Interoception and Mental Health: A Roadmap

The Body Sensing Itself: A New Foundation for Psychiatry

Khalsa and colleagues’ 2018 paper proposes nothing less than a reorientation of psychiatric research around a single construct: interoception — the body’s capacity to sense, interpret, and respond to its own internal signals. Published in Biological Psychiatry, the paper argues that disrupted interoception is not merely a feature of individual psychiatric conditions but a transdiagnostic mechanism — a common pathway through which diverse forms of psychopathology are generated and maintained. The anxious individual who catastrophically misinterprets cardiac sensations, the depressed individual who cannot feel pleasure in the body, the eating-disordered individual who cannot detect hunger or satiety, the addicted individual who confuses craving with need, and the dissociative individual who cannot feel the body at all — these apparently diverse clinical presentations share a common disruption: the body’s system for knowing itself has malfunctioned.

Three Dimensions of Body-Knowledge

The paper’s most significant conceptual contribution is its tripartite distinction among interoceptive accuracy, interoceptive sensibility, and interoceptive awareness. Accuracy refers to the objective ability to detect internal signals — measured, for instance, by heartbeat detection tasks. Sensibility refers to the subjective confidence in one’s own interoceptive abilities — how good one believes oneself to be at sensing the body’s signals. Awareness is the metacognitive dimension — the capacity to reflect on and understand one’s own interoceptive processing. These three dimensions can dissociate, producing clinically meaningful patterns. The anxious individual may have high interoceptive accuracy (they detect every heartbeat) but poor interoceptive awareness (they cannot contextualize or regulate their response to these detections). The alexithymic individual may have low accuracy and low sensibility — genuinely unable to detect or describe their internal states.

The Transdiagnostic Promise

For depth psychology, the transdiagnostic interoceptive model provides empirical support for a position the tradition has always held: that diagnostic categories are surface phenomena. Hillman argued that the DSM’s categorical system fragments the soul into billable codes; van der Kolk demonstrated that many apparently distinct diagnoses are surface expressions of a single underlying trauma. Khalsa extends this argument by identifying interoceptive disruption as the embodied substrate that generates multiple diagnostic presentations. If the body’s system for knowing itself is disrupted, the downstream consequences — anxiety, depression, dissociation, disordered eating, substance use — are not separate diseases but different expressions of the same foundational failure.

Implications for Practice

The paper’s clinical implication is direct: restoring interoceptive capacity should be a primary therapeutic target across diagnostic categories. This is precisely what somatic therapies (Somatic Experiencing, Sensorimotor Psychotherapy, MABT), body-based mindfulness practices, and the Woodmanian tradition of body-soul work have been doing — often without the theoretical framework that Khalsa now provides. The depth tradition’s insistence that healing must include the body is vindicated: the interoceptive system that Khalsa identifies as transdiagnostically disrupted is precisely the system that somatic therapies are designed to restore.