Research gap at a glance
- Question: Do interoceptive differences measured before onset predict later anxiety, depression, eating disorders or related conditions, or do they appear only after symptoms begin?
- Why it matters: The transdiagnostic programme treats interoception as a mechanism and a treatment target. If differences are consequences or correlates, raising or lowering interoceptive contact would treat a byproduct, and the deficit-to-treatment logic of the clinical pages would fail.
- Theme: Clinical
- Status: open
What the wiki already knows
- The field roadmap flags cause or consequence as unresolved and recommends developmental and longitudinal samples with premorbid tracking (Khalsa et al. (2018), Interoceptive psychopathology).
- The NIH review judges that in most conditions the links to interoceptive dysregulation are largely symptomatic and descriptive (Chen et al. (2021)).
- A preregistered meta-analysis of 33 experiments found one convergent site of disrupted activation, the left dorsal mid-insula, across disorders; its authors and an accompanying editorial note it cannot say whether the disruption predisposes or follows illness (Nord et al. (2021), Paulus & Khalsa (2021)).
- Recent reviews and the body-wandering findings are cross-sectional, compatible with attention to the body protecting, with low symptoms freeing attention for the body, or with a third cause (Greenwood & Garfinkel (2025), Banellis et al. (2026)).
- The exteroceptive analogue shows the design is feasible: sensory over-responsivity in 11,210 children prospectively predicted later anxiety and prodromal psychosis (Schwarzlose et al. (2023)).
What would answer it
- A prospective cohort of at-risk children or adolescents assessed repeatedly with multichannel interoceptive accuracy, believed accuracy and bodily attention measures, using cross-lagged models to test whether baseline interoception predicts later symptom onset after adjusting for baseline symptoms, and whether symptom onset is followed by interoceptive change.
Connections
- Raised on: Interoceptive psychopathology, Khalsa et al. (2018), Paulus & Khalsa (2021), Greenwood & Garfinkel (2025), Alexithymia
- Related concepts: Interoceptive psychopathology, computational psychosomatics, Early adverse life events, Sensory over-responsivity (SOR), Alexithymia
- Related debates: Is more interoceptive awareness better?, Is interoception domain-general or organ-specific?
Interoceptive psychopathology returns to this question in almost every section. Each new source, whether a meta-analysis of neural disruption, a review of eight conditions or a large resting-thought study, sharpens the transdiagnostic claim without saying which way the arrow points. The roadmap names the remedy (longitudinal and developmental samples) and the page notes that none of the wiki’s clinical sources have one.
The question is not academic. Interoceptive training in clinical practice shows that reasoning from a cross-sectional deficit to a treatment can fail, as in anorexia, because a deficit may be the illness, a defence against it or a byproduct. The same uncertainty applies to Alexithymia, where the open question is whether it causes interoceptive deficits, labels them or travels alongside them.
The nearest model for the needed design comes from outside interoception. Schwarzlose et al. (2023) used a very large child cohort to show that an exteroceptive sensory feature predicts later psychopathology. An interoceptive version would need measures that work in children, which links this gap to How can interoception be measured in people who cannot report it verbally?, and would need to measure exteroceptive sensitivity alongside interoception to address Is interoceptive dysfunction in mental illness specific to interoception?.