Exploring the Broader Autism Phenotype: How Alexithymia Impacts Recognition of Facial Expressions of Pain.

The team asked 60 college students to watch faces showing pain. Half the group had high autistic traits, half had low. No one had an autism diagnosis.

Each face faded in from a blank screen. Students pressed a key the moment they saw pain. Eye cameras tracked where they looked. Everyone also filled out an alexithymia scale.

The goal was simple: do autistic traits change how fast you spot pain, and does alexithymia matter more?

Speed was the same. High-trait and low-trait groups hit the key equally fast. Eye cameras showed no group difference in time spent on eyes, mouth, or face.

The only standout was alexithymia. Students who scored high on “difficulty describing feelings” needed stronger pain signals before they noticed. Autistic traits alone added zero extra delay.

In plain words, trouble naming your own feelings predicts trouble seeing pain in others.

Bothe et al. (2019) saw the same pattern for happy, sad, and angry faces. In that study, autistic social traits only hurt accuracy when alexithymia was also high. The new pain data extend the story: the link holds even when the emotion is a basic survival cue.

Spanoudis et al. (2011) reported that autistic adults look less at eyes and this drop hurts face reading. The current study found no gaze differences. The gap disappears because the 2025 sample is broader-phenotype, not diagnosed ASD. When you screen out clinical-level social impairment, eye-time evens out.

Vabalas et al. (2016) add a twist. They showed that higher autistic traits shrink visual exploration during live chat. Together the three papers paint a rule: gaze problems show up in real social give-and-take, not in short lab clips of pain.

If a client misses that someone is hurt, check alexithymia first. A short questionnaire like the TAS-20 takes five minutes and predicts the blind spot better than an autism trait score.

For social-skills training, skip generic “look at the eyes” drills when gaze is already typical. Target emotion vocabulary instead: teach words for bodily feelings so clients can map them onto faces. One quick start is to pause videos at wince moments and practice labeling intensity on a 1-5 “pain scale” before moving to live role play.