Interoception (AA23)

Interoception may not even be a word you’ve ever heard before, let alone know what it means.

At its most basic, interoception is “inner body sense”. On top of the five senses that we all know and learned about, there are other senses as well. Interoception is the one that, for example, can tell you you’re hungry, thirsty, or need to toilet.

However, it’s vastly more complicated than that (and the more you study, it’s like the more opens up to you!) Turns out there are a LOT of inner body sensations, and ascribing them meaning is a whole other piece of the puzzle. For a sample of what I mean, imagine an adjective and then imagine any body part. Your hands feel hot and sweaty. Your feet feel cold and tingly. Your lips feel dry and itchy.

Are you able to notice the sensation itself?
Are you able to take the sensation and interpret meaning from it?

That’s interoception. It’s an intensely personal study/understanding, because people’s interpretations might be different, because people’s bodies communicate in different ways.

Maybe when I notice my hands getting hot and sweaty, I realize I’m anxious about something — but maybe when your hands get hot and sweaty, it means you’re angry, and when some other person’s do it, it just means they need to take off their jacket. These are vastly different interpretations and they can all be right!

There’s tons of work in the type of fields I work in — like early childhood education, preschool, school age, therapies, teachers, parents — to try to teach kids “coping strategies for their emotions”. This work is important and good. But it’s also so generalized as to be very nearly meaningless if a child is missing interoceptive cues.

That’s another key piece of the puzzle: interoception can be too strong, too weak, or distorted…oh, and it may not be the same across body parts. Maybe you’re REALLY sensitive to noticing when you’re hungry and you know the exact minute of the day at which you need to have your first snack so you don’t become a raging hangry monster, but you don’t notice you need to urinate until about 4 seconds before you’re going to burst.

So let’s say we’re looking at a child from the outside — a kid we’re parenting, teaching, therapizing, whatever it is. And this child goes into a rage over things all the time and starts flipping furniture, throwing stuff, etc. So we try to teach them “coping strategies”. Take deep breaths when you’re mad. Go for a walk. Listen to music. All of those things might be fine. But we only know they might be, because we’re guessing what will work for them, what will feel good for them. AND, all of those things rely on the child being able to notice when they’re getting angry.

We might think “well of course you notice when you’re getting angry…it’s when stuff makes you feel, well, angry.”

But you can see how vague that is! Maybe the child doesn’t actually notice at all.

We start getting overlap with other parts of the puzzle here. Remember the sensory processing I talked about? Maybe a child has a heightened sense of touch, and being brushed against accidentally feels like an electric shock to their sensitive skin. They’re able to cope with it once or twice but if it keeps happening, suddenly they’ve flipped out. (Or, more likely, it compounds with 8 other things that were also happening, small things individually, but once they’ve added up…)

Heightening interoceptive sense aims to try to help deal with that by breaking it down into minutiae and having the child learn to make check-ins with their bodies, so that they can eventually interpret those signals into helpful actions. Maybe after being brushed against once, their skin feels buzzy and electric, and the back of their neck feels tingly and cold or numb (like chills going up/down your spine). And they can learn that when they feel that way, that means they’re about to be angry.

The emotion they’re feeling right then is overwhelmed, and what they need to do is find one of their feel-good strategies that will make them feel good. (And another piece of the puzzle is that it’s what makes THEM feel good instead of one size fits all, like deep breathing often is.)

Ooh boy, this is another one like sensory processing where I could just write and write and write paragraphs. 😊

Interoception is an absolutely cutting-edge field of research right now that shows overlap with so, so many other things. There is evidence to suggest that people with all sorts of mental health diagnoses and poorer mental health outcomes also have decreased interoception — less awareness of what’s going on internally for themselves.

A key thing here, I must repeat again, is that interoception is so intensely personal. You know how I know that I’m hungry? First I get an intense stomach ache for about ten minutes, but I can’t eat during that ten minutes or it’ll make me feel sick. Then it goes away entirely and I don’t feel it at all anymore. (I also know not to go buy food during that 10 minutes…it overrides my reasoning about what’s reasonable food to buy and I’m much more likely to buy foods that aren’t what I need to eat right then, or buy way more food than I can actually eat!) Then, about an hour later, I know that I ought to eat. If I wait much longer than that hour, I get distracted and get a head ache. But my stomach doesn’t start hurting again.

Meanwhile, chances are good that you experience hunger in a different way.

A second example. It has taken me a lot of my adult life thus far to differentiate between excitement and anxiety/panic in my own body. I mean, sometimes I can tell from context: I’m going to the movies, I’m excited; I’m going to get a shot, I’m anxious/panicky. But both emotions feel the same in my body. My stomach feels nauseated, the intensity correlating with how anxious or excited I am. And for some things in our life, like when we adopted our kids, I could not parse out excitement or anxiety. Was I so excited to meet our son that I was throwing up in the airport bathroom? Was I so anxious to be left alone with a newborn, thousands of miles from home, that I threw up anything other than Pringles? The two emotions are both intense and both very very similar in my body (and, unfortunately, almost entirely tied to stomach sensations!) I know this about myself, so I use my coping strategies and remind myself that this is what this is like for me. But imagine how confused a child would be if they were deeply excited about something and also they just threw up for no reason! They might not put those two things together.

Autistic people have a higher likelihood of too big, too small, or distorted interoceptive awareness than allistic people have. To some extent, all people learn this through childhood (think about having to tell a potty-learning child “you’re holding your crotch and dancing, that means you have to go pee!” or in other words, “notice your body signals and connect them to a sensation and act!”) But it can be a much more challenging learning experience for autistic and, in a greater sense, for all neurodiverse people. Being aware of its existence as one of the body senses, and making intentional efforts to learn it, can help, regardless of what age you are!

Kelly Mahler is the foremost expert on interoception and she’s another OT! If this is a topic that interests you, check out her work.