April 8, 2021

Interoception: all about the eighth sense

Sensory differences in interoception are common amongst neurodivergent people. Here’s why and why it matters.

Interoception: all about the eighth sense

Did you know that there are at least eight senses?! In addition to the five commonly-known senses - touch, sight, hearing, smell & taste - there are three lesser known senses: your vestibular system (sense of balance), proprioception (the sense of your body’s movement in space), and interoception. Note: some people argue that there are actually far more senses - maybe even 20+!

Interoception ‘is the processing and central representation of afferent internal bodily signals’ (Critchley et al. 2017), meaning that interoception is the sense of what’s happening inside of our body. It allows us to feel hunger, thirst, when we need to go to the washroom (our bladder and bowels), internal pain and temperature, our heart, sexual arousal, our gut microbes, our immune response, among many other important bodily experiences (Critchley et al. 2017, Barrett et al. 2004). Interoception also impacts the way we interpret and are able to decipher our emotions, and is related to emotional regulation (Garfinkel et. al 2014).

The way we interpret sensory stimuli stems from our individual neurology - any given person’s brain structure, chemistry, and functioning - and the way our neurology interacts with other parts of our nervous and sensory systems. Interoception is not a very well understood sense (Gibson 2019), however, from what we do know: there are sensory receptors located all around our bodies’ organs and skin (Greutman 2017). These receptors communicate with the brain - in particular with the insula (Papoiu 2016) - about what’s going on inside your body. As with other senses, there is actually significant diversity in how people interpret the internal state of their body! This is related to an individual's sensory processing - or how they uniquely respond to different kinds of sensory stimuli.

While anyone can struggle with interoception challenges, neurodivergent people - autistic people, people with ADHD, dyspraxic people, for example - as well as people with acquired neurodivergence, like people with PTSD, are more likely to have interoception challenges. This is related to neurodivergent people often having differences in sensory processing. Our sensory processing is informed by how our brain is wired and our nervous systems - so, the way our body interacts with the brain and how we sense things. Many neurodivergent people have differences from neurotypical people in the way sensory information is interpreted by the body and brain.

Neurodivergent people - autistic people, people with ADHD, dyspraxic people, for example - as well as people with acquired neurodivergence, like people with PTSD, are more likely to have interoception challenges.

Interoception challenges have a significant impact on people’s lives. Someone who is hyposensitive to interoception, meaning that they are less sensitive to these internal cues from the body, may have trouble sensing when they are hungry, thirsty, need to go to the bathroom or have a high fever - to name just a few examples. Without access to support or support tools, this can present significant challenges in day to day life and wellbeing.

Hyposensitivity to interoception also impacts a person’s ability to interpret and understand what they are feeling. This is related to the interplay between the body, emotions, and emotional regulation (e.g. Barrett et al. 2004). To further illustrate this interplay, Morin writes that someone who is hyposensitive to interoception ‘may not “feel” fear because they don’t recognize that their muscles are tense, their breathing is shallow, and their heart is racing’, for example.

Hypersensitivity to interoception - meaning someone is very sensitive to interoception - can mean someone is overwhelmed by feelings that are a part of the body's day-to-day functioning. This can make sensations difficult to interpret, and can also cause anxiety, stress and/or distraction, as well as discomfort and pain. A common experience reported by many people who are hyper-sensitive to some interoceptive cues is that their own heartbeat can be extremely distracting. Hypersensitivity to interoception can also have a significant impact on emotional regulation. In the words of Price and Hooven, emotional regulation ‘involves the ability to accurately detect and evaluate cues related to physiological reactions to stressful events, accompanied by appropriate regulation strategies that temper and influence the emotional response.’ (Price and Hooven 2018). Feeling heightened sensitivity to certain physiological cues associated with stress, for example, - say one's heart rate or breathing - can have a cascading effect that triggers anxiety, fear, or stress in situations where there is no threat, but someone who is hypersensitive to these feelings actually feels there is, based on their body’s sensations and how they’re interpreted and understood.

It is extremely important that support tools and strategies for interoceptive awareness are readily available to those who are hypo or hyper-sensitive to interoception. Some examples of these kinds of supports may be adjustments that remind someone of their bodies internal needs - like eating, drinking, going to the bathroom, or sleeping (this can be in the form of assistive apps like Tiimo, physical posters/checklists, support-people or family, and so on). Support can also mean accessing therapy that can help build interoceptive awareness. Occupational therapy, MABT, as well as other therapy strategies, can help build interoceptive awareness for some people. Certain mindfulness practices are suggested to potentially be supportive to some with differences in interoception (e.g. Gibson 2019).

Looking into a sensory profile assessment and work with a sensory specialist can be an important first step to start establishing what kind of support this may look like. Interoception is still poorly understood - including by many doctors and occupational therapists - so make sure you talk to someone with specialized experience. A lot of online resources focus on assessments and consultations for children, however it’s important to note that many youth and adults have sensory differences that go unacknowledged and supported until later in life. If you think you may have sensory differences in interoception, know that there are tools that can support you and you deserve to access them! Interoception is tied to keeping our body in physiological balance, and accessing the support you need to maintain this balance in a way you’re happy with can have a huge impact on your health, and comfort. Here’s hoping that we will understand much more about interoception in the coming years and that strategies to support people’s wellbeing with differences in the way their interoceptive senses are processed become more established and effective.

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