{"id":1249,"date":"2026-09-04T07:51:15","date_gmt":"2026-09-04T07:51:15","guid":{"rendered":"https:\/\/valerieocallaghan.com\/?p=1249"},"modified":"2026-09-04T07:51:15","modified_gmt":"2026-09-04T07:51:15","slug":"interoception-and-neurodivergence-when-the-body-warns-too-late","status":"publish","type":"post","link":"https:\/\/valerieocallaghan.com\/en\/interocepcion-y-neurodivergencia-cuando-el-cuerpo-avisa-tarde\/","title":{"rendered":"Interoception and neurodivergence: when the body warns too late"},"content":{"rendered":"

Val\u00e9rie-Anne O'Callaghan<\/em><\/p>\n\n\n\n

Some people don't know they're hungry until they feel dizzy. They discover they're thirsty when they get a headache. They don't register their tiredness until their eyes close mid-sentence. They rush to the bathroom because there was no cell service until that moment.<\/p>\n\n\n\n

And others perceive every heartbeat, every stomach movement, every temperature change, with an intensity that is difficult to ignore.<\/p>\n\n\n\n

Both patterns frequently appear in neurodivergent populations, and often in the same person depending on the time and system. To understand why, it's helpful to return to the insula.<\/p>\n\n\n\n

How the internal signal is built<\/strong><\/p>\n\n\n\n

Interoception is the perception of the body's internal state: heart rate, respiration, visceral activity, temperature, muscle tension, and chemical balance. It is a continuous flow of information that ascends to the brain.<\/p>\n\n\n\n

Craig (2009) described the two functional regions of the insula. The posterior region receives raw data. The anterior region integrates it with memory, context, and expectations, and that is where a sensation becomes a conscious experience.<\/p>\n\n\n\n

And this process works by prediction. Seth (2013) developed interoceptive inference: the brain generates a hypothesis about what the body's state should be before receiving information, and compares it with what actually arrives. Barrett (2017) added emotional consequence: what you experience as emotion emerges from this negotiation between what is expected and what is experienced.<\/p>\n\n\n\n

Hence a conclusion with considerable scope: if the body signal arrives altered, the emotion that is built upon it will also be altered.<\/p>\n\n\n\n

What the research finds<\/strong><\/p>\n\n\n\n

It is important to be precise here, because this area is often misrepresented.<\/p>\n\n\n\n

The research distinguishes three dimensions that do not go together. interoceptive accuracy<\/strong> It measures objective performance on detection tasks, typically counting heartbeats. interoceptive sensitivity<\/strong> It gathers what the person believes about their own abilities, through questionnaires. And the interoceptive awareness<\/strong>It measures the correspondence between the two, that is, to what extent someone is right in judging their own accuracy.<\/p>\n\n\n\n

Many studies find differences in autistic populations, especially in self-report measures. Questionnaires such as the ISQ, validated in adolescent and adult autistic populations, record difficulties such as not identifying signs of hunger, thirst, pain, or the need to use the bathroom until they become intense.<\/p>\n\n\n\n

And a problem arises that should be addressed.<\/p>\n\n\n\n

The alexithymia hypothesis<\/strong><\/p>\n\n\n\n

Bird and his group proposed something that reorganized a large part of the field: perhaps the interoceptive differences attributed to autism actually correspond to coexisting alexithymia.<\/p>\n\n\n\n

Alexithymia describes difficulties in identifying and describing one's own emotions, distinguishing emotions from bodily sensations, and an externally oriented thinking style. It is not listed as a diagnosis in the manuals and is estimated to be present in a high proportion of autistic individuals, significantly higher than in the general population.<\/p>\n\n\n\n

Brewer, Cook, and Bird (2016) proposed alexithymia as a general deficit in interoception. And Trevisan et al. (2019) conducted a meta-analysis in Journal of Abnormal Psychology<\/em> with one important result: alexithymia is moderately associated with interoceptive sensitivity, the subjective measure, and shows no significant association with objective interoceptive accuracy.<\/p>\n\n\n\n

Translated: what is most clearly altered is not so much the ability to detect the signal as the relationship with it, the trust in it and the use that is made of it.<\/p>\n\n\n\n

This has considerable practical implications. Two autistic individuals can have opposite interoceptive profiles, and the presence or absence of alexithymia explains some of that difference. Generalizing is a mistake.<\/p>\n\n\n\n

Why the body gives late warnings<\/strong><\/p>\n\n\n\n

With the above in mind, the pattern I see in consultation admits several explanations that add up.<\/p>\n\n\n\n

The signal arrives with lower resolution.<\/strong> When information is sent up with poor definition, the predictive system has little material to work with and only detects change when the magnitude is large. Hence the direct jump from being fine to being on the edge, without intermediate states.<\/p>\n\n\n\n

It competes with external noise.<\/strong> In a sensory-demanding environment, attention is focused on managing external input. Internal signals are relegated to the background due to a competition for resources.<\/p>\n\n\n\n

One learned to neglect oneself.<\/strong> Many neurodivergent people spent their childhood receiving the message that their sensations were exaggerated: that the clothes weren't itchy, that the noise wasn't that bad, that they couldn't possibly be that hungry. Ignoring their own signals was a reasonable adaptation, and it became automatic.<\/p>\n\n\n\n

Masking consumes attention.<\/strong> Those who constantly monitor their social image have fewer resources to monitor their internal state. Their attention is directed outward for hours.<\/p>\n\n\n\n

The emotional consequence<\/strong><\/p>\n\n\n\n

Here's what has the most consequences in daily life.<\/p>\n\n\n\n

If emotion is based on interpreting bodily sensations, a vague signal produces a vague emotion. Many people describe exactly that: knowing something is wrong without being able to pinpoint what, or bursting into tears or outbursts without having noticed anything beforehand.<\/p>\n\n\n\n

And emotional regulation depends on early detection. Regulation is easier at level 30% on the scale than at level 90%. Those who only receive a signal from level 90% onward have very little room to maneuver, and from the outside, their reaction appears disproportionate when in reality it is a delayed reaction.<\/p>\n\n\n\n

It also explains the pattern of sudden exhaustion. Fatigue builds up for weeks without producing any discernible signs, and by the time the system finally alerts you, it's already in reserve.<\/p>\n\n\n\n

What can be done<\/strong><\/p>\n\n\n\n

The good news is that interoceptive accuracy is trainable. Fermin et al. (2023) found that sustained attention to bodily sensations improves interoceptive awareness, with correlates in insular networks.<\/p>\n\n\n\n

And it's important to do this carefully in this profile, because generic body awareness practices can be aversive.<\/p>\n\n\n\n

Start with the big and obvious.<\/strong> Before the heartbeat, which is the most difficult to detect, there are signals of greater amplitude: the weight of the body in the chair, the temperature of the hands, the depth of breathing.<\/p>\n\n\n\n

Describe without interpreting.<\/strong> Name the physical sensation before assigning an emotion to it. Pressure, heat, tension, emptiness. Assigning an emotional name too soon skips the step that needs to be practiced.<\/p>\n\n\n\n

Use external supports while the internal signal is being fine-tuned.<\/strong> Alarms for drinking and eating, fixed rest schedules, written records of one's condition at specific times. This is often interpreted as a defeat and functions as scaffolding: it provides support while the other is being built.<\/p>\n\n\n\n

Check at neutral times.<\/strong> Ask yourself how your body feels when nothing is wrong, three or four times a day. Training calmly makes the signal more accessible during difficult times.<\/p>\n\n\n\n

Respect the threshold.<\/strong> If paying attention to the body produces activation, it is advisable to shorten the exercise considerably and anchor yourself to something external at the same time, with your feet on the ground or one hand on a surface.<\/p>\n\n\n\n

One final clarification<\/strong><\/p>\n\n\n\n

All of the above describes patterns, not rules. There are autistic people with very fine, sometimes uncomfortably fine, interoception, who perceive signals that others don't even register. And there are mixed profiles, with hypersensitivity in one system and hyposensitivity in another.<\/p>\n\n\n\n

What can be stated is that the relationship with the body's signals deserves to be explored individually, and that assuming it as the norm leads to errors both in clinical practice and in self-care.<\/p>\n\n\n\n

When someone says they didn't realize they were exhausted, they are often describing a literal fact.<\/p>\n\n\n\n

Sources and references<\/strong><\/p>\n\n\n\n

Barrett, LF (2017). How Emotions Are Made: The Secret Life of the Brain<\/em>. Houghton Mifflin Harcourt. Professor of Psychology, Northeastern University.<\/p>\n\n\n\n

Brewer, R., Cook, R., and Bird, G. (2016). Alexithymia: a general deficit of interoception. Royal Society Open Science<\/em>, 3(10), 150664.<\/p>\n\n\n\n

Craig, A.D. (2009). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience<\/em>, 10, 59-70. Neuroanatomist, a leading expert in the study of the insula.<\/p>\n\n\n\n

Fermin, ASR, et al. (2023). Insula neuroanatomical networks predict interoceptive awareness. Heliyon<\/em>, 9(8), e18307.<\/p>\n\n\n\n

Garfinkel, S.N., et al. (2015). Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology<\/em>, 104, 65-74. University of Sussex.<\/p>\n\n\n\n

Seth, A.K. (2013). Interoceptive inference, emotion and the embodied self. Trends in Cognitive Sciences<\/em>, 17(11), 565-573. Cognitive neuroscientist, University of Sussex.<\/p>\n\n\n\n

Trevisan, D.A., et al. (2019). A meta-analysis on the relationship between interoceptive awareness and alexithymia: distinguishing interoceptive accuracy and sensitivity. Journal of Abnormal Psychology<\/em>, 128(8), 765-776. Yale University.<\/p>","protected":false},"excerpt":{"rendered":"

Val\u00e9rie-Anne O’Callaghan Algunas personas no saben que tienen hambre hasta que se marean. Que descubren la sed cuando les duele la cabeza. Que no registran el cansancio hasta que se les cierran los ojos a media frase. Que llegan al ba\u00f1o con urgencia porque hasta ese momento no hab\u00eda se\u00f1al. Y otras perciben cada latido, […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21],"tags":[],"class_list":["post-1249","post","type-post","status-publish","format-standard","hentry","category-articulos-de-interes"],"_links":{"self":[{"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/posts\/1249","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/comments?post=1249"}],"version-history":[{"count":1,"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/posts\/1249\/revisions"}],"predecessor-version":[{"id":1250,"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/posts\/1249\/revisions\/1250"}],"wp:attachment":[{"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/media?parent=1249"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/categories?post=1249"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/valerieocallaghan.com\/en\/wp-json\/wp\/v2\/tags?post=1249"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}