Interoception: The Sense You Didn't Know You Were Missing
- Melanie Du Preez
- 3 days ago
- 10 min read
You work through lunch without noticing hunger until you're shaking at 4 PM.
You don't realize you need to use the bathroom until it's an emergency.
You go from "fine" to complete meltdown in what feels like seconds, with no warning.
You can't tell if you're anxious, hungry, tired, or sick—everything just registers as "bad."
You ignore pain until an injury becomes serious.
You struggle to name what you're feeling emotionally because you genuinely don't know.
If multiple items on that list are familiar, the issue isn't willpower or self-awareness. The issue is interoception—and in ADHD, autism, and AuDHD, interoception is fundamentally different.
What interoception actually is
Interoception is your brain's ability to sense and interpret signals from inside your body. It's sometimes called the eighth sense—after the five external senses (sight, sound, touch, taste, smell) plus proprioception (body position) and vestibular sense (balance).
Interoception tells you:
When you're hungry, thirsty, or need to use the bathroom
When you're in pain or physically uncomfortable
When your heart is racing or your breathing has changed
When you're too hot or too cold
When you're tired or need rest
What emotion you're experiencing (anxiety feels different in the body than sadness or excitement)
For most neurotypical people, interoception operates in the background. The body sends a signal (stomach growls, bladder fills, heart rate increases), the brain registers it accurately, and the person responds appropriately.
For neurodivergent people—particularly those with ADHD, autism, or both—this system is disrupted at multiple levels.
The body might send weak or inconsistent signals. The brain might not register the signals at all. Or the brain receives the signals but can't interpret what they mean.
The result is that you move through the world fundamentally disconnected from your own body's communication system.
How interoception is disrupted in ADHD and autism
The research base is substantial and recent.
A 2025 systematic review by Bruton and colleagues, published in Psychophysiology, analyzed interoception specifically in ADHD. They found decreased interoceptive accuracy in people with ADHD compared to neurotypical controls, and critically, interoceptive deficits correlated with ADHD symptom severity—meaning the more significant the ADHD, the more disrupted the interoception.
A 2025 meta-analysis in Frontiers in Psychiatry synthesized 31 studies on interoception in autism. The findings were consistent: autistic individuals show reduced interoceptive accuracy across multiple body signals.
This isn't subtle. This is a core feature of neurodivergent neurology that affects daily functioning in ways most people—including most clinicians—don't recognize.
In ADHD, interoceptive disruption shows up as:
Not noticing hunger, thirst, or bathroom needs until they become urgent
Difficulty recognizing fatigue (working until collapse rather than resting when tired)
Missing early warning signs of illness (suddenly "getting sick" when you've actually been fighting something for days)
Emotional dysregulation that seems to come out of nowhere because you didn't notice the physical escalation (tight chest, shallow breathing, muscle tension) building for the past hour
In autism, interoceptive disruption shows up as:
Difficulty identifying specific emotions because the physical sensations aren't clear
Sensory overload that isn't recognized as overload until meltdown or shutdown
Alexithymia (difficulty naming emotions) rooted partly in not sensing the bodily experience of emotion
Pain tolerance that looks high but is actually pain under-recognition, leading to untreated injuries
In AuDHD, both systems are disrupted simultaneously, often creating contradictory experiences. You might be hypersensitive to some internal signals (noticing every heartbeat, every digestive sensation) while completely missing others (hunger, need for sleep). The inconsistency itself becomes disorienting.
The three interoceptive profiles
Not everyone experiences interoceptive disruption the same way. Kelly Mahler, an occupational therapist who has done pioneering work on interoception and neurodivergence, describes three primary profiles:
Under-responsive (low interoceptive awareness)
You don't notice body signals until they become extreme. You regularly forget to eat or drink. You work through pain. You don't recognize when you're getting sick until you're very sick. Emotions build without conscious awareness and then erupt.
This is the "I didn't realize I was hungry until I got dizzy" profile. The body is sending signals—you're just not receiving them.
Over-responsive (heightened interoceptive awareness)
You notice everything. Every heartbeat. Every digestive sound. Every temperature shift. Every muscle twinge. The volume is turned up so high that it's overwhelming and sometimes difficult to distinguish signal from noise.
This is the "I can feel my organs working and it's distressing" profile. You're flooded with sensation but can't always tell what's important versus what's normal background body function.
Confused or mixed (inaccurate interoceptive interpretation)
You receive signals but can't interpret them correctly. Anxiety might feel like excitement. Hunger might feel like nausea. Sadness might register as fatigue. Or you experience different profiles for different signals—hyperaware of heart rate but completely unaware of hunger.
This is the "I know something is wrong but I have no idea what my body needs" profile.
Many neurodivergent people experience a mixed profile—under-responsive to some signals, over-responsive to others, confused about still others. The inconsistency makes it nearly impossible to develop reliable self-regulation strategies because what works one day doesn't work the next.
Why interoception disruption matters so much
Interoceptive differences aren't just inconvenient. They're foundational to multiple struggles that neurodivergent people are often blamed for or expected to "just manage better."
Emotional regulation depends on interoception.
You cannot regulate an emotion you don't know you're having. If your interoceptive system doesn't clearly signal "this is anxiety" (tight chest, shallow breathing, racing heart) versus "this is excitement" (similar physical sensations, different context), you can't apply the right coping strategy.
This is why so many neurodivergent people describe going from zero to meltdown with no middle ground. The middle ground existed—your body was sending escalating distress signals for twenty minutes—you just didn't register them until the system was already in crisis.
Self-care depends on interoception.
Every "basic self-care" task—eating regularly, drinking water, resting when tired, using the bathroom before it's urgent, dressing appropriately for temperature, stopping work before burnout—requires accurately sensing your body's needs.
When interoception is disrupted, you're not being neglectful. You're literally not receiving the data you need to make those decisions.
Physical health depends on interoception.
Delayed recognition of illness, untreated injuries, ignored pain, and chronic dehydration or malnutrition aren't character flaws. They're predictable outcomes of interoceptive disruption.
For neurodivergent people with high pain tolerance—which is often actually pain under-recognition—this can lead to serious medical issues going unnoticed until they're severe.
Eating difficulties are often rooted in interoception.
If you can't reliably sense hunger or fullness, eating becomes guesswork. ARFID (Avoidant/Restrictive Food Intake Disorder), binge eating, forgetting meals, eating past fullness, and difficulty with intuitive eating are all connected to interoceptive differences.
Burnout is often an interoceptive failure.
You don't recognize the body's early warning signs—fatigue, muscle tension, digestive issues, sleep disruption, irritability—so you push through until the system collapses. By the time you realize you're burned out, you've been heading there for months.
The interoception-alexithymia connection
Alexithymia—difficulty identifying and describing emotions—affects roughly 50-65% of autistic people and is also elevated in ADHD populations.
The connection to interoception is direct: emotions are physical experiences in the body before they're cognitive labels.
Sadness is a heavy chest, tight throat, low energy.Anxiety is shallow breathing, racing heart, muscle tension.Anger is heat, clenched jaw, surging energy.
If you can't sense those physical experiences clearly, you can't accurately identify the emotion. You might know something feels bad, but you can't distinguish anxiety from sadness from frustration—because the bodily information that would differentiate them isn't reaching conscious awareness.
This is why traditional talk therapy often fails for neurodivergent people with alexithymia and interoceptive difficulties. The therapist asks, "What are you feeling?" and the honest answer is, "I have no idea." Not because you're being resistant or avoidant—because your interoceptive system isn't giving you that information.
Somatic therapy, body-based trauma work, and interoceptive awareness training are often more effective starting points than traditional cognitive approaches.
What actually helps: building interoceptive awareness
Interoceptive awareness can be strengthened, but it requires approaches designed for neurodivergent nervous systems—not generic mindfulness advice that assumes a baseline level of body awareness.
External cues and systems
If internal signals aren't reliable, external reminders create structure:
Timed eating (alarms for meals and snacks, not waiting for hunger)
Scheduled bathroom breaks
Visual body check-in charts (Am I hungry? Thirsty? Tired? Cold?)
Wearable devices that track hydration, heart rate, activity, sleep
This isn't "giving up" on interoception—it's acknowledging that your system needs scaffolding.
Interoceptive awareness practices (adapted for neurodivergent brains)
Kelly Mahler's Interoception Curriculum is specifically designed for neurodivergent populations. The approach focuses on:
Noticing one body signal at a time (heart rate, breathing, temperature) without judgment
Naming what you notice without needing to fix it
Connecting body signals to specific contexts (after eating, after exercise, during stress)
Building a personal body sensation vocabulary
The key difference from generic mindfulness: this isn't about achieving calm or presence. It's about data collection. You're learning your body's language.
Body doubling for interoceptive tasks
For ADHD brains especially, having someone else present can help you notice and respond to body signals. Eating with others, working alongside someone who takes regular breaks, having a friend text "have you had water today?" all provide external cues your internal system isn't generating.
Sensory regulation strategies
For autistic individuals and AuDHD folks, sensory overload often precedes interoceptive shutdown. Managing sensory input—noise-canceling headphones, dim lighting, comfortable clothing, controlled environments—can prevent the overwhelm that makes it even harder to sense internal signals.
Tracking patterns without shame
Keep a simple log:
What time did I eat today?
Did I drink water?
When did I last use the bathroom?
How much sleep did I get?
What physical sensations did I notice?
Not to criticize yourself for "failures"—but to identify patterns. Maybe you consistently forget lunch. Maybe you don't notice thirst until evening. Maybe you sleep through alarm clocks when your body needed rest three hours earlier.
The patterns show you where your interoceptive system is least reliable, which tells you where you need the most external support.
Reframe: this isn't a deficit, it's a difference
Your interoceptive system works differently. That's not the same as broken.
Some neurodivergent people with heightened interoception develop extraordinary body awareness in specific domains—dancers, athletes, bodyworkers who can sense minute shifts others miss.
Some people with low interoception have high pain tolerance that serves them in certain contexts.
The issue isn't the neurology. The issue is living in a world designed for a different interoceptive baseline, without accommodations or recognition that this difference exists.
If you're just figuring this out
If you're reading this and recognizing yourself—if "I didn't know I was supposed to feel those things" is running through your head—you're not alone.
Most neurodivergent adults weren't taught that interoception exists, let alone that theirs works differently. You've spent decades being told you're irresponsible for forgetting to eat, lazy for not noticing when you're tired, dramatic for sudden meltdowns, or detached for not knowing what you're feeling.
You're none of those things.
You've been navigating the world without one of the primary information systems humans rely on for self-regulation. The fact that you've made it this far is evidence of extraordinary compensation, not failure.
Now you have language for what's been happening. That changes what you can do about it.
You can stop blaming yourself for missing signals you were never receiving.
You can build external systems instead of relying on internal ones that don't work reliably.
You can seek support from practitioners who understand interoceptive differences—occupational therapists trained in interoception, trauma therapists who work somatically, coaches who specialize in neurodivergent self-regulation.
And you can start learning your body's language, one signal at a time.
Your body has been talking to you your whole life.
Now you can learn to listen.
For ongoing support, single Life Transformation Coaching sessions are available on my platform using evidence-based subconscious reprogramming techniques that work with your neurology, not against it. International, online, flexible. https://drmel1.podia.com/life-transformation-coaching-session
Download the free guide: https://drmel1.podia.com/interoception-101
REFERENCES AND FURTHER READING
Academic & Clinical Sources:
Bruton, M., Baum, K. T., Garner, A. A., & Kofler, M. J. (2025). Diminished interoceptive accuracy in attention-deficit/hyperactivity disorder: A systematic review. Psychophysiology, 62(1), e14750.
DuBois, D., Lyons-Ruth, K., Mackin, M. L., Schechter, J. C., & Elias Yacoub, S. (2025). Interoception in individuals with autism spectrum disorder: A systematic literature review and meta-analysis. Frontiers in Psychiatry, 16, 1573263.
Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65-74.
Mahler, K. (2022). Interoception: The Eighth Sensory System. AAPC Publishing.
Murphy, J., Brewer, R., Hobson, H., Catmur, C., & Bird, G. (2018). Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 107, 31-40.
Shah, P., Hall, R., Catmur, C., & Bird, G. (2016). Alexithymia, not autism, is associated with impaired interoception. Cortex, 81, 215-220.
2025 Research:
Frontiers in Psychiatry (2025). Interoception in individuals with autism spectrum disorder: A systematic literature review and meta-analysis. [Meta-analysis of 31 studies]
Psychophysiology (2025). Diminished interoceptive accuracy in ADHD: A systematic review. [First comprehensive ADHD interoception review]
ScienceDirect (2025). Enhancing interoceptive awareness in chronic pain and opioid misuse via mindfulness-oriented recovery enhancement. [Interoception intervention research]
Books for General Readers:
Mahler, K. (2019). The Interoception Curriculum: A Step-by-Step Guide to Developing Mindful Self-Regulation. AAPC Publishing.Practical curriculum designed specifically for neurodivergent populations, won Mom's Choice Gold Medal
Mahler, K. (2020). Interoception Activities for Everyone: 50 Mindful Awareness Strategies for Connecting to Your Body. AAPC Publishing.
Price, C., & Hooven, C. (2018). Interoceptive Awareness Skills for Emotion Regulation: Theory and Approach of Mindful Awareness in Body-Oriented Therapy (MABT). Frontiers in Psychology, 9, 798.
Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books.Includes discussion of interoception in trauma and why body-based approaches matter
Online Resources:
Kelly Mahler, OTD, OTR/L (kelly-mahler.com)The leading clinical resource on interoception and neurodivergence. Offers interoception assessments, curricula, and professional training.
Neurodivergent Insights (neurodivergentinsights.com/autism-adhd-interoception-profiles/)Dr. Megan Anna Neff's breakdown of autism, ADHD, and interoception profiles with accessible explanations
The Interoception Network (interoceptionnetwork.org)Research and clinical resources on interoception across populations
STAR Institute (sensoryhealth.org)Sensory processing and interoception resources, offers clinician directory
Autistic Self Advocacy Network (autisticadvocacy.org)Neurodiversity-affirming resources including discussion of interoceptive differences
Assessment Tools:
Multidimensional Assessment of Interoceptive Awareness (MAIA) - Self-report measure of interoceptive body awareness
Toronto Alexithymia Scale (TAS-20) - Assessment for alexithymia (often connected to interoceptive difficulties)
Kelly Mahler's Interoception Assessment tools - Specifically designed for autistic/neurodivergent populations
Therapies & Interventions:
Sensory Integration Therapy / Occupational Therapy with interoceptive focus
Somatic Experiencing (SE) - Peter Levine's trauma therapy focusing on body sensation
EMDR (Eye Movement Desensitization and Reprocessing) - Includes body awareness component
Mindful Awareness in Body-Oriented Therapy (MABT) - Interoception-focused intervention
Dialectical Behavior Therapy (DBT) - Includes emotion regulation through body awareness
Find a Therapist:
Psychology Today - Filter for OT, trauma therapy, somatic therapy, neurodivergent-affirming
STAR Institute Provider Directory - Sensory and interoception specialists
EMDRIA - EMDR therapist directory
Crisis Resources:
If interoceptive difficulties are contributing to self-harm, suicidal thoughts, or crisis:
SADAG (South Africa): 0800 567 567 (24-hour)International: findahelpline.comCrisis Text Line (USA): Text HOME to 741741
NOTE TO READERS:
This blog post discusses interoception as a neurological difference documented in peer-reviewed research. Interoceptive difficulties are not a formal diagnosis but a recognized feature of ADHD, autism, and other neurodivergent profiles. If you're experiencing significant difficulties with body awareness, emotional regulation, or self-care related to interoceptive differences, consult with an occupational therapist trained in interoception or a neurodivergent-affirming mental health professional.
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