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

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 non-autistic transgender, 56 autistic transgender, 106 non-autistic 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 non-autistic transgender participants reported significantly higher mean levels of alexithymia than non-autistic 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 and autistic cisgender participants was significant, with autistic transgender reporting higher mean levels of alexithymia. Conclusion:Results suggest that non-autistic transgender individuals might be more prone to experience alexithymia (including at clinically significant levels) than non-autistic cisgender people. When autism occurs in transgender people, the average level and clinical rate of alexithymia is higher than among non-autistic 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 3 transgender and gender diverse people is a "phenomimic" of autism Lastly, our study highlights the potential importance of screening autistic and non-autistic transgender people for alexithymia.

Approaching Autism Diagnosis and Care Through the Lens of Gender Diversity

“…[38][39][40] It is important to note that one common symptom of autism, alexithymia (difficulty with identifying, expressing, and/or describing one's feelings), may play a role in gender identity differences in people with ASD. 41,42 Because of alexithymia, autistic individuals may have difficulties discussing gender discernment and may lack the ability to advocate for their gender needs. 37 As of 2020, one in 36 children has been identified with ASD.…”