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. 2023 Jun 1;5(2):210-216.
doi: 10.1089/aut.2022.0113. Epub 2023 Jun 13.

Brief Report: An Exploration of Alexithymia in Autistic and Nonautistic Transgender Adults

Aimilia Kallitsounaki  1 , David M Williams  1
Affiliations

Brief Report: An Exploration of Alexithymia in Autistic and Nonautistic Transgender Adults

Aimilia Kallitsounaki et al. Autism Adulthood. .

Abstract

Background: Research has shown that many autistic people have alexithymia, a psychological trait characterized by difficulties in identifying and describing emotions. It is also now clear that there is a high rate of autism among transgender people, but we know little about the intersection of autism and gender diversity or about the clinical features of autistic transgender individuals.

Methods: Seventy-eight nonautistic transgender, 56 autistic transgender, 106 nonautistic cisgender, and 107 autistic cisgender adults completed the Toronto Alexithymia Scale-20 and the Autism-spectrum Quotient as part of an online study. We also used the General Alexithymia Factor Score-8 as an additional alexithymia score.

Results: We found that nonautistic transgender participants reported significantly higher mean levels of alexithymia than nonautistic cisgender participants, and that there was a significant overrepresentation of individuals in this group who met the clinical cutoff for alexithymia. The difference in alexithymia between autistic cisgender and autistic transgender participants was nonsignificant, with >50% of each group scoring above the clinical cutoff point. Of note, when we used the General Alexithymia Factor Score-8, the difference between autistic transgender participants and autistic cisgender participants was significant, with autistic transgender participants reporting higher mean levels of alexithymia.

Conclusion: Results suggest that nonautistic transgender individuals might be more prone to experience alexithymia (including at clinically significant levels) than nonautistic cisgender people. When autism occurs in transgender people, the average level and clinical rate of alexithymia is higher than among nonautistic transgender people and potentially higher than among autistic cisgender people. Our findings are in keeping with evidence of a subgroup of transgender people with "subclinical autism" and inconsistent with the notion that autism among transgender and gender diverse people is a "phenomimic" of autism. Lastly, our study highlights the potential importance of screening autistic and nonautistic transgender people for alexithymia.

Keywords: alexithymia; autism; autistic traits; gender dysphoria; gender incongruence; transgender.

Plain language summary

Why is this an important issue?: Alexithymia is when a person has difficulty recognizing and describing their emotional feelings. It also includes an externally oriented thinking style. Research has shown that many autistic people experience alexithymia. Autistic people with alexithymia might require additional and specialized support and care.

What was the purpose of this study?: There are a large number of transgender and gender diverse people who are autistic. However, we know little about the intersection of autism and gender diversity or about the clinical characteristics of autistic people who identify as transgender. The purpose of this study was to explore alexithymia in autistic and nonautistic transgender individuals.

What did the researchers do?: We conducted an online study that included questions about people's ability to recognize and describe their emotional feelings as well as about their preference to engage with the world around them than the world inside them. Participants also answered questions that tap characteristics of autism.

What were the results of the study?: We found that nonautistic transgender adults had more difficulty identifying and describing their emotional feelings than nonautistic cisgender adults. We also found that autistic transgender adults reported significantly higher levels of alexithymia than nonautistic transgender adults and potentially higher than autistic cisgender adults.

What do these findings add to what was already known?: This study showed, for the first time, that (1) it is not always easy for nonautistic transgender people to identity and describe their emotional feelings and (2) autistic transgender people find at least as difficult as autistic cisgender individuals to describe and identify their emotional feelings.

What are potential weaknesses in the study?: We did not examine depression and anxiety in our participants. People with depression and/or anxiety might score high on the scale we used to measure alexithymia. This was also an exploratory study, so other researchers should replicate our findings before we draw strong conclusions.

How will these findings help autistic adults now or in the future?: Our findings are consistent with the notion that autism in transgender people is “real,” meaning that it has the same underlying basis in autistic cisgender and autistic transgender people, and suggest that autistic transgender people might benefit from receiving support for difficulties related to autism independently of the support and treatment they might receive for gender-related needs.

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Conflict of interest statement

No competing financial interests exist.

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