You forget to eat — not because you’re busy, but because you genuinely don’t feel hungry. You don’t notice you’re cold until you’re shivering. You push through physical pain without realizing anything is wrong, then crash completely hours later.
If this sounds familiar, it might not be willpower or distraction. It might be interoception — the body’s internal sensory system — and research consistently shows that autistic adults experience it differently.
If you’ve ever wondered whether your disconnection from your own body signals is part of a larger picture, exploring an autism evaluation can provide clarity.
- Interoception is sometimes called the “eighth sense” — it’s your awareness of internal body signals like hunger, thirst, pain, and temperature
- Research shows 74% of autistic adults report interoceptive confusion
- Interoception differences can affect not just physical self-care but also emotional awareness and regulation
- This experience is real and neurologically grounded — not a personal failing
- Understanding interoception can be a significant piece of the autism identification puzzle for late-diagnosed adults
What Is Interoception — and Why Does It Matter?
Interoception — sometimes called the “eighth sense” — is your brain’s ongoing awareness of signals coming from inside your body. Research describes it as including awareness of hunger, thirst, heart rate, temperature, pain, bladder fullness, and even the subtle physiological shifts that accompany emotional states.
Unlike vision or hearing, which take in information from the outside world, interoception is your body-to-brain axis — the system that tells you “I’m hungry,” “I’m exhausted,” “something hurts,” or “I’m starting to feel anxious.”
When this system works clearly, you respond to your body’s needs almost automatically. When it doesn’t, the signals either don’t register, register late, register as something confusing, or don’t translate into recognizable sensations at all.
For many autistic adults, interoception is one of the most significant — and least-discussed — sources of daily difficulty.
Key Takeaway: Interoception is the sensory system that keeps your brain informed about your body’s internal state. Differences in this system are common in autism and have real consequences for daily wellbeing.
What the Research Shows
The evidence linking autism to interoceptive differences is substantial and growing.
A foundational study published in Autism Research compared 74 adults with diagnosed ASD to a control group of 228 adults. Those in the ASD group reported clinically significant lower body awareness and thirst awareness compared to controls — with large effect sizes (BAQ; d = -1.26, p < 0.001; TAS; d = -1.02, p < 0.001). The researchers noted that difficulty sensing internal bodily states could impact physical health, mental health, social interactions, and self-awareness in adults with ASD.
A larger study using the Interoception Sensory Questionnaire (ISQ) — a 20-item measure specifically designed to assess interoceptive confusion in autistic adults — found that 74% of adults with autism reported interoceptive confusion across a sample of 511 participants. Critically, the study found that as autistic traits increased, interoceptive confusion increased — with adults with a formal autism diagnosis scoring highest on the measure.
A qualitative study analyzing first-hand accounts from autistic adults found that many described limited awareness of hunger, satiation, or thirst — which contributed to disordered eating patterns in some cases. Others described difficulty recognizing affective arousal, pain, or illness — and difficulty differentiating benign body signals from signals that warranted medical attention.
A 2023 study on emotional dysfunction in autistic adults found significant differences in interoceptive confusion, emotional clarity, and alexithymia between autistic adults and neurotypical controls — and found that training interoceptive ability may enhance emotional clarity and reduce alexithymia among those diagnosed with ASD.
Key Takeaway: The research is clear: interoceptive differences are common in autistic adults, affect multiple domains of daily life, and are measurable and real.
How Interoception Affects Daily Life
Understanding interoception in the abstract is one thing. Recognizing it in your own experience is another.
For autistic adults, interoceptive differences often show up as:
Around hunger and thirst:
- Forgetting to eat or drink for extended periods without feeling any hunger or thirst cues
- Not feeling full until well past the point of satiety
- Difficulty recognizing dehydration until it’s become a problem
Around pain and illness:
- Not registering pain clearly — injuries going unnoticed, medical symptoms dismissed because they “don’t feel that bad”
- Alternatively, experiencing sensory signals as overwhelming or undifferentiated, making it hard to locate or describe what’s wrong
- Delayed recognition of illness — feeling fine until suddenly feeling very unwell
Around fatigue and energy:
- Pushing past exhaustion without clear signals to stop — a pattern closely connected to autism burnout
- Not feeling tired until complete physical or cognitive shutdown has already begun
- Difficulty recognizing the early signs that rest is needed
Around emotion:
- Difficulty identifying what emotion you’re experiencing because you can’t clearly read your body’s physiological signals
- Alexithymia — the reduced ability to identify and describe emotions — is closely linked to interoceptive differences in autism
- Emotions that “appear suddenly” or feel disproportionate may actually have been building for a long time without registering
These patterns often look like poor self-care, emotional dysregulation, or executive dysfunction from the outside — and from the inside, they can feel like a fundamental disconnect between you and your own body.
Key Takeaway: Interoceptive differences affect hunger, thirst, pain, fatigue, and emotional awareness — often in ways that look like “not taking care of yourself” when the underlying issue is neurological.
Interoception and Sensory Processing: The Connection
Interoception sits within the broader context of sensory processing differences in autism. Most people are familiar with external sensory sensitivities — responses to sound, light, texture, or smell. Interoception is the internal equivalent: how your nervous system processes signals originating from within the body.
A meta-analysis published in the Journal of Autism and Developmental Disorders found that autistic participants showed significantly reduced heartbeat counting performance — a standard measure of interoceptive accuracy — compared to neurotypical participants. Interestingly, autistic participants also showed higher confidence in their heartbeat counting abilities, despite lower accuracy. This divergence — reduced accuracy paired with higher subjective confidence — may help explain why interoceptive difficulties often go unrecognized: the signals are off, but you may not know they’re off.
This is part of why so many autistic adults reach adulthood without ever having language for this experience. When your baseline has always been this disconnected, it doesn’t feel unusual — it just feels normal.
Key Takeaway: Interoception is part of the sensory profile of autism — not separate from it. The same nervous system differences that affect external sensory processing also affect internal body awareness.
What You Can Do
Understanding interoception doesn’t mean you’re stuck with the consequences.
Many autistic adults find that structured body check-ins — scheduled, deliberate prompts to ask themselves “am I hungry? thirsty? tired? in pain?” — help compensate for the reduced automatic signal that interoception normally provides. Over time, these prompts can become habitual.
Therapeutic approaches that build interoceptive awareness — including certain mindfulness practices adapted for autistic adults and somatic-based therapy — have emerging support in the research. A post-diagnosis support plan that includes interoceptive awareness is something to discuss with your clinical team.
For adults who are undiagnosed, recognizing interoceptive differences can be an important piece of understanding their overall profile. It often accompanies other autism-related experiences — masking, sensory sensitivity, difficulties with emotional recognition — and together, these experiences point toward an evaluation worth pursuing.
If you’re looking for a diagnosis and wondering whether these experiences fit, Josi Health’s autism evaluation can help you get clarity.
The Bottom Line
Interoception — the ability to sense what’s happening inside your own body — works differently for many autistic adults. The research shows this is neurologically grounded: 74% of autistic adults report interoceptive confusion, and the differences are measurable across multiple domains including hunger, thirst, pain, fatigue, and emotional awareness.
This isn’t a character flaw. It’s a sensory difference — one that has a name, a body of research, and increasing clinical recognition.
If you’ve spent years feeling disconnected from your own body signals, that experience deserves to be taken seriously. It may be one more piece of a picture that makes a lot more sense with an autism evaluation behind it.
Reviewed by the Josi Health Clinical Team, Licensed Psychologists. Josi Health provides telehealth autism and ADHD evaluations across 45 states.