Abstract
Disrupted interoceptive processes are present in a range of psychiatric conditions, and there is a small but growing body of research on the role of interoception in obsessive-compulsive disorder (OCD). In this review, we outline dimensions of interoception and review current literature on the processing of internal bodily sensations within OCD. Investigations in OCD utilizing objective measures of interoception are limited and results mixed, however, the subjective experience of internal bodily sensations appears to be atypical and relate to specific patterns of symptom dimensions. Further, neuroimaging investigations suggest that interoception is related to core features of OCD, particularly sensory phenomena and disgust. Interoception is discussed in the context of treatment by presenting an overview of existing interventions and suggesting how modifications aimed at better targeting interoceptive processes could serve to optimize outcomes. Interoception represents a promising direction for multi-method research in OCD, which we expect, will prove useful for improving current interventions and identifying new treatment targets.
Highlights
obsessive-compulsive disorder (OCD) affects 1–3% of adults [1] and is associated with significant economic cost and a chronic course [2, 3]
The PubMed search resulted in 169 publications, of which 3 examined interoceptive accuracy [31,32,33] and 1 investigated interoceptive sensibility [34] in OCD
It has been proposed that different aspects of interoception follow this tripartite division of function of the insula: afferents carrying sensory signals from the body are first represented at the posterior insula before relaying information to the anterior insula, where interoceptive signals are re-represented with greater complexity through the integration of emotional and cognitive information transmitted from connecting cortical and sub-cortical regions [30, 39, 40, 57, 58]
Summary
OCD affects 1–3% of adults [1] and is associated with significant economic cost and a chronic course [2, 3]. Traditional anxiety-based models form the foundation for evidence-based CBT interventions such as exposure and response prevention ExRP; [8,9,10,11] These models do not account as well for those symptoms of OCD that are less fear-driven, including behaviors that are more motivated by sensory or visceral sensations such as “not-just-right” experiences (NJREs; “I need to arrange objects until they look just right”), disgust, and physical urges (“I feel dirty or sticky so I have to wash my hands repeatedly”). We consider interoception in the context of clinical intervention and discuss implications for research and treatment
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