In honor of National Autism Awareness Month, we are excited to introduce guest blogger and autism expert Kelly Mahler. In a two-part series, she delves into interoception, the sense that helps us understand what’s going on inside our bodies. Developing interoception and body awareness can be a significant challenge for people with autism and related issues, but the good news is that improvement is possible.

How Do I Feel? Interoception, the Eighth Sense

By Kelly Mahler MS, OTR/LSit back and close your eyes. What are the sensations inside your body?

· Is your heart beating fast or slowly?

· Are your muscles tense or loose?

· Is your bladder full or empty?

· Does your mouth feel dry or moist?

· Is your stomach growling, full, or content?

· Do your hands feel cold or warm?

Many people are able to feel all of these body signals and others with the help of our little-known, but very important, eighth sense, interoception.

**Why is it important to feel your body signals?**

Your body signals are clues to your emotions. For example, before speaking in public, you might notice certain physical sensations: your heart may race, your muscles may feel tense and shaky, your breathing may become shallow, and your stomach may feel fluttery. These body signals let you know that you are feeling nervous. Without awareness of these body signals, it is difficult to identify emotions with speed and clarity. Interoception helps us to feel these body signals, thus allowing us to clearly identify a wide variety of sensations including hunger, fullness, pain, illness, need for the bathroom, anxiety, anger, calmness, and sensory overload.Interoception and self-regulation: When our interoceptive system is working at its best, our body signals alert us that something feels “off” and motivate us to do something to help our body feel more comfortable. For example, if we notice a dry mouth and know that this means we are thirsty, we are urged to get a drink; if we notice sweat on our skin and warm muscles and know that it means we feel hot, we are urged to seek shade or a fan; if we notice tight fists and tense muscles and know that it means we are getting frustrated, we are urged to seek help or find a way to calm down. Interoception underlies our urge to use a self-regulation action (a.k.a. coping skill). If we feel that our internal balance is off, and understand what that feeling means, we are motivated to seek immediate relief from the discomfort. You need to know exactly how you feel in order to manage it effectively!

How does difficulty with interoception influence self-regulation?

Typical interoception is one of the biggest predictors of the ability to independently self-regulate because the ability to notice body signals and connect them to an emotion serves as the urge or motivation to promptly and independently use coping skills. Therefore, when an individual has difficulty with interoception, they are often missing an important foundation of self-regulation. Here are some examples of the challenges people face without well-functioning interoception:“I wouldn’t realize I was angry until I hit or kicked something. I didn’t notice the anger feelings in my body.” --Jackson, 10 years old“I was an encyclopedia of coping strategies. I could tell you over 50 strategies that people taught me to use to ‘calm down.’ Amount I could use in the moment? Zero. I did not feel the need to use the strategies.”--Chloe, 22 years old“I didn’t realize I was hungry until I was irritable and HANGRY. Even at that point, I didn’t always realize that my uncomfortable, irritable feeling was extreme hunger.”--Declan, 14 years old“I used to eat and eat and eat to the point of vomiting. I did not notice the signals in my body telling me when I was full and it was time to stop eating.”--Becky, 30 years old“My son broke his leg and walked around like everything was just fine for 3 days. He didn’t notice the pain.”--Julie, mom to a 5 year old“My daughter does not realize that she has to go to the bathroom until it is an extreme sensation. We are always running for the nearest toilet and don’t always make it on time.” --Dan, dad to a 7-year-old

How common are interoception difficulties?

Interoception difficulties are very common and have been tied to conditions such as autism, anxiety, depression, developmental trauma, PTSD, ADHD, eating disorders, and sensory processing disorder. It’s important to understand the basics of interoception and its role in everyday life in order to help people who face challenges in this area. Now that I’ve explained the basics, my next blog post will offer specific techniques for improving an individual’s interoception.For more information and free resources, please visit www.kelly-mahler.com.Kelly Mahler MS, OTR/L, has been an occupational therapist for 17 years, serving school-aged children and adults. Kelly is an adjunct faculty member and research chair in the Department of Occupational Therapy at Elizabethtown College, Elizabethtown, PA. She is an international speaker and presents frequently on topics related to the 7 books she has authored including The Interoception Curriculum: A Step-by-Step Guide to Developing Mindful Self-Regulation.

How Do I Feel? Interoception, the Eighth Sense