taken into account.²⁶

Rejection is also an outside fact. In three studies reported in one paper, non-autistic observers who watched short clips formed less favorable first impressions of autistic adults and boys from video clips a few seconds long, and said they would be less inclined to interact with them. The ratings did not change over repeated viewings. The autistic people filmed were few (39 across the studies) and mostly male without intellectual disability. In the one study that tested it, the gap was not found when observers read only a transcript of what was said.²⁷

Alexithymia is a familiar word in autistic writing. Megan Anna Neff, an autistic psychologist, writes that "About half of Autistic folks grapple with alexithymia" and that emotions felt "like an alien landscape" to her; her tools include feeling wheels, fiction, music and journaling.^c1 Devon Price gives the same figure, from Geoff Bird's research, and describes sometimes working out what was wrong only "hours or days later".^c6 Price suggests alexithymia "may arise, in part" because autistic people are taught to track others' feelings ahead of their own.^c6 Steven Smith offers a different reading: "We know in such detail how we feel as to be unable to label it with just one feeling."^c3 Others describe knowing a feeling only through the body. Jack K., writing in a guide for clinicians, says: "Sad is pressure behind my eyes." When others talk about emotions, Jack K. writes, "it’s like trying to describe a color."^c10 Daniel Burford, who describes "severe alexithymia", recalls meeting a loss not as grief: "I experienced it as too much."^c11

On empathy, many writers reject the idea that autistic people lack it. Sarah Nannery calls it "factually incorrect" and writes that "many people with ASD experience too much empathy"; seeing a person who is homeless bed down for the night, "In my mind, I am that person."^c5 Neff describes autistic people as either hypo-empathetic or hyper-empathetic, and herself as having "porous skin" that lets others' emotions in; her answer is "artificial skin" built from routines, interests and boundaries.^c1 Not every writer describes too much. Price writes, "I have to actively choose to be caring."^c7 Pete Wharmby describes autistic people as "emotional sponges" who take on the tension in a room, and adds that the inside does not always show: with flat affect, a neutral face, an autistic person "may be absolutely emotionally floored by the sadness of a friend, but look completely nonchalant and unbothered".^c12

Rejection sensitivity comes into autistic writing largely from ADHD circles. Megan Griffith notes that RSD is not an official criterion for diagnosing ADHD but is "very popular in the ADHD community".^c9 Neff calls rejection sensitivity common among ADHDers and autistic people and suggests naming it: "That's my rejection sensitivity acting up."^c2 Wharmby calls RSD the trait that, along with executive dysfunction, "disables me the most".^c13 Smith describes being "so sensitive to it that you arrange your life to avoid the feeling at all costs".^c4 Price questions the label itself, writing that RSD "has not been formally studied in the scientific literature very well" and that "We're not irrational for fearing that others will dislike us."^c8 That is Price's argument about the term; the research section above describes what has been measured.