Interoception: The Eighth Sense

What is interoception?

Interoception is the sense of the body’s internal state. Cleveland Clinic describes it as awareness of the body’s internal senses or signals: it is how you can feel that you are hungry, that your heart is beating or that you need to pee.⁠¹ Researchers define it more fully as the way the nervous system senses, interprets and integrates signals from inside the body, giving a moment-by-moment map of the body’s internal landscape, both consciously and unconsciously.⁠⁶

The signals it carries are familiar. Cleveland Clinic’s examples are a full bladder, anxiety or nervousness, hot or cold temperatures, hunger, itchy skin, muscle tension, nausea, thirst, pain and the heartbeat.⁠¹ Researchers add breathing effort, fatigue, satiety and muscle ache.⁠⁵

Those signals matter beyond the body. The neuroscientist A. D. Craig described a pathway that represents every aspect of the body’s physiological condition, a representation of “the material me” that may underlie subjective feelings, emotion and self-awareness.⁠³ Interoceptive signals are considered part of reflexes, urges, feelings, drives and emotional experience.⁠⁶

Which sense is associated with hunger, thirst and emotional state?

Interoception. The STAR Institute, a sensory processing research and treatment center, describes it as sensations related to the physical condition of the body, gives hunger and thirst as examples, and places the feelings it creates, including pain, temperature, itch, muscle and internal-organ sensations, hunger, thirst and the need for air, in the brain’s insula.⁠² The same system is tied to emotion: influential theories hold that emotional feeling states arise from physiological changes inside the body.⁠⁴

How does interoception work?

Cleveland Clinic describes three steps.⁠¹

1. Sensing. A sensor on a nerve cell detects a signal, and a nerve pathway carries it to the thalamus in the brain. Your stomach rumbles.⁠¹
2. Interpreting. The thalamus passes the information to the insula, which decodes it into a feeling you can understand. You feel hungry.⁠¹
3. Integrating. You read the message and decide whether to act. You eat something.⁠¹

Once the need is met, the signal stops, a state of balance called homeostasis. The same sensation can be read as harmless, unclear or threatening, and that reading shapes the response.⁠¹

The idea is older than the word. Sherrington’s 1906 book The Integrative Action of the Nervous System wrote of “interoceptors” alongside proprioception and exteroception, but the noun interoception first appeared in journals in the 1940s. Its meaning has since widened from sensations from the internal organs alone to the felt state of the whole body.⁠¹⁵

What are interoceptive accuracy, sensibility and awareness?

Researchers separate three abilities that are easy to blur. Interoceptive accuracy is performance on objective tests such as detecting your own heartbeat. Interoceptive sensibility is how good you believe you are, measured by questionnaires or interviews. Interoceptive awareness is how well that belief matches your actual accuracy. In 80 adults, the three were distinct, and accuracy was only partly predicted by the other two.⁠¹⁶

Cleveland Clinic uses simpler terms: attention, how often you notice body signals, and accuracy, how correctly you understand them, and notes that both vary widely from person to person.⁠¹ The distinction explains why studies can seem to disagree: someone can believe they read their body well and do poorly on a heartbeat task, or the reverse.⁠¹⁶

Why is interoception called the eighth sense?

Because sensory processing frameworks count eight senses, not five. The STAR Institute groups them as the five basic senses (sight, hearing, smell, taste and touch), the three that Ayres focused on in describing sensory integration dysfunction (touch, the vestibular sense and proprioception), and “the most recently discussed set of sensations related to internal organs”: interoception.⁠² Pediatric occupational therapists describe it as an emerging practice area.⁠¹⁴

Is interoception part of sensory processing?

Yes. The STAR Institute calls interoception “the eighth, often neglected, but frequently problematic sensory system in SPD” and lists it among the systems sensory processing differences can affect, alongside sight, hearing, touch, smell, taste, the vestibular sense and proprioception.⁠^2,17 Its description of an interoceptive discrimination difference is trouble interpreting stimulation from internal organs such as the stomach, heart, gut and lungs, and the sensations related to emotion that are felt inside the body.⁠¹⁷ Interoception also works with the vestibular and proprioceptive senses to shape how a person perceives their own body.⁠² More on the eight sensory systems.

Explore the other systemssensory over-responsivitysensory under-responsivityvestibular and proprioceptive processingsensory processing disorder

What happens when interoception works differently?

Cleveland Clinic lists the common signs that interoception is not working as well as expected: difficulty knowing when the bladder is full, difficulty managing emotions, feeling easily anxious, a high or low pain tolerance, and not feeling hungry or thirsty, or not feeling full after a meal.⁠¹ Differences run in two directions. In interviews with 13 autistic teenagers, some could not detect body signals even when they tried, while for others the signals became overwhelming, and experiences varied within the same person depending on arousal and cognitive load.⁠¹⁸

What happens when body signals are faint or hard to read?

• A full bladder goes unnoticed. Teenagers who were hypoaware described not noticing the need to use the bathroom until it was almost too late.⁠¹⁸
• Hunger and thirst are missed. The same teenagers described not knowing when to eat until they felt faint, and one said, “I just cannot tell when I’m thirsty or not.”⁠¹⁸
• Fullness does not register, or pain tolerance is unusually high.⁠¹
• Tiredness and temperature are hard to judge. Alexithymia has been linked to poorer perception of non-emotional signals, which include fatigue and temperature.⁠⁵
• Anxiety builds unseen. Teenagers who missed low-level anxiety could not step away early, so the anxiety grew.⁠¹⁸

What happens when body signals feel too intense?

• Ordinary sensations feel alarming. Some autistic teenagers found constant awareness of their heartbeat, breathing or movement overwhelming and over-stimulating.⁠¹⁸
• A racing heart reads as danger. Catastrophizing about a faster heartbeat triggered panic and a feedback loop of anxiety.⁠¹⁸
• Harmless sensations feel threatening. Cleveland Clinic notes that anxiety disorders may lead a person to perceive benign sensations as threats, which can cause more symptoms and stress.⁠¹
• Everyday states feel unbearable. “I absolutely detest feeling full up,” one teenager said.⁠¹⁸
• Emotions and body states blur together. People with more alexithymia perceive more similarity between emotional and physical states, such as feeling hot with anger or nauseous with disgust.⁠⁵

What signs can show up either way?

Some signs fit both patterns. Overwhelm may be noticed only once it is extreme; one teenager said that spotting it earlier would have meant a smaller meltdown. Strong emotion itself also crowds out body signals: “Trying to listen to your body sometimes does become very difficult if you are feeling very strong emotions,” one teenager said.⁠¹⁸ Difficulty answering “how are you feeling?” is the core of alexithymia, trouble identifying and describing one’s own emotions.⁠⁵

A child who reaches the bathroom too late can look careless. The interoceptive explanation is different: the signal may not have registered in time. Teenagers who missed bathroom signals worried that others would judge them for running to the bathroom at the last moment.⁠^1,18

What are the signs of poor interoception in adults?

In adults, the signs are the ones Cleveland Clinic lists: missing a full bladder, not noticing hunger, thirst or fullness, a high or low pain tolerance, trouble managing emotions and feeling easily anxious.⁠¹ Research ties lower interoceptive ability to ADHD in adults: in one study, 14 adults with ADHD counted their own heartbeats less accurately than 16 adults without it.⁠¹⁹ Alexithymia in adults, in the general population and in people with psychiatric diagnoses, goes with poorer awareness of non-emotional body signals.⁠⁵ Interoceptive problems are also part of anxiety, mood, eating, addictive and somatic symptom disorders.⁠⁶

What does poor interoception look like in a child?

In children, interoception is still developing. Cleveland Clinic calls it a learned skill and counts feeling the need to pee or poop, and knowing when to use the toilet, among the skills children learn as they grow.⁠¹ Pediatric occupational therapists see differences in daily routines: responding to hunger and fullness cues, toileting, bladder and bowel management, dressing and hygiene.⁠¹⁴ How interoception develops from infancy through adolescence is still under-researched.⁠²⁰ In preschoolers aged four to six, scores on an adapted heartbeat task changed with age.⁠²¹

How does interoception shape emotions?

Emotions have a body side. Theories going back to William James and Carl Lange link feelings to the state of the body, and emotional feelings often carry visceral or muscular signatures: a racing heart, a churning stomach, feeling hot-headed or tense.⁠²² Current research treats interoception as part of how emotions are generated and felt.⁠^3,4 Cleveland Clinic’s example: in a dark room with your heart beating fast, you might feel scared, and that feeling helps you decide to turn on a light.⁠¹

How strongly someone perceives their body seems to matter. People who judge their heartbeat accurately experience emotions more intensely, a team studying hypermobility notes in summarizing earlier work.⁠¹⁰ The link is not simple in young children: in 49 preschoolers, interoceptive accuracy was unrelated to recognizing emotions and only marginally related to regulating them.⁠²¹

How is alexithymia linked to interoception?

Alexithymia is difficulty identifying and describing one’s own emotions, a trait rather than a diagnosis.⁠⁵ In about 200 adults, more alexithymia went with poorer perception of non-emotional body signals and more perceived overlap between emotional and physical states, which led the researchers to describe it as a general failure of interoception rather than a purely emotional problem.⁠⁵ A developmental review notes the link between low interoceptive sensitivity and alexithymia and proposes atypical interoception as a common factor across several psychiatric conditions.⁠²⁰

How is interoception linked to toileting and bedwetting?

Knowing when to go is an interoceptive skill. As the bladder fills, sensors in its wall relay the stretch to the brain, and healthy people feel the need to empty the bladder well before it is full, which leaves time to find a toilet.⁠²³ The STAR Institute lists the need to urinate or have a bowel movement among interoceptive sensations, and Cleveland Clinic counts difficulty knowing when the bladder is full as a sign of poor interoception.⁠^1,2

When the signal is faint, late or overwhelming, toileting suffers. A scoping review of pediatric occupational therapy found that toileting, bladder and bowel management came up repeatedly, with under- and over-responsivity to toileting cues linked to constipation or incontinence.⁠¹⁴

The evidence for treating this through interoception is thin. In one case report, an 8-year-old girl with daytime urgency and leakage had eight weeks of sensory integration therapy combined with interoceptive training. Her daytime symptoms resolved by week 12, but her nighttime wetting persisted, which the authors read as a sign that sensory approaches do little during sleep.⁠²⁴ Standard first-line care for daytime wetting, called urotherapy, covers fluid intake, toilet position, urination patterns and bladder training.⁠²⁴ More on bedwetting.

Full guidePediatric pelvic floor therapy for daytime wetting, constipation and soiling

How is interoception linked to hunger and eating?

Hunger, thirst and fullness are interoceptive signals: a rumbling stomach says you are hungry, and once you eat, the signal stops.⁠¹ Not feeling hungry or thirsty, or not feeling full after a meal, is on Cleveland Clinic’s list of signs that interoception is not working as expected, and pediatric occupational therapists report that poorer interoception affects how children respond to hunger and fullness cues.⁠^1,14

The direction of the link is not always what people assume. In 1,657 children aged 6 to 11 followed for a year, emotional and external eating in overweight children predicted later interoceptive sensitivity rather than the reverse, and interoceptive sensitivity was not directly related to body mass index.⁠²⁵ In adult women with eating disorders or obesity, researchers found disorder-specific interoceptive profiles rather than a general deficit, and overeating was not tied to marked changes in heartbeat perception.⁠²⁶

Eating is a particular concern in autism. In a study of 402 adults, autistic adults reported more eating disorder symptoms than non-autistic adults, in a model that included interoception, alexithymia and body image.⁠²⁷ When a child’s eating is very limited, ask about feeding therapy.

How is interoception linked to anxiety?

Anxiety is partly a body state, and the way body signals are read shapes it. Cleveland Clinic notes that anxiety disorders may lead a person to read harmless sensations as threatening, which can cause more symptoms and stress.⁠¹ Researchers describe anxiety and depression not as interoceptive disorders as such but as altered interoceptive states, driven by noisy, amplified body signals and the beliefs built on them.⁠²⁸ Interest in the link goes back to the 1980s, when studies documented interoceptive disturbances in panic disorder.⁠⁶

Autistic teenagers described several routes from body signals to anxiety: missing early signs and letting anxiety build, being overwhelmed by too much awareness, and catastrophizing about a racing heart. The links ran both ways, with anxiety also changing how signals were noticed.⁠¹⁸ A training program aimed at interoception reduced anxiety in a randomized trial in autistic adults.⁠¹³ More on sensory issues and anxiety.

How is interoception linked to autism and ADHD?

Cleveland Clinic lists both autism and ADHD among the conditions that can affect interoception, with anxiety, depression, eating disorders, panic disorder and post-traumatic stress disorder.⁠¹ The research picture is more mixed than that list suggests.⁠^7,9

Is interoception different in autistic people?

Not consistently. A 2025 systematic review of 31 studies found no significant difference in heartbeat-detection accuracy between autistic and non-autistic adults across five comparable studies, and inconsistent findings in children and adolescents and for self-reported interoception.⁠⁹ Alexithymia appears to explain much of what has been attributed to autism: across two experiments, alexithymia, not autism, was associated with atypical interoception.⁠⁸

That does not make the everyday experience less real. Autistic teenagers described missing hunger, thirst and bathroom signals, being overwhelmed by their heartbeat, and noticing their bodies less when already focused on many other things.⁠¹⁸ Cleveland Clinic describes lower interoceptive accuracy in autism, with trouble identifying needs such as hunger and regulating or expressing emotions.⁠¹

Relatedmonotropismautistic burnoutsensory processing in autism

Is interoception different in ADHD?

The evidence leans toward reduced interoception. A 2025 systematic review found 17 eligible articles: of five studies comparing people with and without ADHD, three found reduced interoception in ADHD, and in the general population interoception was lower in people reporting more inattention, hyperactivity, impulsivity and emotional dysregulation. Study quality was moderate, with small samples.⁠⁷ Cleveland Clinic describes a different pattern, noticing signals but having trouble acting on them, such as feeling thirsty but being unable to decide what to drink.⁠¹ More on ADHD and sensory processing disorder.

Is hypermobility linked to interoception?

Research suggests it is, mainly through anxiety. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor for anxiety. In 36 healthy volunteers, hypermobility went with higher state anxiety, interoceptive sensitivity mediated that link, and hypermobile participants showed stronger reactions to sad and angry scenes in the insula.⁠¹⁰

A 2026 imaging study compared 30 people with generalized anxiety disorder and 33 without. In people with both hypermobility syndrome and anxiety, activity was amplified in the amygdala, a threat-processing region, and the mid insula, described as primary interoceptive cortex. The authors suggest that calming threat reactivity while sharpening interoceptive precision may help symptomatic hypermobile people.⁠¹¹

Hypermobility may also affect body sense through proprioception. A 2024 model from researchers in the same group proposes that variant connective tissue determines whether surprises in the sense of body position are linked to emotional dysregulation in neurodivergent people.⁠²² More on autism and Ehlers-Danlos syndrome and Ehlers-Danlos syndrome.

How is interoception assessed?

There is no single test. Cleveland Clinic describes three kinds of measure: questions about what you feel, tasks such as counting your heartbeats for a minute, and device-assisted tasks in which a heart rate monitor checks accuracy.⁠¹ Heartbeat tasks measure accuracy, questionnaires measure sensibility, and the match between the two gives awareness.⁠¹⁶ Children need adapted tasks: one preschool method has children estimate their heart rate before and after 10 seconds of jumping jacks.⁠²¹ Caregiver questionnaires are another route; a school study of autistic students used the Caregiver Questionnaire for Interoceptive Awareness.⁠¹²

In occupational therapy, the tools are still developing. A 2025 scoping review found that pediatric occupational therapists use several assessments and interventions, but that evidence to support them is lacking and few assessments are based on everyday activities.⁠¹⁴ Differences in measures also explain many of the inconsistent findings in autism research.⁠⁹

What helps with interoception difficulties?

Two kinds of help run side by side: routines that do not depend on body signals, and practice that builds awareness of them. Pediatric occupational therapy programs adapt interoception work to everyday activities such as eating, toileting, dressing and physical activity.⁠¹⁴

How can routines help while body awareness develops?

• Put the bladder on a schedule. Standard care for daytime wetting includes instructions on urination patterns and bladder training, and the case report above tracked scheduled bathroom trips with a parent’s help alongside the training.⁠²⁴
• Build in breaks. Allowing breaks and time to move are standard school accommodations for children with ADHD.⁠²⁹
• Watch the busy moments. Cognitive overload and strong emotion made body signals harder to notice for autistic teenagers, so needs are easiest to miss when the day is full or stressful.⁠¹⁸
• Treat each signal separately. Bathroom and thirst signals felt mostly neutral to the teenagers, while heart-rate signals were the ones most often tied to anxiety.⁠¹⁸

How can interoceptive awareness be built?

Structured programs teach noticing first. The Interoception Curriculum, an occupational therapy program by Kelly Mahler, teaches children to notice body signals, link emotional meaning to them and act on them.⁠¹⁴ In a self-contained school, 14 autistic students aged 9 to 19 followed it for 25 weeks, and their interoceptive awareness and emotion regulation scores improved significantly. The study had no control group.⁠^12,14

In autistic adults, a randomized trial of 121 people tested six sessions of heartbeat-detection practice with feedback and exercise that briefly raises heart rate. Three months later, trait anxiety was lower than after a comparison therapy, and 31% of the training group met the trial’s criteria for recovery, against 16% of controls.⁠¹³

Mindfulness also shifts self-reported interoception. A 2025 meta-analysis of 29 randomized trials with 2,191 participants found a small to medium improvement, largest for mindfulness-based programs, and the gains went with lower psychological distress.⁠³⁰ Cleveland Clinic lists deep breathing, mindfulness, yoga, meditation and cognitive behavioral therapy as ways to improve interoception.⁠¹ More on mindfulness and meditation.

What should you avoid when body signals are hard to read?

• Treating a missed signal as defiance. Hypoaware teenagers could not detect some body signals even when they tried.⁠¹⁸
• Expecting one strategy to cover every signal. Experiences varied between people, within the same person and from one signal to another.⁠¹⁸
• Raising the heart rate on someone frightened by it without support. In the adult trial, the one adverse event was cardiac anxiety after the exercise-based training.⁠¹³
• Expecting quick or certain results. Evidence for interoception interventions in pediatric occupational therapy is still lacking.⁠¹⁴

Can an occupational therapist help with interoception?

It is becoming part of pediatric practice. Occupational therapists are integrating interoception into their assessments and interventions, although the evidence base is still being built.⁠¹⁴ If your child’s sensory assessment did not cover interoception, ask about it. For adults, see sensory tools for neurodivergent adults.

What does the research say about interoception?

Interest has surged in recent years because of interoception’s role in emotion, self-regulation, decision making and consciousness. In 2016, the first Interoception Summit called it an important part of anxiety, mood, eating, addictive and somatic symptom disorders, while noting conceptual and measurement problems that have held back its use in research and treatment.⁠⁶

• Measurement is hard. Accuracy, sensibility and awareness can come apart in the same person.⁠¹⁶
• The autism picture is unsettled. Alexithymia, not autism, predicted atypical interoception in one line of work, and a 2025 meta-analysis found no consistent difference in adults.⁠^8,9
• Development is under-studied. How interoception changes from infancy through adolescence remains under-researched.⁠²⁰
• Treatment evidence is early. A school curriculum and an adult trial are promising, but pediatric occupational therapy still lacks strong evidence.⁠^12,13,14

Interoception is a useful lens for hunger, toileting, pain and emotion. Claims that a program reliably improves it go beyond what the studies show so far.⁠¹⁴

Frequently Asked Questions

Sources

1. Cleveland Clinic. Interoception. Health Library, last updated February 19, 2025. Checked October 11, 2026.
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   “Interoception is the understanding of your body’s internal senses. You can feel that you’re hungry, that your heart is beating or that you need to pee. It’s a learned skill that you develop as you grow.” “Interoception is awareness of your body’s internal senses or signals. It identifies how you feel.” “if your stomach rumbles, you know you’re hungry. You can go have a snack. Once you’ve satisfied your hunger, you’ve reached a state of balance ... This is called homeostasis.” “As you grow and develop, you learn more about what important interoception skills are necessary, like feeling the need to pee or poop and knowing when to use the toilet.” “if you’re in a dark room and your heart is beating fast, you might feel scared. By identifying how you feel, interoception helps you make a decision. In this example, you can decide to turn on a light.” Examples: “A full bladder”, “Anxiety or nervousness”, “Hot or cold temperatures”, “Hunger”, “Itchy skin”, “Muscle tension”, “Nausea”, “Thirst”, “Pain”, “Your heartbeat”. The three steps: “Sensing (you feel a sensation). An interoceptor (sensor in a neuron/nerve cell) detects a signal. A neuron sends it along a nerve fiber pathway to your brain. It lands in a region called your thalamus.” “Interpreting (you determine what the feeling is). Your thalamus sends the information to the insula to decode it. Your insula rewrites the message into a language that you can understand.” “Integrating (you take action). You read the message with your conscious mind and determine whether or not you need to take action.” A sensation may be read as “Benign”, “Ambiguous” or “Threatening”; “Certain mental health conditions like anxiety disorders may make you perceive benign sensations as threatening ones. This could potentially cause you to have more symptoms and stress.” “Attention: How often you notice signals from your body”; “Accuracy: How correct you are at understanding signals from your body”; “It varies significantly from person to person.” Measures include “Answer questions about what you feel”, “Perform a task, like count how many times you feel your heartbeat in a minute” and “Use a device-assisted task performance. For example, while wearing a heart rate monitor”. Symptoms of poor interoception: “Difficulty knowing when your bladder is full (when you need to pee)”, “Difficulty managing emotions”, “Feeling easily anxious”, “Having a high or low pain tolerance”, “Not feeling hungry or thirsty or not feeling full after a meal”. Conditions that may affect it include anxiety disorders, ADHD, autism, depression, eating disorders, panic disorder and post-traumatic stress disorder. Autism: “Interoception accuracy (how correct you are at identifying feelings) is low. For example, it might be hard for you to regulate or express your emotions. You might also have trouble identifying bodily needs, like hunger.” ADHD: “Interoception attention (how often you notice signals) is strong but you may have trouble acting on those signals. For example, you feel thirsty but can’t decide what you want to drink.” Ways to improve: deep breathing exercises, mindfulness, yoga, meditating and “Participating in cognitive behavioral therapy”.
2. STAR Institute for Sensory Processing. Your 8 Senses. Sensoryhealth.org, undated. Checked October 11, 2026.
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   The page lists “The five basic sensory systems” (visual, auditory, olfactory, gustatory, tactile), “The three sensory systems Ayres focused on in describing sensory integration dysfunction” (tactile, vestibular, proprioceptive) and “The most recently discussed set of sensations related to internal organs” (interoception). “The eighth, often neglected, but frequently problematic sensory system in SPD is the Interoceptive System. Interoception refers to sensations related to the physiological/physical condition of the body. Interoceptors are internal sensors that provide a sense of what our internal organs are feeling. Hunger and thirst are examples of interoception.” “Interoception detects responses that guide regulation, including hunger, heart rate, respiration and elimination.” “The same is true for hunger and thirst, as well as the feeling of the need to urinate or have a bowel movement.” “Interoception is associated with autonomic motor control, and is different than mechano-reception (in the skin) and proprioception (in the muscles and joints). Interoception is located in the dorsal posterior insula and it creates distinct feelings from the body including pain, temperature, itch, muscular and visceral sensations, vasomotor activity, hunger, thirst, and the need for air.” Vestibular: “The vestibular system contributes to balance and orientation in space. It is the leading system informing us about movement and position of head relative to gravity.” Proprioception: “senses the position, location, orientation, and movement of the body muscles and joints. Proprioception provides us with the sense of the relative position of neighboring parts of the body and effort used to move body parts.”
3. Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience. 2002;3(8):655–666. PMID 12154366. Checked October 11, 2026.
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   The abstract: “As humans, we perceive feelings from our bodies that relate our state of well-being, our energy and stress levels, our mood and disposition.” “Recent functional anatomical work has detailed an afferent neural system in primates and in humans that represents all aspects of the physiological condition of the physical body. This system constitutes a representation of ‘the material me’, and might provide a foundation for subjective feelings, emotion and self-awareness.”
4. Critchley HD, Garfinkel SN. Interoception and emotion. Current Opinion in Psychology. 2017;17:7–14. PMID 28950976. Checked October 11, 2026.
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   The abstract: “Influential theories suggest emotional feeling states arise from physiological changes from within the body. Interoception describes the afferent signalling, central processing, and neural and mental representation of internal bodily signals.” “This growing grasp of interoception is enriching our understanding of emotion and its disorders.”
5. Brewer R, Cook R, Bird G. Alexithymia: a general deficit of interoception. Royal Society Open Science. 2016;3(10):150664. PMID 27853532. Checked October 11, 2026.
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   “Alexithymia is a sub-clinical construct, traditionally characterized by difficulties identifying and describing one’s own emotions.” “Interoception refers to the perception of a wide range of physical states beyond emotions, including heart rate, respiratory effort, temperature, fatigue, hunger, thirst, satiety, muscle ache, pain and itch”. Participants: typical individuals (n = 105) and individuals reporting a psychiatric diagnosis (n = 103). “Findings indicated that alexithymia was associated with poor non-affective interoception and increased perceived similarity between affective and non-affective states, in both the typical and clinical populations. We therefore suggest that rather than being specifically associated with affective impairment, alexithymia is better characterized by a general failure of interoception.” Examples of states that go together: “feeling hot while experiencing anger” and “experiencing nausea while feeling disgusted”.
6. Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, et al. Interoception and mental health: a roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2018;3(6):501–513. PMID 29884281. Checked October 11, 2026.
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   “Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences”. “Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit”. “During the 1980s, biological psychiatry was inundated with observations of interoceptive disturbances in panic disorder”; “Recent years have witnessed a surge of interest on the topic of interoception due in part to findings highlighting its integral role in emotional experience, self-regulation, decision making, and consciousness.”
7. Bruton AM, Levy L, Rai NK, Colgan DD, Johnstone JM. Diminished interoceptive accuracy in attention-deficit/hyperactivity disorder: a systematic review. Psychophysiology. 2025;62(2):e14750. PMID 39905593. Checked October 11, 2026.
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   “Of 636 articles identified, 17 articles (based on 18 studies) met inclusion criteria. Five studies compared interoception in participants with/without ADHD, 3 finding that interoception was reduced in participants with ADHD.” “Overall, results suggested interoception is reduced in individuals who reported higher symptoms of inattention, hyperactivity, impulsivity, and emotional dysregulation. Studies were of moderate quality; issues included small sample sizes and inadequate reporting.”
8. Shah P, Hall R, Catmur C, Bird G. Alexithymia, not autism, is associated with impaired interoception. Cortex. 2016;81:215–220. PMID 27253723. “Across two experiments, it was found that alexithymia, not autism, was associated with atypical interoception. Results indicate that interoceptive impairments should not be considered a feature of ASD, but instead due to co-occurring alexithymia.” Checked October 11, 2026.
9. Klein M, Witthoft M, Jungmann SM. Interoception in individuals with autism spectrum disorder: a systematic literature review and meta-analysis. Frontiers in Psychiatry. 2025;16:1573263. PMID 40909407. Checked October 11, 2026.
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   “A total of 31 studies meeting stringent inclusion and quality criteria were identified”; “The meta-analysis of five adult studies using comparable assessment tools found no significant differences in cIA between adults with ASD and neurotypically developed (NTD) controls”; “Descriptive summaries of studies in children and adolescents, as well as those examining IS and IAW across age groups, revealed inconsistent findings”; “Methodological diversity, differences in measurement instruments, and variability in sample characteristics likely contribute to these inconsistencies.”
10. Mallorqui-Bague N, Garfinkel SN, Engels M, Eccles JA, Pailhez G, Bulbena A, Critchley HD. Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility. Frontiers in Psychology. 2014;5:1162. PMID 25352818. Checked October 11, 2026.
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    “Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders.” “Thirty-six healthy volunteers undertook interoceptive sensitivity tests”; “We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex.” “People who can judge their bodily signals (e.g., the timing of their heartbeats) to a high level of accuracy experience emotions more intensely”.
11. Kampoureli CN, Rae CL, Gould Van Praag C, Harrison NA, Garfinkel SN, Critchley HD, Eccles JA. Neural processes linking joint hypermobility and anxiety: key roles for the amygdala and insular cortex. British Journal of Psychiatry. 2026;228(2):101–107. PMID 39895195. Checked October 11, 2026.
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    “Anxiety symptoms are elevated among people with joint hypermobility.” Participants: “people with generalised anxiety disorder (GAD) (N = 30) and a non-anxious comparison group (N = 33)”. “Notably, interaction between HMS and anxiety was expressed in reactivity of the left amygdala (a region implicated in threat processing) and mid insula (primary interoceptive cortex) where activity was amplified in people with HMS with GAD.” “interventions to regulate amygdala reactivity while enhancing interoceptive precision may have therapeutic benefit for symptomatic hypermobile individuals.”
12. Mahler K, Hample K, Jones C, Sensenig J, Thomasco P, Hilton C. Impact of an interoception-based program on emotion regulation in autistic children. Occupational Therapy International. 2022;2022:9328967. PMID 35539883. Checked October 11, 2026.
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    “One-group pre- and posttest design implementing The Interoception Curriculum: A Guide to Developing Mindful Self-Regulation in a self-contained school. Participants were 14 (11 male, 3 female) students between 9 and 19 years old.” The study ran “a 25-week school-based intervention” and used the “Caregiver Questionnaire for Interoceptive Awareness-2nd Edition (CQIA-2)”. “Statistically significant improvements were found between the preintervention and postintervention scores for both interoceptive awareness and emotion regulation.”
13. Quadt L, Garfinkel SN, Mulcahy JS, Larsson DE, Silva M, Jones AM, Strauss C, Critchley HD. Interoceptive training to target anxiety in autistic adults (ADIE): a single-center, superiority randomized controlled trial. EClinicalMedicine. 2021;39:101042. PMID 34401684. Checked October 11, 2026.
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    “autistic adults (18–65 years) from clinical and community settings in Southern England were randomly assigned (1:1) to receive six sessions of ADIE or an active ‘exteroceptive’ control therapy (emotional prosody identification)”; “ADIE combines two modified heartbeat detection tasks with performance feedback and physical activity manipulation that transiently increases cardiac arousal.” “121 participants were randomly allocated”; “One adverse event (cardiac anxiety following ADIE) was recorded. A statistically significant group effect of ADIE on trait anxiety continued at T2” (three months), “with 31% of ADIE group participants meeting trial criteria for recovery (compared to 16% in the control group).”
14. Clark E, Brown T, Yu ML. Interoception and its application to paediatric occupational therapy: a scoping review. Australian Occupational Therapy Journal. 2025;72(1):e12997. PMID 39505563. Checked October 11, 2026.
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    “Interoception, the ability to sense internal body signals, is an emerging practice area”; “A total of 18 articles were included”; “Findings indicated that paediatric occupational therapists are integrating interoception concepts alongside occupational therapy principles to inform assessment and intervention processes. Several assessments and interventions are utilised to support children; however, evidence to strengthen use is lacking. Further, there are limited occupation-based assessments and intervention programs to address interoception deficits in children.” On the Interoception Curriculum (Mahler, 2019): “IA can be improved through learning how to notice body signals, linking emotional meaning to body signals and acting upon” them. “Specific adaptations for various occupations (e.g. eating, toileting, dressing, physical activity) are noted to help generalise skill development.” “poorer interoception skills were found to impact eating behaviours such as responding to hunger and satiety cues. Four articles discussed self-care, specifically related to toileting, bladder and bowel management, dressing, and personal hygiene. Common performance issues relating to toileting highlighted interoceptive under- and/or over-responsivity to toileting cues, leading to further challenges with constipation or incontinence”.
15. Ceunen E, Vlaeyen JW, Van Diest I. On the origin of interoception. Frontiers in Psychology. 2016;7:743. PMID 27242642. Checked October 11, 2026.
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    “Over the course of a century, the meaning of interoception has changed from the restrictive to the inclusive.” “Interoception is a relatively recent concept which arose together with the concepts proprioception and exteroception during the early 20th century. The first known usage of the concept interoception in publication dates to Sherrington (1906) in his book ‘The Integrative Action of the Nervous System’”; “Sherrington talks of ‘interoceptors,’” ... “it is only in the 1940s that the word ‘interoception’ first appears in scientific journals”. “The restrictive meaning holds that only sensations stemming from viscera are interoceptive.”
16. Garfinkel SN, Seth AK, Barrett AB, Suzuki K, Critchley HD. Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology. 2015;104:65–74. PMID 25451381. Checked October 11, 2026.
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    The abstract describes “(1) interoceptive accuracy (performance on objective behavioural tests of heartbeat detection), (2) interoceptive sensibility (self-evaluated assessment of subjective interoception, gauged using interviews/questionnaires) and (3) interoceptive awareness (metacognitive awareness of interoceptive accuracy, e.g. confidence-accuracy correspondence). In a normative sample (N=80), all three dimensions were distinct and dissociable. Interoceptive accuracy was only partly predicted by interoceptive awareness and interoceptive sensibility.”
17. STAR Institute for Sensory Processing. Patterns or Subtypes of Differences in Sensory Integration & Processing. Sensoryhealth.org, undated. Checked October 11, 2026.
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    “These differences can affect multiple sensory systems, including visual, auditory, tactile, olfactory, gustatory, vestibular, proprioceptive, and interoceptive modalities.” Among the sensory discrimination differences, interoception: “Related to interpreting stimulation from internal organs (stomach, heart, gut, lungs etc.) and sensations related to emotion that are ‘felt’ inside the body.”
18. Adams Kiera, Smith Jonahs, Brown Mary, Bird Geoffrey, Waite Polly. Experiences of interoception and anxiety in autistic adolescents: a reflexive thematic analysis. Autism. 2025;29(6):1585–1596. doi:10.1177/13623613251314595. PMID 40087861. Checked October 11, 2026.
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    Interviews with “13 UK-based, autistic adolescents, aged 14–17 years”. “While hypoawareness of interoceptive signals led to a reduced ability to detect and regulate anxiety, hyperawareness became overwhelming and anxiety-inducing. Overly negative evaluations of interoceptive signals, including catastrophising about the signals indicating danger, also triggered anxiety. Relationships between interoception and anxiety appeared bidirectional”; “Interoceptive experiences were variable both across and within participants, with factors such as arousal and cognitive overload affecting experiences.” “they were unable to detect internal signals, even if they tried ... Frequently discussed examples were not knowing when to eat until they felt faint, or not being aware of the need to use the bathroom until it was almost too late.” “I just cannot tell when I’m thirsty or not I have no idea.” Participants worried about “negative appraisal from others (e.g. needing to run to use the bathroom at the last moment)” and were “not being able to recognise low-level anxiety and remove themselves from such situations, thus allowing anxiety to increase.” “I absolutely detest feeling full up.” “Some participants found it harder to notice interoceptive sensations (Theme 1) when focusing on numerous other things already.” “Trying to listen to your body sometimes does become very difficult if you are feeling very strong emotions.” “I sometimes only realise I’m getting overwhelmed when it gets quite extreme ... that can lead to ... a bigger meltdown than I would have had if I’d spotted it earlier.” “signals typically associated with the symptoms of anxiety, such as elevated heart rate and faster breathing, were more commonly cited as anxiety-inducing”, while “signals relating to more general bodily needs (such as thirst or needing the bathroom) were more commonly seen as neutral.”
19. Kutscheidt K, Dresler T, Hudak J, Barth B, Blume F, Ethofer T, Fallgatter AJ, Ehlis AC. Interoceptive awareness in patients with attention-deficit/hyperactivity disorder (ADHD). ADHD Attention Deficit and Hyperactivity Disorders. 2019;11(4):395–401. PMID 30937850. Checked October 11, 2026.
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    The abstract: “14 adult patients with ADHD and 16 healthy controls performed a heartbeat detection task, in which they had to count their heartbeat without any external help”; “patients with ADHD performed significantly worse on this task than controls, which indicates that they were less aware of internal bodily signals”.
20. Murphy J, Brewer R, Catmur C, Bird G. Interoception and psychopathology: a developmental neuroscience perspective. Developmental Cognitive Neuroscience. 2017;23:45–56. PMID 28081519. Checked October 11, 2026.
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    “existing research indicates an association between low interoceptive sensitivity and alexithymia (a difficulty identifying one’s own emotion)”; “the developmental trajectory of interoception across the lifespan remains under-researched, with clear gaps in our understanding.” “These bodily signals are thought to be represented within the insula and anterior cingulate cortex (ACC), leading these structures to be collectively referred to as the ‘interoceptive cortex’”. The authors propose that “atypical interoception is the common factor underlying a range of psychiatric disorders”.
21. Schaan L, Schulz A, Nuraydin S, Bergert C, Hilger A, Rach H, Hechler T. Interoceptive accuracy, emotion recognition, and emotion regulation in preschool children. International Journal of Psychophysiology. 2019;138:47–56. PMID 30731102. Checked October 11, 2026.
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    The abstract: “Forty-nine children (aged 4-6 years) completed the jumping jack paradigm (JJP), a heartbeat tracking paradigm, which includes a noninvasive physical perturbation via performing jumping jacks for 10 s.” “The derived scores for interoceptive accuracy increased with age”; “the interoceptive accuracy score was unrelated to emotion recognition, but marginally associated to emotion regulation.”
22. Eccles JA, Quadt L, Garfinkel SN, Critchley HD. A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility. Philosophical Transactions of the Royal Society B: Biological Sciences. 2024;379(1908):20230247. PMID 39005028. Checked October 11, 2026.
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    “We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals.” “the neurophysiological reformulation of seminal propositions of William James and Carl Lange”; “emotional feelings often have visceral and/or muscular sensory signatures, e.g. ‘heart racing, ‘stomach churning’, ‘blood draining’ and ‘hot-headed or ‘tense’.”
23. Verstegen AMJ, Marshall KL. From bladder to brain: how you know when it’s time to go. Current Opinion in Neurobiology. 2025;95:103114. PMID 41075343. Checked October 11, 2026.
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    “The decision to urinate relies on assessing bladder fullness and context to determine an appropriate time and place to go. Any disruption in this interoceptive process results in frequent and sometimes debilitating consequences in daily life.” “As the bladder fills, distension is sensed by mechanosensory afferents in the bladder wall that relay this signal to the brain.” “Healthy people experience the sensation of needing to empty their bladder well before the bladder is full, and this allows for preparedness and anticipat”ion.
24. Ma L, Zhang Y, Yao S, He S, Li J. Sensory integration combined with interoceptive interventions for functional urinary incontinence in children: a case report. Frontiers in Rehabilitation Sciences. 2025;6:1599599. PMID 40697955. Checked October 11, 2026.
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    “This case describes an 8-year-old girl presenting with urgency, urine leakage and frequent nocturnal enuresis. An 8-week sensory integration therapy combined with interoceptive training was implemented”; “Her urinary urgency and leakage symptoms gradually decreased over the 8 weeks of treatment and resolved completely by week 12. However, nocturnal enuresis persisted, suggesting the limited efficacy of sensory-based interventions in non-awake states.” “The first-line treatment for children with daytime urinary incontinence is urotherapy, which mainly includes education regarding diet, fluid intake and toilet position, urination pattern instructions, and bladder training”. The figures track “mother-assisted scheduled voiding episodes”. “Improvement in urinary incontinence symptoms was only observed in a single case and is not universal.”
25. Koch A, Pollatos O. Interoceptive sensitivity, body weight and eating behavior in children: a prospective study. Frontiers in Psychology. 2014;5:1003. PMID 25250006. Checked October 11, 2026.
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    “Data on IS measured by heartbeat perception ability in 1657 children between 6 and 11 years of age were collected on the basis of two measurement points with a year distance in time.” “only in overweight children external and emotional eating behavior were predictive for later IS, whereas no such relation was found in normal weight children. There was no direct relation between IS and body mass index.” “our data indicate that altered interoceptive processes rather follow than precede non-adaptive eating behavior patterns in overweight children.”
26. Lutz APC, Arend AK, Voderholzer U, Vogele C, Blechert J. Interoceptive profiles of eating and weight disorders. Scientific Reports. 2025;16(1):1045. PMID 41422313. Checked October 11, 2026.
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    Participants were “adult women with anorexia nervosa (AN; n = 38), bulimia nervosa (BN; n = 35), binge eating disorder (n = 22), obesity (OB; n = 20), and healthy control individuals (n = 46)”. “Overeating is not associated with marked alterations in cardiac interoception. The results do not support the notion of general interoceptive deficits, but rather disorder-specific interoceptive profiles.”
27. Westwood H, Mandy W, Brewer R. The relationship between interoception, alexithymia, autistic traits and eating pathology in autistic adults. Journal of Autism and Developmental Disorders. 2026;56(7):2574–2587. PMID 39948294. Checked October 11, 2026.
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    “Autistic adults (n = 196) and non-autistic adults (n = 206) completed online self-report measures assessing ED pathology, atypical eating, body image dissatisfaction, interoception, alexithymia, and autistic traits.” “Autistic adults self-reported higher ED pathology than non-autistic adults.”
28. Paulus MP, Stein MB. Interoception in anxiety and depression. Brain Structure and Function. 2010;214(5–6):451–463. PMID 20490545. “We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a consequence of noisily amplified self-referential interoceptive predictive belief states.” Checked October 11, 2026.
29. Centers for Disease Control and Prevention. ADHD in the Classroom. Cdc.gov, page dated June 1, 2026. Checked October 11, 2026.
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    “Children with ADHD can do well in school with the support of parents, teachers, and school administrators working together.” “There are some school-based management strategies shown to be effective for students with ADHD”: behavioral classroom management and organizational training. Behavioral classroom management works “through a reward system or a daily report card”; “Parents report that only about 1 in 3 children with ADHD receive behavioral classroom management.” Organizational training “teaches children time management, planning skills, and ways to keep school materials organized”. An IEP “Provides individualized special education services to meet the unique needs of the child and is governed under the Federal law known as the Individuals with Disabilities Education Act (IDEA)”; a 504 plan “Provides services and changes to the learning environment to meet the needs of the child as adequately as other students”. Accommodations: “Extra time on tests”, “Instruction and assignments tailored to the child”, “Positive reinforcement and feedback”, “Using technology to assist with tasks”, “Allowing breaks or time to move around”, “Changes to the environment to limit distraction”, “Extra help with staying organized”. “There is limited information about which types of accommodations are effective for children with ADHD.” “However, there is evidence that setting clear expectations, providing immediate positive feedback, and communicating daily with parents through a daily report card can help.” “Children with ADHD benefit when schools use positive rather than punitive disciplinary strategies.” Tips: “Be sensitive to the influence of ADHD on emotions, such as self-esteem issues or difficulty regulating feelings.” “Provide extra warnings before transitions and changes in routines.” “Understand that children with ADHD may become deeply absorbed in activities that interest them (hyper-focus) and may need extra assistance shifting their attention.” “Make assignments clear”; “Provide choices to show mastery”; “Make sure assignments are not long and repetitive.” “Allow breaks”; “for children with ADHD, paying attention takes extra effort and can be very tiring.” “Allow time to move and exercise. Minimize distractions in the classroom. Use organizational tools, such as a homework folder, to limit the number of things the child has to track.” “Observe and talk with the student about what helps or distracts them (for example, fidget tools, limiting eye contact when listening, background music, or moving while learning can be beneficial or distracting, depending on the child).” “Communicate with parents on a regular basis. Involve the school counselor or psychologist.”
30. Treves IN, Chen YY, Wilson CL, Verdonk C, Qina Au J, Pustejovsky JE, et al. A meta-analysis of the effects of mindfulness meditation training on self-reported interoception. Scientific Reports. 2025;15(1):38889. PMID 41198766. Checked October 11, 2026.
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    “Twenty-nine randomized controlled trials with 2,191 participants”; “Results showed a small-to-medium positive effect on interoception measures across all studies”; “Mindfulness-based programs demonstrated the largest effects”; “Improvements in self-reported interoception were similar in size to improvements in self-reported mindfulness and were related to improvements in psychological distress.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Difficulties recognizing hunger, pain, or body needs can have many causes, including medical ones. Always consult a qualified healthcare provider about your child.