Autism and Interoception

How are you feeling?

Have you ever heard of interoception?
This a sensory function which is still being described, and there is still some disagreement over what its definition should include.

Interoception is the sense of your inner self which includes the ability to feel what is going on inside you.

The initial definitions were about giving a person ability to recognize inner physical symptoms of needs: when you felt hungry, thirsty, needed to go to the bathroom, felt pain or discomfort in your internal workings.

The definition has been refined over time and using recent studies now includes also your emotional status.

Studies are in the initial stages but tend toward showing that neurological ties to the inner body are the same that are used for ‘feeling’ emotions, and that yes, emotions are tied to physical feelings as well.

We all know that, if we think about it. Tension headaches, anxiety stomach aches, the burning that comes with anger and the churning gut of distress, and how do you suppose the term ‘heartache’ was coined?

Right now there is debate over which comes first, the physical sensations or the emotional processes involved in recognizing ones “feelings”. Some scientists are saying that the physical responses are the initial ones which cause us to then recognize the emotions behind them.

I think the jury is still out on that idea, but it is interesting to think about the implications.

Interoception as it is described today is related to recognizing physical and emotional status of our inner selves. It is the neurological sense that tells us ‘how we feel’ in the most literal way.

How is this likely to be tied to autism?

Interoception is believed to exist because of human neurology. It is being defined as another sense.
We are equipped with an internal monitor through a network of nerves which sense and report “how we feel”.

Autism being a function of neurology and strongly tied to sensory processing, can show its effects in any part of the human neurological system.
Many autistic people are not good at recognizing when they are hungry, thirsty, tired, whether their bladder is full, and on and on.
We are notoriously poor at sorting our emotions as well.
All of these issues are related to interoception because they are all issues of sensory processing within us.

I will use imaginary Sally as an example.
Sally was late to be toilet trained, she simply was not able to tell when she ‘had to go”. She often wet the bed. Her body did not wake her when her bladder was full because it did not recognize that discomfort.
Sally had a ruptured appendix when she was 25, and did not recognize the abdominal ache, which she reported as vague and undefined. She finally had uncontrollable vomiting which drove her to the emergency room where she was barely in time for her life to be saved by immediate surgery.
Sally will get so involved in a project that she forgets to eat, and when she finally does eat, she does not know when to stop, often getting sick from overeating.
She is known for her volatile temper and her extreme emotional outbusts.
All those struggles are likely to have their base in processing input from her interoceptive system.

Do you have signs of interoceptive struggles in your own life?

Emotions and Autism

Sorting or recognizing emotions is something not addressed too often in discussions about autism, yet I see it as being one of the most troubling features of my autism for most of my life.

I am not sure how my emotions got so tangled. How much was due to the dysfunction of our family, and my position in the dynamics? How much was due to the autistic inability to recognize the emotional state of others? I was dependent on others to explain the world to me, and for the most part the explanations I got ( or at least the way i understood the explanations- which were few) were wrong. If I assimilated the explanations I was given and applied them, it ( my perceptions of these explanations ) just dug me deeper into confusion. I really had no idea about emotions, how to identify them, and what they actually meant.

Autism confused me further… when I believed I grasped a concept or a rule, inflexibility did not allow me to see I might not have understood “the rules” after all. I held that rule fast to my heart and mind because I understood somehow that there were rules and I needed to follow them, and the better I learned the rules, the less trouble I would be in, the less angry people would be with me, the less I would be scolded or spanked or scorned or ridiculed. There was safety in being able to cling to a rule. Of course my autistic perceptions were inaccurate, and incomplete. My understanding of explanations was literal, my concepts of ‘the way the world is” were drastically skewed.

So it is no wonder that the world of emotions, which I did not perceive in others until i brought their wrath down around me, was left behind in my search to understand how to avoid the complications by learning the rules. My emotions were not useful, other’s emotions were not clearly understood and the dynamics of what things activate emotions was for the most part very unclear to me. I was told over and over that I was rude, unfeeling, selfish, thoughtless, etc… but nobody ever explained in what ways or how I was ‘being’ all of those things. I was told over and over “you should know”… but that did not show or explain to me how I “should know”, nor yet the specifics of what I “should know” and how to apply that knowledge to whatever situation it was I was in that got me into perpetual trouble.

It was not until I became suicidal and finally found a good counselor that I began to figure out emotional dynamics, both other people’s and my own. I had no idea I was autistic at age 30, that understanding finally arrived at age 66, but mean time the therapist I worked with was able to point out several misunderstandings in my thinking. He taught me to be healthily self assertive… but before I could be self assertive, I had to know what I needed and wanted. I had always tried to please others and appease/prevent their aggression and anger, but never had looked at trying to figure out who I was or what I needed, what I thought about any topic, what I wanted. I went from such family dynamics into a married state that duplicated the patterns at home, only perhaps escalated the severity of the problems in patterns that existed. During that time the therapist encouraged me to write. I had been in the habit of writing long apologetic letters to people whenever they were upset with me. The therapist somehow could see that for me the written word, and writing was my best form of understanding, communication, and self expression.
He assigned me books about making healthy choices and how to have effective and healthy communications to read, and asked me to write about my problems.

This was such an illuminative experience! What most people probably learn in their early teens, I was learning for the first time as a 30 year old adult. It was freeing! When I read back the things I wrote ( I wrote letters which i never sent to the individuals who I had struggles with) I began to understand what my problems were… and the therapist was able to point out how I could choose to respond in different ways to those problems.
Among other things, I had to learn to recognize anger in myself and to express it. I had to learn how to say NO to people instead of bending over backwards and going far out of my way to please them. Family member or complete stranger, I was the servant and the doormat and the “please don’t be angry or aggressive with me, I will do anything to avoid that” person. Think of Archie Bunker’s Edith and you will have a small idea.
I still have to resist this tendency in every day life and measure in my mind exactly what is reasonable and sane for me to do as opposed to simply responding with”yes” to avoid any discomfort.

I had to learn to recognize frustration, sadness, shock/surprise and understand how these emotions could be acknowledged and expressed as well.

I learned communication tools and how to use them. I had empathy/sympathy when others’ pain was explained to me, but had (and still have) struggles with recognizing distress or anger or other emotions in others.
I am better at trying to put myself in people’s places , endlessly comparing in my mind their current experience to any previous experience I may have had to get a clue to what they may be thinking or feeling as I interact with them.

This seems to be something “neurotypical”( non autistic) people know without working at it, they are able to perceive emotion and understand its significance as if by instinct. I still am not good at this, but I have better skills with practice 37 years after the counselor than I had as a child and young adult.

In struggles for everyday function, my emotions tend to get shoved to the background and not recognized or acknowledged until they build into ‘overload’. Then it all comes out. I have got much better at recognizing the first hints of emotions in myself and paying attention to them, and if and when I can do that, I might be able to better respond to a situation instead of its building until I fall apart.

I have to say that going to that therapist was the hardest thing I have ever done. It was also the best thing I ever did in making my life better and easier for myself. I have so much more understanding than I did before.

I have lived with fear and anxiety as being my 2 predominant emotions for most of my life. Certainly in those days, they were the only emotions I deeply experienced on an every day level. Never knowing when you are going to get punished for ‘doing wrong’ and never knowing when or understanding why it happened are powerful motivators to be anxious and worried. As I have got more practice and made better choices , and now especially since I understand that my autism caused so many misunderstandings, and how that worked, my anxiety is leaving me, and I am rarely bothered by depression.

I think both anxiety and depression were because I was helpless in my former roles with no way to avoid the emotional and physical pain.
I learned how to recognize my emotions and how to change my behavior patterns by making better choices. But first I had to recognize that I had the power to choose.