When You No Longer Recognize Your Own Emotions

What if someone asks you, “How do you feel?” and you honestly don’t know the answer?

One of the most significant indicators for many common mental disorders, particularly anxiety and depression, is called interoceptive dysfunction. Interoceptive means that you perceive, recognize, and understand your own emotions, moods, and mental well-being.

Interoception is the act of paying attention to your body’s internal senses. Interoception tells you if you have a full bladder; whether you feel hot or cold, hungry, itchy, tense, nauseous, thirsty, hungry, or in pain; or that your heart is beating too fast or too slow. Demonstrating normal interoceptive ability is what you do when someone asks, “How do you feel?” When you are depressed, this ability can be impaired. We’re simply not sure how we feel.

Having reduced interoceptive abilities is associated with an impaired ability to regulate emotions, impaired self-awareness, called alexithymia, which is a personality trait that makes it hard to feel and understand emotions. Not being able to determine how you feel also makes it harder to express your emotions.

Where Is Alexithymia?

A series of recent studies have pinpointed the three brain regions that are the substrate for interoception. Their dysfunction may underlie alexithymia. The first is the somatosensory cortex, which is the first region of the brain that receives sensory information from your body. The second region is the insula, which processes sensory information and “decides” whether you like the sensory experience or not. For example, the insula processes listening to music and determines whether you like the music or not. The insula is also pivotal in linking cardiac interoception—i.e., knowing how fast your heart is beating during an anxiety attack. The third brain region involved is the anterior cingulate cortex. The cingulate gives strong emotional meaning, usually negative, to the sensory experience. It’s part of a larger network called the limbic system. (For an easy introduction to brain function, go here.)

Interoception and Depression

Because individuals with depression exhibit reduced interoceptive processing, another recent study explored the relationship between interoceptive abilities and mental health outcomes in middle-aged and older adults. It is believed that depression symptoms may stem from disrupted interoceptive sensitivity. For example, depressed people are not able to accurately perceive how fast their heart is beating. We all depend on this intrinsic ability to inform us whether we feel relaxed or stressed. The study confirmed a significant association between impaired interoception and alexithymia. People with low interoceptive ability exhibit more difficulty verbalizing their feelings and mitigating the impact of emotions from negative experiences in daily life. These individuals spend too much time ruminating over bad decisions or negative comments from friends and family. Studies have shown that training people to have better interoceptive attention may improve emotional regulation and promote better mental health.

This showed that depression and its somatic symptoms are linked to abnormal interoceptive processing within the insula. Essentially, this brain region stops paying attention to incoming sensory signals from the body. Precisely how this reduced activation contributes to depression is unknown. Future studies will investigate how training with neuromodulation techniques (such as transcranial magnetic stimulation and vagus nerve stimulation) could become an effective strategy for enhancing mental well-being by helping people to listen better to their inner sensory signals and to accurately tell someone how they feel.