Autism, depression & suicidality – Alexithymia vs Empathy!

Clinician’s and other experienced mental health professionals report that people with autism have an associated risk to developing depression, hopelessness and suicidality. This means they are among the highest individuals at risk of ‘suicidality,’ – the term suicidality includes thoughts, plans and attempts to harm and kill oneself.

These suspicions have been evaluated by several large studies of adolescents and adults with autism and these studies have revealed that bleak and/or low moods and suicidal despair are alarmingly common, particularly among those on the milder end of the spectrum with so-called high-functioning autism or Asperger syndrome.

Although Asperger syndrome is no longer an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, the term is still in used in the U.K. and elsewhere, and many individuals still identify with it. The new correct terminology is Autism Spectrum condition (ASC) which works along a continuum scale with varying degrees of impairments in other areas, along this scale.

A common theme affecting those with ASC is the lack of empathy, and this lack of empathy could be misunderstood due to the nature of other complexities, inherent with this condition. It’s not because they don’t have those feelings, they just may not be able to access or have the vocabulary to describe their emotional state.

A common element associated with autism is alexithymia!

Alexithymia is the inability to talk about feelings due to a lack of emotional awareness. Individuals with Alexithymia are typically unable to identify, understand or describe their own emotions, and the construct of alexithymia refers to some of the chief manifestations of this deficit in emotional functioning. (maybe this explains the lack of empathy for those affected?)

Alexithymia is not a clinical disorder in its own right and this condition should not be confused with:

Apathy (a lack of emotional reactivity or motivation)
Emotional repression (subconscious but motivated denial of emotion).
Stoicism (deliberate resistance of emotional impulses)
Sociopathy (a lack of concern for others)

Common problems associated with alexithymia affecting Individuals include the notion that those on the spectrum find it difficult to talk about their emotions. They develop anxiety as they may be perceived by others as excessively logical or unsentimental without being unfriendly, and they may also become bewildered by other people’s emotional reactions. They give pedantic and long-winded answers to practical questions and they rarely daydream or fantasize about personal prospects and they have a subdued reaction to art, literature or music. They make decisions according to principles rather than feelings and also suffer occasional inexplicable physiological disturbances such as palpitations, stomach ache, or hot flushes. (Anxiety plays a huge role in autism and is one of the leading symptoms.)

This question is often asked in psychiatric syndromes, usually with the aim of attributing responsibility (capacity) or identifying suitable therapies – Is it psychological or neurological? – In my view, it’s both! The evidence for this condition can be either neurological (caused by biological abnormalities, birth/brain trauma – born this way) or psychogenic (caused by upbringing or psychological trauma, made this way).

Individuals with Autism often report that they don’t feel they belong here, that they should be somewhere else, on another planet. Due to the triad of impairments in social interaction, integration and communication, these difficulties compound the underlying depression and suicidality for those on the spectrum. Whereas the neuro-typical individual, who doesn’t have any underlying biological deficit, yet can exhibit the exact same symptoms to that of the autistic individual.

Note: (high functioning refers to the ability to articulate verbal language, whereas low functioning refers to having limited or no capacity to express language!) Along the continuum, there are those who are learning disabled and the higher end of the spectrum is those who are more intelligent, demonstrating exceptional skills and talent in many areas in the corporate world.

In one study of children with anxiety and high-functioning autism, researchers found that the children sometimes made suicidal threats for attention or to escape from an unpleasant situation. This is a reaction due to some limit being set being set or placed on the child, for example, a parent might announce that it’s time to stop playing video games, the child might throw a tantrum, lose control and say that he is going to kill himself. This leaves the parents in a state of anxiety and confusion. (A common thread in CAMHS) Some people will state that this is a behavioural manipulation tactic to continue with their favourite game, however, for those on the spectrum, it is evidently clear that due to limited emotional ability to understand and express emotions, the true reason for the threat is actually a red flag alert, indicating a problem and expression of their emotional state, saying that they need help.

In occupational science, and among professionals in this field, there are two schools of thought that oppose each other, one is the sensory / neurological theory, and the other is the behavioural / social theory. A common ground for much of the debate within the two fields of science!

There are also two scientific aspects for autism, one is the neurological (neuro is sensory related) and the other is sociological- (psychological – behaviour related!) There is increasing recognition of the co-occurrence of autism and schizophrenia spectrum disorders. However, the clinical significance of this on outcomes such as depression and suicidal thinking has not been explored. Autism is referred to as a developmental disorder, and one that underpins many other mental illnesses.

Schizophrenia being at the extreme end of the severity scale. Anxiety, depression tends to be at the lower end of the scale.

Autism and lack of empathy

Empathy involves two major components: a cognitive component (e.g., theory of mind, perspective taking, or mindreading) and an affective component (emotional processing) which allows us to share the feelings of others. The affective component of sympathy involves having an appropriate emotional reaction to another person’s thoughts and feelings. When engaged in affective empathy, we vicariously experience the emotional states of others, understanding that our feelings are not ours but rather those of the other individual.

Although alexithymia is not a core feature of autism, recent studies have found varying degrees of this trait in 50 to 85% of individuals with ASD. The alexithymia trait appears to have the following properties: (a) it is more common in individuals with ASC than in the general population (b) it is more common in parents of individuals with ASC than in parents of individuals with another developmental disabilities, (c) it is stable over time in ASC, and (d) problems in the domain of emotion awareness are positively related to depression, anxiety, somatic complaints, worry and rumination.

The medical field seems to be overwhelmed with the growing number of children, often under five, who are diagnosed with learning disabilities that frequently fall into one of these categories: ADD, ADHD, or Autism. It was reported that before the 1960’s these medical terms were non-existent. In 1985, in the space of 15 years, 500,000 children in the US were diagnosed with ADHD/ADD and by year 2000, 5 to 7 million were diagnosed. That is an alarming increase in such a short space of time, 1000 to 1200 percent rise within 15 years.

Something needs to change! Is it public attitude and perception towards those affected with this condition, or is it an environmental concern, needing a whole lot more education and a more compassionate, inclusive approach?

Alexithymia is a personality characteristic in which the individual is unable to identify and describe their emotions. The main feature of Alexithymia is an emotional unawareness, lack of social attachment, and poor interpersonal relating. Furthermore, those suffering from Alexithymia have difficulty recognizing and understanding the emotions of others.

Some would argue that men are all men partially alexithymia? Is that fair?
The stereotypical male is renowned for making stupid remarks in sensitive contexts, for being unable to talk about his feelings and misunderstanding emotional signals from their partners, but this doesn’t mean he is alexithymic. Cultural and societal trends tend to stereotype men and report that they may not say anything about how they are feelings, or try to verbalize their feelings. But he who is also fiercely passionate—about women, cars, football, career, house and children shows that he has not been educated or encouraged to express his feelings verbally, but he understands what they involve and acts accordingly. He may be deficient in emotional expression but he shows no impairments in awareness of feelings or in understanding what the feelings mean.

Therefore, this does not mean all men are alexithymic??  No, of course not, they do however, outscore women on this trait!

Women are apparently more intuitive and sensitive to the emotions of others. This may be partly due to learned cultural gender roles and partly to sex differences in neural organisation. The typical man may be poor in social intuition while being adept at heeding his own feelings and hunches. A common trait, which is merely incidental to alexithymia, and hence is sub-diagnostic for that condition.

So, to conclude, it appears that more males than females are alexithymic, however, alexithymia is by no means a ‘typical’ male trait. And suicidality, which is now becoming a growing concern, presents as a higher risk for those individuals with autism – (neurological impairment) as opposed to those who don’t. Secondly, suicidality affects both genders, on an equal level!

We need to move away from stigmatising mental health conditions and begin to combine both the social/psychological model alongside the biological/neurology, for a better outcome where an enhanced quality of life can be achieved, for all parties affected with ASC.

Compassion and care are fundamental in supporting those affected, social and emotional teaching is NOW VITAL and absolutely NECESSARY for childhood development, because these developmental disorders, have an increased risk for suicidality, and also demonstrate an increased risk, entering into mental health services.

5 Thoughts

  1. I’ve always viewed other kids my age as aliens when I was a child, ever since kindergarten. And I truly don’t belong anywhere, although I’ve tried to. I also have alexithymia. I can be depressed for days until I notice it. I feel totally calm before a dentist appointment, and suddenly realize my hands are shaking.

    Depression in autism might be situation-based, but it might also be partly because our brains are just wired this way, susceptible to depression.


    1. Hi Aspie girl. Yes i completely understand. It’s like living and longing for belonging in a society that doesn’t like people who are different, eccentric or/and sensitive. Anxiety is a common thread with all those who have this condition and depression is the curse.
      Were all different and diverse, I hope you find some true friends who do understand you and can support you. X


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