Adaptive and Maladaptive Bodily Awareness: Distinguishing Interoceptive Sensibility and Interoceptive Attention from Anxiety-Induced Somatization in Autism and Alexithymia.
Body-awareness surveys in autism may flag anxiety, not poor body sense.
01Research in Context
What this study did
The authors wrote a theory paper. They looked at past studies that used body-awareness questionnaires with autistic people.
They asked: Do these surveys really measure how well you feel your heartbeat? Or do they just pick up worry about body signs?
What they found
The team says most tools mix up two things. One is helpful body focus, like noticing you are thirsty. The other is fear-driven focus, like scanning for pain because you feel anxious.
They warn that low scores may look like poor body sense, but they may really show anxiety-driven somatization.
How this fits with other research
Fiene et al. (2015) found adults with autism scored much lower on body and thirst surveys. Shawler et al. (2021) reply: those low scores may be anxiety talking, not true interoception.
Hatfield et al. (2019) said weak global body integration drives both autism traits and poor body awareness. Shawler et al. (2021) push back: once you remove anxiety-driven reports, the true integration picture is unclear.
Symons (2019) showed no single body-arousal pattern marks anxiety in autism. This supports A’s view that arousal can come from worry, not from poor body sense.
Why it matters
Before you treat “low interoception,” ask if the client is anxious. Try a brief worry scale first. If scores are high, teach coping skills, then re-check body tasks. This avoids targeting the wrong skill and saves session time.
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02At a glance
03Original abstract
There is growing interest in "interoception" (i.e., detection and interpretation of internal body signals) as a relevant mechanism contributing to certain symptoms and features of autism spectrum disorder (ASD) and alexithymia. However, inconsistent measurement and operationalization of interoception has led to confusion and inconsistent findings in the literature. In this commentary, we present alternative interpretations of findings from existing studies to demonstrate that ASD and alexithymia are conditions associated with reduced adaptive forms of interoceptive attention (i.e., attention toward bodily signals) but heightened maladaptive forms of interoceptive attention related to anxiety-induced somatization. Differentiating adaptive and maladaptive forms of interoceptive attention reveals a clearer pattern of findings in the research literature for further investigation of interoceptive processes that are involved in the neurobiology of ASD. However, interoception is a complex and multi-faceted construct that requires continual refinement in conceptualization and operationalization. Interoception research may benefit from self-report measures that clearly differentiate adaptive and maladaptive forms of bodily awareness. LAY SUMMARY: Some research suggests that autistic people have difficulty understanding bodily feelings such as hunger, illness, or emotions, whereas some studies have reported the opposite pattern of findings. We argue that this latter subset of studies reached false conclusions from using measures of bodily awareness that largely measure physical symptoms of anxiety. While attention to unpleasant bodily signals is an important ability necessary for maintaining healthy bodily functioning, excessive attention, and worry toward bodily signals can increase anxiety and be harmful.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2458