Interoception and autism: why “I don't know how I feel” can be the exact truth

What interoception is

Interoception is arguably the most important sense for wellbeing, and the least understood. It's the sense of your body's inner state: hunger, thirst, temperature, pain, needing the toilet, heart rate, breathing, muscle tension, and the physical sensations that underlie emotion. It's one of at least eight senses, and many Autistic people describe interoceptive differences. Research is still unpicking this: some differences seem linked more closely to alexithymia than to autism itself (DuBois et al., 2016; Garfinkel et al., 2016; Shah et al., 2016).

What interoceptive differences can look like

• Not noticing hunger or thirst until it's extreme, and then it feels sudden and overwhelming.
• Difficulty telling where in your body an emotion or pain is, or whether a sensation is physical or emotional.
• Alexithymia: difficulty identifying and describing your emotions. It's not the same as autism, but it often occurs alongside it.
• Seeming to have no reaction to something painful or upsetting, then a large, delayed reaction hours or days later.
• Trouble regulating without outside cues, because the internal signals that would normally guide you are unclear, absent or too late to act on.
• Signals that feel too loud: a heartbeat, a full stomach or a slight temperature change can be distracting or distressing.
• Losing track of your body during deep focus. For monotropic minds, and for many AuDHD people, hunger, thirst and the toilet can disappear completely while attention is elsewhere. See our guide to monotropism.

Why it matters more than people think

The consequences are far-reaching and badly underestimated. If you don't reliably notice thirst, you can become dehydrated, which lowers your thinking capacity, which gets written off as a bad day. If you can't locate pain, you may not seek medical help until a condition is advanced. Women, people of colour and Autistic people are already more likely to have pain dismissed by health services, so these effects can stack. Health passports, written notes for appointments and an advocate can help. If you can't identify rising distress, you can't take early action, so the first you know of a problem may be the meltdown itself.

It also connects to burnout, where your link to your body's signals can become even less reliable, and to meltdowns and shutdowns, where noticing early is so valuable.

For Autistic people who don't use speech, or who have profound and multiple learning disabilities, supporters carry the responsibility to notice signs of pain, hunger and discomfort.

It is not emotional flatness

Interoceptive differences aren't a sign that you don't feel deeply or don't care. They're a sensory processing difference in noticing and interpreting internal signals. Your feelings may arrive late, be muted, or be expressed in ways others don't expect. Someone who says “I don't know” when asked how they feel is very often telling the exact truth.

What helps

Interoception can't be willed into clarity, so support works through scaffolding, not effort. Some ideas that may help:

• Structured prompts for eating, drinking, toileting and rest: alarms, routines, a note on the door.
• External check-ins you can use in place of feeling it, such as a simple body check list: hungry? thirsty? need the toilet? in pain? too hot or cold? tense? If tuning into your body feels uncomfortable or unsafe, especially after trauma, an outside checklist alone is completely fine.
• Knowing your own early signs of overload or distress, from what you can observe, such as more stimming, going quiet or feeling more on edge.
• Patience with delay. It's fine to take time before you know how you feel, and to answer later.
• Offering options, not open questions, when asking how you feel: “are you more tired, sore, or worried?” can be easier than “how are you?”.
• Curious, playful body awareness rather than compliance-based training. Kelly Mahler's work on interoception centres connection and curiosity (Mahler, 2019).
• Eating differences often connect to interoception. See Autistic Realms' Being Autistic and Eating.

Common questions

What is interoception?

It's your sense of your body's internal state, including hunger, thirst, temperature, pain, heartbeat, breathing and the physical side of emotions.

Is alexithymia the same as autism?

No. Alexithymia is difficulty identifying and describing your own emotions. It is distinct from autism but often occurs alongside it, and it relates closely to interoceptive difference.

Why do I only realise I'm hungry when I feel awful?

Many Autistic people don't get clear early hunger or thirst signals, so the first thing they notice is when the state is already extreme. Reminders and gentle structured prompts can help, so you don't have to wait to feel it.

Does not noticing feelings mean I don't have them?

No. Feelings may be delayed, muted or hard to locate, but they are there. It's a difference in noticing internal signals, not a lack of emotion.

References

• DuBois, D., Ameis, S. H., Lai, M.-C., Casanova, M. F., & Desarkar, P. (2016). Interoception in autism spectrum disorder: A review. International Journal of Developmental Neuroscience, 52, 104–111.
• 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.
• Mahler, K. (2019). The interoception curriculum: A step-by-step framework for developing mindful self-regulation. Kelly Mahler.
• Shah, P., Hall, R., Catmur, C., & Bird, G. (2016). Alexithymia, not autism, is associated with impaired interoception. Cortex, 81, 215–220.