Alexithymia and Interoception

I never knew I was anxious as a child, or ever really. I thought everyone experienced sweaty palms and a difficult time speaking, or reading things, in front of others. I thought everyone was in pain with loud noises, and we were all supposed to pretend. I would try not blinking whenever I got startled or when my ears hurt (which was often). I’d try to distract myself with books.

I had approximately 4 ways to describe my feelings: content, unpleasant, annoyed, or frustrated.

And annoyed and frustrated were two different intensities of the same feeling.

This is all I ever used. I never said I was in pain – after all, my ears were in pain daily, but that was “normal.” Who’s to say any other physical pain wasn’t normal too? In fact, physical pain was often not as bad as the sensory pain I experienced (especially with hair brushing – that was very painful). I thought I was never supposed to complain, since I knew if I did (at least with loudness), they would not believe it really did hurt me, because I didn’t use the word hurt, or pain. I’d just ask to turn it down, that it was too loud. I was used to things being too loud. I learned I did not have control over it, so I had to learn to live with it. That this was just life. I thought everyone experienced this. Once something is a baseline for so long, you don’t know how anything else feels – how a lack of anxiety would even feel. Of course, I didn’t know I had anxiety. I just knew I had to prepare for things others didn’t, and had to compensate for, you know, being my “weird” self that I was thought to be.

 

Interoception

Since my diagnosis, I’ve found ways to learn what I am feeling. Sometimes I will check my pulse (just touch my neck, sometimes I can feel/hear it without doing this) to see if it is fast. That is how I know I am very anxious.

For me, sensory issues are very much relate to my anxiety. For example, I get anxious every time someone walks next to my office. What if they’re going to talk to me? What if I’m not working hard enough (even though I’m literally working) and they think I’m not doing a good job? What if it’s someone I haven’t seen in a while? What if I have to get up right then and I forget what I was reading?

Getting rid of that input – closing the door, or putting on headphones, really helps me think. I guess it is tied with worrying that I am not doing enough, since I have been a perfectionist growing up and often worried about the validation of others (because that’s how you measure your worth when all you have is your “smarts,” in your mind).

Even simply wearing headphones for half of the day has absurdly reduce my anxiety in general, and I am very lucky that this has helped me this way (not saying others have similar experiences or not).

Strategies for Daily Emotional Regulation:

When I realized that wearing headphones had helped me with anxiety in multiple ways/multiple places, I tried to check in with my sensory environment at least every few hours every day. Setting a reminder might help.

Here are some pragmatic things I check to determine my emotional state (of course not everyone experiences things this way, this is just my experience and what helps me):

Check pulse – am I anxious? Are my palms sweaty? Does my breathing feel weird or kind of like butterflies/tingly?

•  Pulse is low: Maybe it’s a sensory thing. Feel uncomfortable/annoyed.
  • Motion/Pain/Comfort: Maybe I’m restless. Have I been sitting in a weird position? Do I need to move my angle on my monitor? How do my muscles feel? Am I in mild joint pain without realizing? Do I need to sit up straight/pull my neck back and down? Do I need to do some stretches? Am I getting sleepy? Get up and walk to the window, or do stretches. – Try it. Sometimes helps.
  • Temperature: Do I feel really restless?
    • This sometimes happen when I’m too warm. I should take my jacket off! Do I feel better? (70% of the time I do but I’ve only learned about this recently. I used to think my being restless was a motion issue).
    • Am I distracted from being too cold? Is it unpleasant? I should put my jacket on.
  • Sound: Do I need to move rooms? Is there too much ticking/random noise? Is it too loud, do I need to wear headphones? – Try it.
    • Getting sleepy and annoyed? Try listening to music or a podcast (often helps). Need to move rooms because it didn’t help? Try it. It will likely help.
  • Light: Is my laptop too bright? Is there a weird glare on it? Am I having a hard time focusing my eyes? Do I need to change my background color on my computer, or flux? Do I need to work somewhere else, or look out the window for a few minutes? Am I working under fluorescent light? Do I need to move to a room with natural light? – Try it. Other people may also wear sunglasses for this.

• Pulse is high: I must be anxious. 
  • Possible reasons: Am I worried about something? Is there a future event coming up? Am I procrastinating doing a task? Yes – drink some water, make sure you’re eating, listen to some music or do a manual task or reading task that is productive. Try focusing on something else.
    • If that doesn’t work, talk to your co-worker about the thing that is worrying you, or go to the sensory list above.

 

Sometimes I get the feeling that something’s just “not right.” I’ve been trying to get better at detecting this feeling. It seems to get easier when you check in with yourself regularly consistently. You could even put a reminder on your phone every hour during the day (if nothing else, just to remind you to blink while looking at a computer screen!).

I used to think that I never felt nauseous. Ever. Turns out, I just didn’t know what nauseous felt like. I don’t think I had it often, but it’s hard to remember an entire 20 years. Some medication I take makes me nauseous but only randomly pops up from time to time and is not consistent. Many times I will say to my husband, “my stomach feels weird, I don’t know why. I’m not sure if I should eat though.” Until recently, I didn’t know that I was experiencing nausea.

This picture that was shared on social media made me realize what it was. I get this strange feeling right under the center of my ribs, especially when I’m breathing. That to me is how I experience nausea. It usually takes me anywhere from 2-5 hours to realize that I am experiencing it, while I am of course still forcing myself to eat (because you know, my stomach just feels weird, I’m not nauseous!). It’s kind of hard to remember the feeling since I only have it maybe 5-6 times a month too.

Book cover of a book called Interoception: The Eighth Sensory System by Kelly Mahler, MS, OTR/L.

I also have trouble recognizing when I’m tensing my muscles (which of course, likely caused TMJ and some low muscle tone, since I held my shoulders up as a kid all the time without knowing how to relax them – this leads to weirdly large neck muscles to compensate for your very weak shoulder muscles – not recommended!). It’s like your body isn’t giving you enough feedback on what you are actually physically doing. This is probably why I exert a lot of force when it is unnecessary – either I’m not using the correct group of muscles (for things like writing or opening jars) or I’m not getting the feedback that other people do when they tense their muscles the same way. It’s like I don’t have enough finesse in my muscle groups (except for fine motor skills of hands/fingers oddly, I appreciate my kid piano lessons..). Many things that come “naturally” for other people to do physically, do not come naturally to me. I often end up using the wrong muscle group or doing something a different way to compensate for my lack of finesse in other muscle groups. Oh and I also have terrible balance, which shouldn’t be too surprising after that explanation.

 

How My Emotions Physically Feel:

• Anger/frustration – it’s like there’s an energy I have to get out of my vocal chords. I often want to growl. My throat gets tight from suppressing it, and I tense my jaw muscle a lot (often without realizing it until later). I often tighten/wring my hands to try to get the energy out, and my chest can sometimes feel hot, as well as my head.
• Sadness – It feels like my head is weighed down, or I’m kind of sinking down when I breathe. I’m not sure if it’s necessarily heavy breathing. I feel like a rag doll. I just let my arms kind of sit there and don’t really tighten many muscles (which is noticeable because I usually do that in baseline life).
• Restlessness – The obvious one is feeling like I need to move. I also seem to feel energetic, like wanting to do some manual task or something. Similar to being angry in terms of getting energy out of my system, but not with a tight chest or anything, and not wanting to scream. More like needing to be productive or something. I feel kind of itchy, like, none of my positions I’m sitting in are comfortable or pleasant. Nothing feels “right” but I’m not upset by anything and am not intentionally tensing anything. This also may be overlapping with motion/pain/comfort section, so maybe I haven’t worked out restlessness yet.
• Anxiety – Usually I can hear my heartbeat. Honestly this is the hardest one to describe because I’ve felt it for so long. I’m more noticing what it feels like without it. If it’s social, I’ll have something to say in my head, or repeat a thought over and over to try to get it right. I’ll often put my hands on my neck/shoulder or face. Sometimes I’ll dig my fingernails into my skin to get a distraction to reduce it if it’s really bad and also overlaps with anger or frustration. I might have sweaty palms and try to put pressure on my hands – put them under my knee or sit on them. It’s like I need to put my hands somewhere that they will sink in and be safe, where they are not just roaming around everywhere. Maybe it helps me feel grounded. I’ll feel my throat tighten up and notice saliva in my mouth a lot more. The inside of my head becomes louder (my own mouth movements/talking/breathing/heartbeat becomes louder). I tense my jaw and neck. I get tingling/butterflies when I exhale, slightly lower than where I would get the feeling of nausea.
• Nausea – Weird feeling of moving pressure right under the center of my ribs, or at the sternum. Feels like it’s near my lungs (but it’s probably my stomach). Doesn’t really cause pain. It kind of pulsates when I breathe which I really dislike.
• Hunger – I only notice hunger when it gets to the point of pain. It feels more like pain near the gut, so lower than nausea, but I can feel kind of an empty space above where the pain is, like there’s a deflated organ right there (which, there might be, cause I probably haven’t eaten that much..).

 

It’s very hard to describe the physical effects of feelings, but it is so important to think about, especially for people who don’t get that kind of automatic interoceptive feedback that other people have. I think it is a large key to emotional regulation for me as a person because otherwise I wouldn’t be able to describe feelings or understand what I need to do to take care of my body. I still don’t think I necessarily use words the correct way in terms of feelings (I still mostly use those 4 words when I talk about how I really am) but I think looking at the physical has helped me make a good start on working towards being able to explain and communicate my emotions to others.

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