Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry?

Abstract

Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.

Keywords: anorexia nervosa; bulimia nervosa; depression; exposure therapy; heartbeat detection; interoception; panic disorder; somatic symptom disorders.

Figure 1

Number of articles published on interoception versus articles published measuring interoceptive facets without directly referencing the concept. The timeline starts in 1905, 1 year before the publication of Charles Sherrington’s book, “The integrative action of the nervous system,” which introduced the term interoception into the literature.

Figure 2

Facets of cardiac interoception. Representative constructs, tasks, and exemplar studies from the literature. We recommend that future studies include multiple tasks evaluating the facets of cardiac interoception from converging perspectives (e.g., red and blue highlighted tasks). An analogous approach is recommended for other interoceptive sensory modalities (see text for details).