By Myshl Beyer, MOT, OTR/L
We all know of the five basic senses: smell, taste, sound, touch, and sight. Two of the lesser known senses are movement and proprioception. There’s a new buzz in town, however, and it is interoception. It’s considered the 8th sense.
Thanks to advances in brain imaging, we’re not only learning about what it is, but we’re also learning how it impacts our daily life. Think of interoception as the physical feelings in your body, which then tell us what emotions we’re feeling. In fact, think of some of these phrases. There is truth to all of them: lump in your throat, broken heart, butterflies in my stomach, cold feet, gut feeling, follow your heart, clammy hands.
So, how does this apply to us?
Many people with Autism Spectrum Disorder (ASD) and other disorders have difficulties with interoception. In fact, what we are learning about interoception might explain some of the little understood patterns of ASD.
We know that individuals with ASD have limited information alerting them to act or use strategies. Therefore, emotional regulation is different. We see meltdowns, high anxiety, rigid thinking, overwhelming emotions, resistance to change, and poor problem solving.
Basically, we can look at interoception as an over or under awareness of our physical body signals.
With under responsive interoception you may not notice internal signals. You don’t feel states or emotions until they’re very intense. For example, with explosive anger you don’t recognize the feeling of anger, but recognize anger because “I hit someone” and were taught that means anger. Or, it’s hard to answer questions about how your body feels when hungry, angry, calm, thirsty, etc. It’s a vague feeling but you can’t identify the sensation. In fact, poor interoception awareness can lead to wet pants due to an inability to register the sensation of a full bladder.
In one case study, a boy described a feeling in stomach. Was it hunger? He ate. No, it wasn’t hunger. Did he have to use the bathroom? He did use the bathroom, and that wasn’t the feeling either. He learned from occupational therapy sessions that the feeling was stress.
With over responsive interoception awareness, you feel internal states more readily which causes distractions and anxiety. You feel a lot of sensations at once which becomes overwhelming and confusing. You can can’t discern which ones you’re feeling. This can lead to meltdowns as well.
Emotion, self-regulation, and interoception
Self- regulation and interoception are inseparable. Two aspects of self- regulation are affected when we have decreased interoception awareness: body state regulation and emotional regulation.
It’s speculated that the cause of emotional difficulties is poor interoception awareness. One study suggests 65% of people with ASD have problems identifying, describing and recognizing subtle differences in emotions (called alexithymia).
Think of how you feel when your stomach is fluttering. You might identify it as nervousness. In individuals with interoception difficulties, these feelings become difficult to identify. We need to understand our own emotions before we can understand other’s emotions.
What can we do to bridge the gap?
Occupational therapy and speech therapy are helpful to bridge the gap. An individual can learn to use rules to guide her through a social situation (i.e memorization, if/then, steps), and learn to identify her own body sensations. Doing so can help bridge the connection in social situations and with self-regulation.
Mahler, Kelly J., and A. D. Craig. Interoception: The Eighth Sensory System: Practical Solutions for Improving Self-regulation, Self-awareness and Social Understanding of Individuals with Autism Spectrum and Related Disorders. Shawnee Mission, AAPC Publishing, 2016.