<p>Empathy difficulties are frequently cited as a hallmark of the social challenges experienced by autistic individuals. However, a growing body of research suggests that these difficulties may be more accurately attributed to co-occurring alexithymia rather than autism per se. This systematic review aimed to clarify the relationship between autism, alexithymia, and empathy. A comprehensive search following PRISMA guidelines identified 11 studies from an initial pool of 271 articles. Our findings indicate a high prevalence of alexithymia among autistic individuals and suggest that difficulties in both cognitive empathy (i.e., the ability to identify emotions in oneself and others) and affective empathy (i.e., the ability to share others’ emotions) are more strongly associated with alexithymia than with autism itself. Moreover, age-related differences appear to further shape this interaction. Together, these findings underscore the importance of distinguishing between autism and alexithymia in empathy research and point to key directions for future studies and clinical approaches.</p>