Citation
Garfinkel, S.N., Tiley, C., O’Keeffe, S., Harrison, N.A., Seth, A.K. & Critchley, H.D. (2016). Discrepancies between dimensions of interoception in autism: implications for emotion and anxiety. Biological Psychology, 114, 117–126. doi: 10.1016/j.biopsycho.2015.12.003
Key findings
- Autistic adults showed reduced interoceptive accuracy (measured via heartbeat tracking) compared to non-autistic controls, but elevated interoceptive sensibility (measured via the Body Perception Questionnaire).
- The discrepancy between self-reported body awareness and actual accuracy — termed the interoceptive trait prediction error (ITPE) — was significantly greater in autistic participants.
- Higher ITPE scores predicted greater anxiety symptoms in the autistic group. In other words, the mismatch between believing you are attuned to your body and actually being inaccurate was associated with more anxiety.
- Interoceptive accuracy was not related to autism symptom severity, but the ITPE measure was, suggesting that the mismatch between dimensions is more clinically informative than any single dimension alone.
Method in brief
The study compared autistic adults (diagnosed per DSM-IV/ICD-10 criteria; without intellectual disability) with age- and IQ-matched non-autistic controls. Interoceptive accuracy was measured using a heartbeat tracking task (Schandry paradigm). Interoceptive sensibility was measured via the Body Perception Questionnaire (BPQ). Interoceptive awareness was operationalised as the correspondence between accuracy and confidence. Anxiety was measured using the Beck Anxiety Inventory.
Relevance
This paper is significant for two reasons. First, it introduced the concept of the interoceptive trait prediction error to autism research, moving the conversation beyond simple questions of “better or worse” interoception towards a more nuanced understanding of how different dimensions of interoception can be dissociated. Second, and more practically, it suggests a mechanism for the high rates of anxiety in autism: if you feel as though you should be able to read your body but consistently get it wrong, the resulting uncertainty may itself be a source of distress.
From a predictive processing perspective, the ITPE can be understood as a failure of the brain’s internal model to update appropriately — the prediction (I am good at sensing my body) persists despite evidence to the contrary, generating prediction error that manifests as anxiety.
For practitioners, the implication is that anxiety in autistic people may sometimes have an interoceptive root. Interventions that improve actual interoceptive accuracy (or that help calibrate self-perception to match reality) may have downstream effects on anxiety.
Limitations
- The study used a relatively small sample, limiting statistical power and generalisability.
- Participants were autistic adults without intellectual disability; findings may not generalise to the broader autistic population.
- The heartbeat tracking task has been subject to methodological critique, including concerns about whether it truly measures interoceptive accuracy or is confounded by knowledge of resting heart rate and counting ability.
- The BPQ, used to measure interoceptive sensibility, has since been shown to be variably interpreted by different respondents — some treat it as measuring attention to bodily signals, others as measuring accuracy of perception (Gabriele et al., 2022). This complicates interpretation of the sensibility findings.
- Alexithymia was not controlled for as a potential confounding variable, which is a significant gap given subsequent evidence that alexithymia may drive interoceptive differences more than autism itself.