The neurobiology of interoception in health and disease

Abstract

Interoception is the sensing of internal bodily sensations. Interoception is an umbrella term that encompasses (1) the afferent (body-to-brain) signaling through distinct neural and humoral (including immune and endocrine) channels; (2) the neural encoding, representation, and integration of this information concerning internal bodily state; (3) the influence of such information on other perceptions, cognitions, and behaviors; (4) and the psychological expression of these representations as consciously accessible physical sensations and feelings. Interoceptive mechanisms ensure physiological health through the cerebral coordination of homeostatic reflexes and allostatic responses that include motivational behaviors and associated affective and emotional feelings. Furthermore, the conscious, unitary sense of self in time and space may be grounded in the primacy and lifelong continuity of interoception. Body-to-brain interactions influence physical and mental well-being. Consequently, we show that systematic investigation of how individual differences, and within-individual changes, in interoceptive processing can contribute to the mechanistic understanding of physical and psychological disorders. We present a neurobiological overview of interoception and describe how interoceptive impairments at different levels relate to specific physical and mental health conditions, including sickness behaviors and fatigue, depression, eating disorders, autism, and anxiety. We frame these findings in an interoceptive predictive processing framework and highlight potential new avenues for treatments.

Visceral Signals Shape Brain Dynamics and Cognition

“…In addition to being continuously and automatically monitored by the brain, visceral signals can sometimes become the object of conscious perception, resulting in explicit interoception. Sensitivity to internal signals in everyday life, as assessed through self-report questionnaires [185,186], appears to be altered in psychiatric disorders [3,187,188], notably in anxiety and depression [189], as well as in autism spectrum disorder [190].…”

Interoceptive accuracy predicts nonplanning trait impulsivity

“…Interoceptive ability is another factor associated with adaptive behavior: Interoception refers to the communication and central processing of internal bodily signals. The nature and strength of internal signals and the quality of their perceptual representation, including the accuracy of judging changes in bodily arousal, can guide actions and decisions (Craig, 2009;Damasio, 1996;Khalsa et al, 2018;Paulus, Stewart, & Haase, 2013;Quadt, Critchley, & Garfinkel, 2018). Therefore, if arousal theories of impulsivity are correct, impulsive individuals may be more sensitive to low states of, or subtle reductions in, bodily arousal and manifest increased interoceptive perceptual accuracy.…”

Tools and Resources: Remote, automated and MRI-compatible administration of interoceptive inspiratory resistive loading

“…Methods to induce controlled perturbations of interoception have so far been trialled in the cardiac domain (via intra-venous administration of isoproterenol 13 ), with breathing (via inspiratory and/or expiratory resistance 12,14-17 ), with gastric and bladder disturbances (via inflation of inserted balloons 18 , or via baroreceptor manipulation 19 ). While pharmacologicallyinduced cardiac alterations induce strong effects and appeal to the wide body of research on natural fluctuations in interoceptive heart-related signals [20][21][22][23][24][25] , the time-related decays required for returning to baseline as well as the burden and risks associated with repeated pharmacological interventions within the same subject pose restrictions on widespread application of this method. Similarly, the use of both gastric/bladder balloons and baroreceptor manipulations face challenges with regard to patient comfort and acceptance.…”