Silent Struggles: Exploring PTSD, Autism, and Alexithymia
Post-Traumatic Stress Disorder (PTSD) is most often associated with war, natural disasters, or single-incident traumas. Yet for many autistic individuals, trauma arises through less visible but equally devastating pathways: years of social exclusion, relentless sensory overwhelm, or systemic invalidation in schools, workplaces, and healthcare. While such experiences may not always fit the narrow definitions of trauma in diagnostic manuals, they can leave profound and lasting imprints on the mind and body.
One critical yet often overlooked factor in this intersection is alexithymia a condition marked by difficulty identifying, describing, and processing emotions. Around 40–65% of autistic individuals experience alexithymia, but it is also prevalent in people with PTSD, depression, eating disorders, and substance use disorders. Alexithymia often functions as a protective adaptation: muting emotional awareness to shield individuals from overwhelming suffering. However, it also blocks emotional growth, relationships, and recovery.
Trauma in the Autistic Context
Trauma Beyond DSM-5 Definitions
The DSM-5 defines trauma as exposure to events involving actual or threatened death, serious injury, or sexual violence. While autistic individuals certainly encounter such traumas, they also report PTSD symptoms after experiences that the DSM does not traditionally recognize such as prolonged bullying, coercive therapies, or repeated sensory assaults (Rumball, Happé, & Grey, 2020).
Consider an autistic child repeatedly forced to endure loud fire alarms in a school hallway, or an autistic adult undergoing invasive medical procedures without consent or accommodation. These experiences may not be labeled as “trauma” in clinical frameworks, yet they can trigger the same hyperarousal, flashbacks, and avoidance behaviors as more conventional traumas.
Elevated Risk Factors
Research identifies multiple overlapping vulnerabilities that place autistic individuals at elevated risk of trauma:
Bullying and Victimization – Autistic youth are significantly more likely to be bullied or socially excluded (Hoover & Kaufman, 2018).
Systemic Ableism – Schools, workplaces, and healthcare often dismiss autistic distress or force compliance (Kerns et al., 2015).
Medical Trauma – Repeated coercive interventions or insensitive care foster mistrust and fear.
Sensory Vulnerability – Heightened sensitivity to sound, light, or touch can turn otherwise tolerable events into traumatic imprints (South & Rodgers, 2017).
The accumulation of these stressors often results in complex trauma, formed not by a single catastrophic event but through chronic exposure to invalidation, overwhelm, and harm.
Alexithymia: The Missing Link
Defining Alexithymia
Alexithymia literally means “no words for emotions.” It involves both cognitive aspects (difficulty identifying feelings, distinguishing emotions from bodily sensations, describing emotions, recognizing facial expressions) and affective aspects (limited imagination, externally focused thinking) (Taylor et al., 1997).
Contrary to stereotypes, alexithymia does not mean a lack of emotions. Instead, emotions remain inaccessible to conscious awareness, often surfacing only through physiological arousal or behavior. A person may be experiencing deep stress or grief but, when asked how they feel, sincerely answer: “I’m fine.”
Alexithymia as a Protection Mechanism
Alexithymia often develops as a defense against overwhelming emotional distress. Trauma rewires the brain to mute awareness of feelings, shielding the person from collapse. While this reduces suffering in the short term, it also blunts positive emotions, blocks relational growth, and impairs trauma recovery (van der Kolk, 2014).
Having said that, reduced access to emotion does not mean absence of emotion. Emotions continue to play out in the subconscious and body but rarely surface in ways the person can name.
Suffering from Alexithymia
The deepest suffering of alexithymia may not be acute distress but chronic disorientation. Without access to emotions, individuals cannot chart where they are in their emotional or spiritual journey, nor identify what they need to move forward.
People with alexithymia often dismiss tools like mindfulness or therapy as ineffective, only to later realize once emotionally ready that such practices can be transformative. Many grow up believing emotions are irrational or dangerous, failing to recognize that emotions are vital to logic and decision-making.
Being cut off from one’s own emotions also means being cut off from others’. Empathy may fluctuate unpredictably, leaving relationships strained. Others may perceive people with alexithymia as emotionally shielded or intimidating, further isolating them.
At the same time, alexithymia fosters endurance. Those who feel less consciously are sometimes more resilient to hardship. Yet what is gained in endurance is lost in intimacy, vulnerability, and relational healing.
Consequences of alexithymia include:
Inaccessibility of emotions, leading to poor self-understanding.
Delayed emotional development, requiring “catch-up” later in life.
Fluctuating empathy, sometimes harming relationships.
Reduced sociability and increased loneliness.
Shallow positive emotions, with negative emotions lingering longer.
Somatization, in which unprocessed feelings manifest as chronic pain, inflammation, or exhaustion.
Trauma expression leaking into relationships and behaviors without conscious control.
As Carl Jung (Swiss psychiatrist, psychotherapist, and psychologist who founded the school of analytical psychology) observed: “Until you make the unconscious conscious, it will direct your life and you will call it fate.” highlights the idea that our unconscious mind significantly influences our thoughts, feelings, and actions, often without our awareness
Who Gets Alexithymia?
Alexithymia is not exclusive to autism. Prevalence in the general population ranges from 4.9% to 13%. Among autistic individuals, prevalence ranges from 40–65% (Bird & Cook, 2013), with some studies reporting up to 70%. Alexithymia’s presence across diverse groups underscores its role as a coping mechanism for trauma and hardship.
PTSD Phenomenology in Autism
Overlapping and Masked Symptoms
PTSD in autistic individuals often looks different from textbook cases. Common presentations include:
Meltdowns or shutdowns in response to triggers.
Skill regression, such as reduced communication or daily living independence.
Avoidance of sensory triggers, environments, or people linked to trauma.
Sleep disruption, nightmares, or circadian rhythm dysregulation.
Somatic complaints, including chronic pain, headaches, or digestive distress.
Because these overlap with baseline autistic traits, clinicians may misattribute them to autism rather than trauma (Kerns et al., 2022). This diagnostic overshadowing delays treatment.
Intrusive Symptoms
Autistic PTSD survivors often experience sensory-based flashbacks (sounds, smells, tactile sensations) rather than narrative memories. A child who experienced restraint at school may feel overwhelming panic simply when hearing footsteps behind them.
Hyperarousal
Autistic individuals often live with heightened baseline arousal due to sensory sensitivities. Trauma exacerbates this, producing constant hypervigilance, exaggerated startle reflexes, and difficulty calming down after stress.
Emotional Numbing and Dissociation
Alexithymia intensifies the numbing aspect of PTSD. Survivors may appear calm or indifferent, when in fact they are deeply disconnected from their emotions. Dissociation may be misunderstood as apathy rather than a trauma survival strategy.
Suicidality
Trauma significantly increases suicidality among autistic populations. Storch et al. (2013) found autistic youth with PTSD symptoms were far more likely to experience suicidal ideation. When combined with alexithymia, which obscures distress, this risk becomes acute.
Shared Mechanisms Linking PTSD, Autism, and Alexithymia
Heightened Sensory Encoding – Traumatic memories are more vivid due to sensory sensitivity (Green & Ben-Sasson, 2010).
Chronic Systemic Trauma – Lifelong bullying, exclusion, and ableism accumulate into complex trauma (Botha & Frost, 2020).
Alexithymia as Barrier – Protects against suffering while obstructing emotional integration.
Physiological Stress Reactivity – Autistic individuals show altered cortisol rhythms and heightened stress (Corbett et al., 2009).
Relational Disconnect – The “double empathy problem” (Milton, 2012) reduces mutual understanding and social validation, deepening trauma.
Conclusion
The intersection of PTSD, autism, and alexithymia reveals a cycle: autistic traits increase vulnerability to trauma, trauma fosters alexithymia, and alexithymia obscures PTSD. This cycle deepens suffering but also reveals pathways to resilience.
By recognizing autistic experiences of trauma, understanding alexithymia as both shield and barrier, and adapting therapeutic approaches, clinicians and communities can move beyond crisis management toward genuine healing. Trauma may shape autistic lives, but it does not define us. With trauma-informed, neurodiversity-affirming care, autistic individuals can reclaim connection with their emotions, their bodies, and their communities.
References
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Storch, E. A., Sulkowski, M. L., Nadeau, J., Lewin, A. B., Arnold, E. B., Mutch, P. J., & Murphy, T. K. (2013). The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(10), 2450–2459.
Taylor, G. J., Bagby, R. M., & Parker, J. D. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge University Press.
Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.