I used to get hangry a lot. Not feisty hangry, usually. Just seriously low-tolerance for nonsense hangry. I also used to frequently get afternoon headaches. I “cured” them each day with coffee or soft drink, because it felt like a dire need for caffeine/sugar. I’ve been noted to have a “bladder of steel” because I tend not to use plane toilets even on long haul flights without any problem, or to need the bathroom on long adventures. I used to be convinced I wasn’t tired at all, until minutes later I was asleep on the sofa, or the floor, or at my desk.
On the flipside, I knew the position of my first baby from the time I was about 5 months pregnant, and could tell sonographers exactly where they’d find her head, feet, etc, before they’d even warmed up the machine. Similarly, I knew my labour wasn’t progressing normally despite her being my first child, and midwives insisting for the first 20 hours or so that it was (they were wrong). When I get a chest or lung infection, I can tell the GP precisely where the infection is; I can literally feel it from the inside. I can tell when I’m going to be noise sensitive before the noise begin.
Then I discovered interoception processing disorder. Ha. So that’s what’s going on.
What is Interoception, and Disordered Interoception?
Interoception is our internal system in which we sense our physical and emotional needs. This can be conscious or unconscious, but generally results in recognition of, and response to, the need. For unknown reasons, the development of interoception in neurodivergent people can either slow down, or entirely stop, before they have developed a standard level of interoceptive awareness. It can result in either (or both!) being less or more aware of internal processes than neurotypical people generally are.
As a result, neurodivergent people can find it difficult to self-regulate and achieve homeostasis. For example, if we don’t know we’re thirsty, it’s not always front of mind to drink and avoid dehydration.
Interoception difficulties can also result in alexithymia, where people are unable to recognise or name their feelings, however this is also a separate disorder.
Why Does It Happen?
There have been some studies as to whether this is due to the structure of the insula in the brain being different in neurodivergent people, or whether it is due to hypo- or hyper-connectivity. But, as can be the case in niche fields, the hypothetheses have been supported in their own independent studies. Perhaps they are all correct, given the broad spectrum of skills and behaviours in autistic people. Perhaps some of us have abnormal interoception for one reason, and some of us for another.
I have learned that my interoception awareness is a mix of under-responsive in some areas, over-responsive in other areas, and an overarching inability to differentiate or understand many of my body signals. Once I learned about the connection between interoception and autism, I gained a better understanding of why my body has often felt confusing to occupy.
DR NEFF, NEURODIVERGENT INSIGHTS
How to Handle It?
I’m big on alarms. I have frequent alarms throughout the day to remind me to drink water. A breakfast alarm. I eat dinner with my husband because even though I could easily forget to feed myself, I would almost never forget to make dinner or at least eat with him.
Other people will train themselves to recognise other sensations that may be indicative of a need, such as learning to realise that if you’re feeling headachy during the afternoon it might be time to drink water. Or if you’re grumpy, eating something before deciding if there’s actually a problem.
Smart Watches can be very useful in terms of tracking heart rate, and providing reminders.
How to Help
How you can help your neurodivergent person with interoception dysfunction varies greatly depending on how it presents for them. As always, understanding and acceptance is key. If you find their emotions are frequently big, acknowledge that they might not be aware of these feelings when they are small emotions, rather than that they are out of control or not trying. If they struggle with remembering to eat or drink, offering these (or even just making them something without any expectation they’ll have it) might help. Suggest strategies such as alarms or reminders. Help develop healthy habits.
Body scanning can help when neurodivergent people are feeling uncomfortable, upset, irritated, etc, for no apparent reason. This involves lying on your back somewhere calm, and gradually working through each part of the body to assess how it feels. Even if hunger hasn’t registered, for example, it might be recognised once you directly focus on how your stomach feels or if your hands feel shaky.
We have a beautiful series of posters from Wondermade, to assist with emotion recognition and self-esteem. When any of my children are “out of sorts”, we often curl up on cushions in front of the Emotions Poster and they can simply point at what they’re feeling or think they might be feeling. Or use their hand to cover up any they know they’re not feeling so we can try to narrow it down. The act of recognising what the emotion is often provides considerable respite in itself, and can lead to gentle conversations about triggers, coping mechanisms, mindfulness, recovery, and positivity.
There are health professionals who can assist you further with interoception complications, including psychologists and occupational therapists.