What Is Interoception and How Does It Impact Those With Autism?
INTEROCEPTION: THE EIGHTH SENSORY SYSTEM
by Kelley Mahler
Sit back and close your eyes. What do you feel inside your body?
- Is your heart beating fast or slow?
- Are you breathing deeply or shallowly?
- Do you have to go to the bathroom?
- Are your muscles tense or loose?
- How does your stomach feel?
Most of us are able to feel all of these sensations with the help of our little-known, but very important, eighth sensory system, Interoception.
How does the interoceptive system work?
There are little receptors located throughout the inside or our body, in our organs, muscles, skin, bones and so forth. These receptors gather information from the inside of our body and send it to brain. The brain helps to make sense of these messages and enables us to feel things such as hunger, fullness, itch, pain, body temperature, nausea, need for the bathroom, tickle, physical exertion and sexual arousal. Additionally, interoception allows us to feel our emotions.
How is interoception connected to our emotions?
Typically, each emotion feels differently in the body. For example, before speaking in public, your body may feel a certain way: the heart may race, the muscles may feel tense and shaky, the breathing may become shallow, and the stomach may feel fluttery. These sensations let us know that we are feeling a bit nervous. Without clearly feeling these sensations, it is difficult to identify emotions with a high degree of clarity.
How does interoception influence self-regulation?
When the interoceptive system is properly working, the sensations alert us that our internal balance is off and motivates us to take action, to do something that will restore the balance and help us feel more comfortable. For example, if we feel thirsty – we get a drink; if we feel full – we stop eating; if we feel cold – we get a sweater; if we feel the need to urinate – we go to the bathroom; if we feel anxious – we seek comfort; if we feel frustrated—we seek help. Interoception underlies our urge for action. If we feel that our internal balance is off, we are motivated to act, to seek immediate relief from the discomfort caused by the imbalance.
Is interoception important to any other areas?
In addition to self-regulation, interoception is clearly linked to many other important skill areas including:
| · Self Awareness | · Flexibility of Thought |
| · Problem Solving | · Social Understanding |
| · Intuition | · Perspective Taking |
The research showing just how important interoception is to many aspects of life is unequivocal. The brand-new book Interoception: The Eighth Sensory System Practical Solutions for Improving Self-Regulation, Self-Awareness and Social Understanding of Individuals With Autism Spectrum and Related Disorders (Mahler, 2016, aapcpublishing.net) delivers an overview of this research and describes the clear link between Interoception and these important skill areas.
What do we know about Interoception and Autism?
As with other sensory systems, the interoceptive system can be impacted in individuals with autism. To date, only two research studies have examined the interoceptive experience of individuals with autism*. Both have found the participants with autism to have significantly lower awareness of their interoceptive signals. Although a great deal more research is needed in order to have a full understanding, these two studies confirm the numerous personal experiences reported by individuals with autism.
For example, Chloe Rothschild, a 22-year old with autism reports:
‘I did not realize I had trouble feeling my internal body signals, as I had never heard of interoception before November 2014, but when I did, everything started to make sense. That is, difficulties with interoception help to clarify why I have such a hard time pinpointing my symptoms when I am not feeling well, why sometimes I seem to eat snack after snack without feeling full and why I get upset/anxious/overwhelmed so quickly, because I don’t feel it until I’m already far into the storm of the discomfort and frustration.’
Hollis, an 18-year old with autism reports:
‘I went and got a plate of food thinking that I was hungry. I wasn’t hungry. I was bored. My body was not giving me clear signals, so I did not know what I was feeling. There have been many instances of this growing up. After learning about interoception, I started working on feeling my heart beat. I would lie in bed every night with my hand on my heart. It took about six months for me to feel my heart beat consistently. Interoception has been an important concept for my personal development as a teen with HF-ASD. Being able to receive clear internal signals has allowed me to be more successful in all areas of my life.’
What can be done to improve interoception?
The good news is that interoception can be improved. Mahler provides an entire chapter filled with practical and easy-to-use strategies that target the development of Interoceptive Awareness (which is the ability to both notice & give meaning to internal sensations). Also included is an entire chapter dedicated to the assessment of Interoceptive Awareness.
Could interoception be a missing link in the field of autism? The evidence suggests so. Interoception: The Eighth Sensory System provides a thorough opener to this important conversation.
*Fiene, L., & Brownlow, C. (2015). Investigating interoception and body awareness in adults with and without autism spectrum disorder. Autism Research. Doi:10.1002/aur.1486
Garfinkel, S.N., Tiley, C., O’Keeffe, S., Harrison, N.A., Seth, A.K., & Critchley, H.D. (2016). Discrepancies between dimensions of interoception in autism: implications for emotion and anxiety. Biological psychology, 114, 117-126.
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I was diagnosed with autism in 2007. A couple months ago I had the dawning realization that I get my “I’m hungry or thirsty” signal mixed up with my “I need to pee” signal. Looking back, I’ve always had issues recognizing when I had to use the restroom. As a child I used to do the potty dance while saying I didn’t have to go. My parents would scream “How can you not know you need to go to the bathroom?!”. Now I know.
Jen, thank you for taking the time to write and offering this insight. It’s not uncommon to mix up body signals.
I can see how Anne. Whatever we focus on, everything else is cast aside. If we happen to focus on our wee, we really really focus on it!!!!!! Like how many times do I wee myself whilst at the front door! But if the postman comes along at the same time, Im fine!
Thankyou for perserving on our behalf Tricia.
First time I hear about this. Now I’m beginning to undsr. Recently took my son to dentist after finally finding a dentist that could sedate him to have work done, came after x-rays told me he had a bad cavity towards the back if he had complain about pain. I told him that’s why I needed him to he seen and get treatment done. When he was 2 years old he somehow he pulled its thumb nail with closing the door. He didn’t tell me or cried . Lastly he sometimes tells me he wants to have a B/M but he pees. Or I have to ask him atleast once a day if he needs to have a BM. Thanks for the enlightenment.
Lizzy, learning about interoception changed my life and how I parent my two autistic children. It helped me to understand why they don’t know if they are thirsty or hungry, for example. If you want to learn more, we have a great webinar on this topic – https://autismawarenesscentre.com/shop/webinar/past-webinars/interoception-the-eighth-sense/
Yup, this basically sums it up. I will get hungry, eat a salty snack, pass out with a splitting headache and realize that, ooooops, guess I was actually thirsty instead. I, for the life of me, cannot tell hunger and thirst apart! I just have a two little water bottle that I gradually drink up during the day and keep an eye on my urine. That seems to work best for me.
Thanks for the article! First time I’ve seen interoception in this context, but boy oh boy does it make sense of alexithymia. Readers may wish to Google that term for additional, “Well, that explains things…” moments. Cheers for the food for thought.
I’ve been trying to figure this out for so long, I can’t believe I finally found this when the only reason I did research tonight was because my mothers started making fun of me for my symptoms. I often can’t tell when I have to pee until I HAVE TO PEE, or if I’m hyperfocused I have to pee every 30-60 minutes. I keep getting told it must be a bladder infection or something similar (regardless of all tests coming back totally normal for years).. I seem to go to very opposite ends of either being super aware of some things in my body, or completely unaware. I can feel my heartbeat and my breathing, but I don’t feel thirsty and get dehydrated often, and either forget to eat without getting hungry or snack a bunch out of boredom without getting full. I also seem to get extremely frustrated and upset at the drop of a hat; I thought I just had a short temper but I’ve been noticing the build up more lately (I’ve being trying to be more aware of my attitude, my outbursts have affected my social life and I’ve wanted to fix the issue..). CBT was great but it just wasn’t quite enough which was frustrating in itself. So thankful for this
There doesn’t seem to be much about interoceptive HYPERsensitivity…yet that’s my main problem (I am also ASD and have joint hypermobility). Has anyone looked at reducing the noise caused by overstimulation of this sense?
I’m 60. I didn’t recognize that I was autistic until 2005. Had neuropsycic exam 2008. This article explains a great deal. Now I know why whenever I go into hyper-focus, upon returning to poly-focus, I just don’t need to go, it’s an emergency. Thanks so much. I might contact you. I have taught myself to slow my heart rate. I need to do this periodically. I weigh 120 lb because I forget to eat. When I’m hungry, I can’t concentrate but I don’t recognize that my problem is hunger. I have stomach issues.
Robert, thank you for taking the time to write. I would highly recommend that you contact Kelly Mahler, the OT who brought interoception into the autism field. https://www.kelly-mahler.com/ She also has a workbook for adults that you may find helpful – https://autismawarenesscentre.com/shop/new-titles/my-interoception-workbook-a-guide-for-adolescents-teens-and-adults/ We also have a webinar that you can take too which will provide a lot of information. https://autismawarenesscentre.com/shop/webinar/interoception-the-eighth-sense/
I have a daughter 43years of age with intellecutely disability / Autism a sensory assesstment was undertaken 11 years ago its been brought to my attention that interoception program can greatly assist her.
Is there evidence that providing activities such as yoga to young children support well regulated development and provide learning & cognitive improvements?
Joanna, there are a lot of research articles on Google Scholar that you can look at – https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=benefits+of+yoga+for+children&oq=benefits+of+yoga
I have always struggled to tell when I need to drink, and when I’m affected by sensory overload or ill I get no thirst sensations at all. I’m only just figuring all this out, and I think it’s a very prevalent problem. Many people in ASD social network groups report the same issues.
Since I’m much worse when overloaded, I’d guess that we get the signals, but our brains don’t filter them properly.
Simon, interoception is a prevalent problem, but we are only just coming to understand what exactly this is. The good news is the awareness of interoception is increasing so perhaps there will be more support developed around this topic. Kelly Mahler is leading the pack on this topic. Have a look at her website – https://www.kelly-mahler.com/
I think it can go on the opposite end of the spectrum and we can over feel our symptoms also. I wholeheartedly believe that hypochondria is rooted in autism.
I am an autistic person. I get the “psychosomatic” label often – to find months/sometimes YEARS later that there legitimately was something physical going on. It’s not surprising that we would over feel as our senses are often hyperaroused compared to the general population.
My son had kidney failure (hydronethopathy) at age 11 due to “autism related neurophatic bladder and bowels”. He is now 17 and still does not feel when he needs to use the toilet and we work on routines and alarms to remind him ……. also high pain threshold and we never know when he hurt himself – school nurse has a weekly check to make sure …… at least now we understand what the “autism related neuropathy” actualy means …. at 17 he now still needs to wear a nappy pad ……
This makes so much sense and I see what you are saying in both my boys with autism. I just need to know what to do best about it.
I am a clinical specialist occupational therapist working with adults with developmental conditions . I cannot tell you how many times I have written in my reports that my client lacks the ability to interpret or in some cases even acknowledge his own bodies physiological cues to maintain homeostasis. I have been ignored by both social workers and psychiatrists. Thanks to Bud Craig I now have the neuro science to prove my clients case, and an ot role model for the first time in my professional career, thanks to Kelly Mahler.
I have worked in the area of developmental conditions for fifteen years and I cannot count the no of times I have written in my reports that mny client lacks the ability to interpret and sometimes to even acknowledge their own bodies physiological cues to maintain homeostasis. I have been consistently ignored by social workers and by psychiatrists who regard the client as having the capacity to choose the behaviours they have. I now for the fist time in my clinical career have an ot role model, thanks to Kelly Mahler . Thanks to Bud Craig and Hugo Critchely I have the neuro science to back me up.
Tricia, learning about interoception has changed my life. I always thought I had some shortcoming as a parent because my now young adult children still don’t know when they are hungry or thirsty. I think we are going to see a huge change around this topic as interoception enters more into mainstream society. It’s an exciting development!
Can you please contact me? I have a 12 year old autistic nonverbal daughter.