Research gap at a glance
- Question: In autistic and non-autistic people whose self-reported interoceptive sensibility is low rather than high, does the discrepancy between objective accuracy and sensibility still predict anxiety, and is it the signed or the absolute discrepancy that matters?
- Why it matters: The interoceptive trait prediction error is offered as the stable predictor that reconciles mixed anxiety findings, but its evidence comes from a sample with elevated sensibility, while most autism studies report reduced body awareness. If it fails when sensibility is low, the construct is narrower than claimed.
- Theme: Clinical
- Status: open
What the wiki already knows
- Autistic adults showed reduced cardiac accuracy with elevated self-reported sensibility, and the accuracy-sensibility gap predicted trait anxiety in both autistic and control participants (Garfinkel et al. 2016) (Interoceptive trait prediction error (ITPE), Quadt et al. (2018)).
- The first systematic review found only five studies, all small, male-skewed and verbal, and two of the three sensibility-relevant studies reported decreased body and thirst awareness (d about -1.0 to -1.3) or lifelong hyposensitivity (DuBois et al. (2016), Interoception in autism (ASD)).
- A large negative sensibility with low accuracy could shrink the discrepancy, a case the framework has not confronted (Interoception in autism (ASD)).
- The ITPE uses the Body Perception Questionnaire (BPQ) as a belief about aptitude, while later work classes that questionnaire as a measure of bodily attention rather than believed accuracy (Interoceptive taxonomy (Farb et al. Box 1), Murphy et al. (2020)).
- Atypical interoception in autism may track co-occurring Alexithymia rather than autism itself (Alexithymia).
What would answer it
- Recruit autistic and non-autistic adults sampled to include low as well as high self-reported sensibility, measure accuracy with a discrimination task and sensibility with both the Body Perception Questionnaire (BPQ) and the Interoceptive Accuracy Scale (IAS), compute signed and absolute discrepancy scores, and test which predicts anxiety, controlling for alexithymia.
Connections
- Raised on: Interoceptive trait prediction error (ITPE), Interoception in autism (ASD), DuBois et al. (2016)
- Related concepts: Interoceptive trait prediction error (ITPE), Interoception in autism (ASD), Alexithymia, Interoceptive taxonomy (Farb et al. Box 1), Discrepancy awareness
- Related debates: Is the heartbeat-counting task a valid measure of cardiac perception?
The Interoceptive trait prediction error (ITPE) treats the gap between how well a person performs on a heartbeat task and how good they believe themselves to be as a stable, predictive quantity. Quadt et al. (2018) use it to reconcile an anxiety literature in which accuracy is raised in some studies, lowered in others and null in others: the discrepancy, they argue, is what reliably tracks anxiety.
The evidence for that comes from one direction of mismatch, low accuracy with high sensibility. DuBois et al. (2016) read the autism literature overall as tending towards hyporeactivity in self-reported awareness, which is the opposite direction. Interoception in autism (ASD) and the ITPE page both state that whether the discrepancy story survives low sensibility is untested.
There is also a construct question inside the measure. If the sensibility half of the ITPE is an attention scale rather than a belief about accuracy, as the Murphy et al. (2020) correlation structure suggests, then computing it with a believed-accuracy scale may give a different answer. Running both versions in one sample is the simplest way to find out, and controlling for alexithymia addresses the confound that runs through this whole literature (see Is alexithymia a deficit in perceiving the body or in beliefs about it?).