Understanding interoceptive modeling and categorization following early-life adversity

Interoception – the process by which the nervous system senses, perceives, and models the internal state of the body – is suggested to be a transdiagnostic mechanism in both mental and physical health disorders. It is an inherently multidimensional and complex construct, which poses both conceptual and measurement challenges. This complexity is illustrated by a recurrent debate in the field, which concerns whether “more” interoception is inherently beneficial for health. We argue that this tension arises from ambiguity between two distinct constructs of interoception, which we label: interoceptive modeling and interoceptive categorization. We define interoceptive modeling as the underlying process via which the nervous system predicts and tracks sensory information from the periphery to generate a model of the current or future state of the body. In contrast, interoceptive categorization refers to the categorization and interpretation of interoceptive information. These are not independent processes, but a conceptual distinction which highlights underlying differences in variation of interoception. Clarifying this distinction reveals that health risks are more likely to stem from poor interoceptive modeling and/or maladaptive interoceptive categorization, rather than from an excess of interoception broadly (i.e., better modelling is always beneficial for mental and physical health). We illustrate this framework using the example of early-life adversity, proposing that features of early-life environments can shape both modeling and categorization processes in ways that confer vulnerability to later mental and physical health challenges. By disentangling these interrelated constructs, this framework advances conceptual clarity in the field, with important implications for theory, measurement, and intervention.