Have you ever skipped a meal on accident because you didn’t realize you were hungry? Have you ever forgotten to go to sleep because you didn’t realize you were tired? Or maybe you have found yourself feeling really dehydrated because you haven’t had any water all day and now you’re parched? If you have experienced these things or have had similar experiences, you may have poor interoception. So what do you do about it?

I have personally had a lot of trouble with my interoception. A couple of years ago, I used to leave work feeling ill with a headache, stomachache, and fever-like symptoms, and I couldn't understand why. After a few months of this happening, I realized that my body was reacting to sensory overload and not having its basic needs met, such as drinking enough water, eating, and getting enough movement. Once I made these connections, I changed my daily routine and the fever-like symptoms and stomach pain disappeared!

Interoception issues can cause a lot of problems. In this article, I’m going to go over what interoception is, how it relates to neurodivergence, and what to do about it. We’ll talk about some tools you can use to adapt to interoception deficits as well as ways you can improve your body’s interoception awareness. But first, let’s define some terms!

Practices for Poor Interoception

This article is all about helping you if you have poor interoception. However, before we dive into all of that, it’s important to have a basic understanding of a couple of things. First, let’s go over what interoception is and then we’ll talk about it’s relationship to neurodivergence.

What is Interoception?

Interoception is one of eight sensory systems in the body. Most of us already know of the basic five senses (sight, touch, hearing, smell, and taste). However, there are three more sensory systems that most of us overlook. Those are equilibrium, proprioception, and interoception. Equilibrium is the ability to sense gravity, proprioception is the ability to sense where our body is in space, and interoception is our ability to sense our internal states of being like hunger, stress, and sleepiness.

Our sense of interoception allows us to maintain homeostasis (internal balance) by monitoring imbalances and motivating us to take action to fix them. For example, using sensory cells called chemoreceptors in the blood vessels, the body can detect when our blood sugar is too low. And when our blood sugar is too low, our sense of interoception makes us feel hungry which motivates us to eat. Other things our interoception detects are thirst, temperature, discomfort, pain, whether or not we need to use the bathroom, heart rate, breathing rate, sleepfulness, wakefulness, and even emotional states like stress, fear, sadness, etc.

Interoception and Neurodivergence

Neurodivergent people often experience sensory processing difficulties. Most of us are aware that neurodivergent people can be sensitive to light, sound, or touch. However, these sensory processing difficulties can affect all senses, including interoception. That means that we can have a hard time sensing these internal states and/or understanding what to do about them. For example, our bodies may not be able to effectively sense low blood sugar, and/or our brains may not properly receive the hunger signals. This prevents us from feeling hungry and therefore can affect our health and nutrition.

Interoception difficulties can cause a host of problems for Autistic people and ADHDers. Not only may we have trouble with hunger and eating, but also emotional regulation, sleep, understanding, feeling pain, knowing when to use the bathroom, and understanding when our bodies have unmet needs.

From Poor Interoception to Better Interoception

Does this sound like you? Do you feel like you have a hard time feeling and interpreting your body signals and sometimes don’t take care of your body for that reason? When we struggle with interoception there are two overarching goals:

1) Build adaptations into our environment to help support us and

2) Implement practices to increase our interoception awareness.

In this section, we are going to discuss tools you can use to help accommodate for poor interoception as well as review exercises to help increase your body’s interoceptive awareness.

Interoception Adaptions

Assistive technology and adaptations are incredibly valuable to neurodivergent people. Working on increasing interoceptive awareness can take a long time, so it’s helpful to have tools to fill in the gaps in the meantime. In this section, we’ll discuss the importance of building in accommodations and interoception adaptations into our lives.

Timers, Alarms and Apps

Timers are my best ally to my interoception trouble. I personally set an alarm to go off every three hours on my phone. Every time an alarm goes off, I take a minute to check in with my body, take care of any needs it has, and just remind myself that time is passing. When these timers go off, I remember to eat, drink water, go to the bathroom, and stretch. Almost every time a timer goes off, I realize I have been sitting in the same position for three hours and that my body really needs to stretch or move around some.

Whatever areas you may have trouble with in terms of interoception, you can find creative ways to use timers to help you meet those needs. Whether that’s a daily alarm that reminds you to do a body scan, alarms to remind you when to eat or drink, or timers that remind you to take a sensory break or move your body.

Additionally there are several apps designed to support people with low interoception. For example Tiimo is app designed with neurodivergent people in mind to help them build a visual schedule.

Routine

Usually, I don’t have to preach about the importance of routine to other Autists, but us ADHDers often have trouble with this. If you have a routine, it’s worth considering how you can add to it or modify it to make sure your body’s needs are being met every day. For example, if you take a lunch break every day at noon, you could maybe add a quick trip to the bathroom or a five-minute walk, or some stretching exercises. If you have a bedtime routine, consider including a glass of water at the same time.

By linking activities in this way, you'll establish neurological associations and connections in your brain, and before you know it, you'll be grabbing that glass of water before bed or doing those mid-day stretches without even thinking about it.

If you don’t have a routine, you may want to consider why and if one could benefit you. Having a regular daily routine or rituals to follow is one of the best ways to ensure your body is being taken care of. When I fall out of my routine, I find myself forgetting to take care of my basic needs. If you’re someone who needs spontaneity and chaos, you can find creative ways to fit that into a routine, too! Maybe after you finish work, you give yourself three hours to do whatever you want. Or maybe every Saturday is completely routine-free.

Interoception Awareness Activities

Now that you have some tools to help aid poor interoception in the present moment, let’s work on helping increase your body’s overall interoception so that you don’t need to rely so much on external tools and can feel more confident you know how to meet your body’s needs! In this section, we’re going to talk about mindful check-ins, body scans, and two exercises called “interoception on-the-go” and “how low can you go?”

Mindful Check-Ins

Mindful check-ins are a way to check in with the body and begin to notice sensations we were previously unaware of. These check-ins can be brief (10-15 seconds) or they can be a longer, more meditative practice. It’s up to you! There are a few variations to this exercise. The first is the external check-in which is the easiest to do. The second is the internal check-in, and the last is the emotional check-in, which is the most difficult.

EXTERNAL CHECK-IN

Hold a hot or cold drink in your hand. Bring your awareness to the sensations the temperature creates: what does it feel like? Where do you feel it? Does it feel pleasant, unpleasant, or neutral? Once you’ve checked in, put the drink down and check in again. How does the sensation change? Where do you feel the change? Is it pleasant, unpleasant, or neutral? After a few moments, pick the drink up one more time and do another check-in.

SENSATION CHECK-IN

Do something that creates a physical sensation in your body, like a stretch. Make sure it’s gentle and not painful in any way. If you feel pain, choose a different movement! Bring your awareness to the sensation of the movement. Where in your body do you feel it? What does it feel like? Is it pleasant, unpleasant, or neutral?

Then, similarly to the above exercise, stop doing the movement and check in again in the same way. What does it feel like to stop doing the movement? Where do you feel it? Is it pleasant, unpleasant, or neutral? And then, do the movement again and check in with the sensations one more time.

EMOTIONAL CHECK-IN

You can do this exercise whenever you feel a whisper of an emotion. In this exercise, it’s important to observe without judgment or a need to analyze the emotion. All you’re doing is practicing being aware. If you notice a judgment, a thought, or a story arise, notice that, too, and bring your awareness back to the body’s sensations.

Notice that you felt the whisper of emotion and ask yourself where in your body you feel that emotion. Bring your awareness to the place or those places and check-in. What does that emotion feel like? What is the intensity of that emotion on a scale of 1-10? Is the emotion moving? What does the emotion want you to do or how does it want to move your body? Track the emotion until you feel a shift.

Body Scans

Body scans are similar to mindful check-ins but we are looking over the body for sensations that are already there. You can start with just doing a scan of a particular part of the body (like just the feet or just the legs). This could be an easy way to begin if doing a full body scan is overwhelming (Note: for those with a history of trauma particularly body-based traumas body scans can be dysregulating and should be done with a therapist). If you’re comfortable, and it’s safe to do so, you can jump in and scan the whole body. The basic body scan is, well, the basic variation. The other variations—the color and sensations scans—are options if the basic scan isn’t working for you or if you want to try something different.

THE BASIC BODY SCAN

This is where to start. As I said above, you can start with just one body part or one area or you can jump right in and scan the whole body. Do whatever feels most comfortable for you. Here’s how to do the basic body scan:

1. Get into a comfortable position where your body can relax and your head is supported.

2. Bring your awareness to the breath. Notice your current breathing rate and invite a few deep breaths if that feels good.

3. Start at your feet (or the lowest area of the body part you’re working with). Notice what they feel like. Use a few descriptive words to identify the feelings there (buzzy, numb, soft, heavy, tight, open, etc.). Try to be descriptive and avoid judgment words like good or bad.

4. Move up to the next area and notice what that body part or area feels like. What words describe those sensations?

5. Continue moving up the body taking at least 5 or 10 seconds with each area before moving on.

6. Finish at the top of your head or the area you’re working with. Once you’re done, bring your awareness back to your breath. Invite a few more deep breaths before wiggling your fingers and toes to start coming out of the meditation.

7. Feel free to write the words down if that feels helpful to you!

THE COLOR BODY SCAN

For some neurodivergent people, we have a hard time finding the right descriptive words to match the sensations we’re feeling. If that’s true for you, you can try the color body scan. The only thing that’s different from the basic scan is, instead of using descriptive words, you can identify the colors of each area. For example, my feet feel light blue, by belly feels deep red, and my head feels light purple. You can assign meanings to different colors if you want to or you can just label the body parts with whatever color arises.

I’ve also found that some people do really well when they can use objects or images to identify the sensations of a body part. For example, my feet feel like bricks, my belly feels like a messy ball of yarn, and my head feels like a cloudy sky.

THE SENSATIONS BODY SCAN

Similarly to the color scan, the sensations scan is a variation of the basic scan that may help those who have trouble using descriptive words. For the sensations scan, follow the steps of the basic scan, but instead of using descriptive words to label the sensations, label what those body parts are doing. For example, my fists are clenched, there are butterflies in my stomach, my shoulders are raised, my breath is shallow, I’m grinding my teeth, etc.

Interoception On-The-Go

Instead of sitting down to do a more thoughtful body scan, this exercise is designed for you to use throughout the day. The body scan is useful for promoting a deeper sense of self-awareness. But the on the go exercise is designed to help you check in with your body in moments where you may forget about it while helping you to connect sensations to emotions and needs. It’s useful to build this into your routine or to set alarms to remind you to do the exercises at set times during the day. It’s best if you practice this exercise once or twice per day and pair it with mundane activities with washing the dishes or folding the laundry.

1. Notice the sensations in the body.

2. Notice your emotional state.

3. Ask yourself if they are connected.

Over time, you will begin to notice the connections between sensations to emotions and unmet needs of the body. For example, I notice there’s some tightness and pain in my belly and I’m feeling irritated by people who don’t typically irritate me. Am I hungry? Would food resolve this discomfort?

How Low Can You Go?

This exercise is a fun, informal biofeedback practice. The goal of the exercise is to help you detect your heartbeat (which can be very difficult for those with poor interoception) and practice self-regulation. You can use a tool to help you track your heartbeat like a Fitbit or an Apple Watch, or you can just use your fingers and a stopwatch. If you’re using your fingers and a stopwatch, then make sure you know how to detect and measure your heartbeat. This YouTube video should help!

Here’s how it goes:

1. Take your resting heart rate and write it down.

2. Do an activity that increases your heart rate like jumping jacks or running in place for 30-60 seconds.

3. Draw your attention to your heart rate without using any tools and try to feel your heart beating in your chest. Write down how many beats per minute you think you counted.

4. Now Measure it with a device or with your fingers and see how close you were.

5. Practice this exercise regularly! Maybe once a day if you’re really serious about improving your interoception or just once a week if you feel more relaxed about it.

6. After practicing the above steps for a few weeks, move on to the below steps!

7. Do steps 1-5. Then, try to get your heart rate as low as possible in 60 seconds. For example, you measured your heart rate, exercised, guessed your heart rate, and then measured it again. Then, you could lay down on the floor and take some deep breaths for a minute. Check your heart rate again to see how much your heart rate has gone down.

8. Do this exercise daily or weekly and try to beat your previous record for how low you can get your heart rate. You can also try different breathing techniques, listening to calming music, slow and gentle movements, etc.

There are two goals to this practice: the first is to help us more accurately detect our heart rate which, in turn, increases interoception. And second, it helps us practice self-regulation which is often really difficult for neurodivergent people to do. (Credit, this exercise comes from the work of Kelly Mahler, check out her book for more great interoception resources).

For us neurodivergent people, tricks and tactics to help us down-regulate sometimes don’t work so well for us. So, when practicing this exercise, you may need to experiment with different down-regulation strategies.

Summary: Poor Interoception Practices

It is so common for neurodivergent people to struggle with poor interoception and not even know they’re struggling! I hope this article has given you the information you need to better understand and improve your interoception.

In this article, we discussed what interoception is, how neurodivergence can affect interoception, some tools to use to adapt to poor interoception, and some exercises to help improve overall interoceptive awareness.

References

Mahler, K. (2017). Interoception. The eighth sensory system. Lenexa, KS: AAPC Publishing.