Two Scales, Two Constructs: Interoceptive Accuracy Is Not Interoceptive Attention
- Validation study from Leiden University Medical Center and the University of Groningen; 779 Dutch adults (mean age 52.98, SD 16.47; 49.6% female) completed Dutch translations of the Interoceptive Accuracy Scale (IAS-D) and the Interoceptive Attention Scale (IATS-D).
- Both self-report scales showed good-to-excellent internal consistency: IAS-D Cronbach's alpha 0.895 (omega 0.989); IATS-D alpha 0.940 (omega 0.980).
- The two scales pulled in opposite clinical directions: IAS-D (self-reported accuracy) was negatively associated with interoceptive confusion (beta -0.638) and with depression (beta -0.298).
- IATS-D (self-reported attention to the body) was positively associated with interoceptive confusion (beta 0.481), with body-focused attention on the Body Perception Questionnaire (beta 0.207) and with depression (beta 0.377).
Clinicians use "interoceptive awareness" as one word for one thing. This validation study is a reminder that it is at least two things, and that they carry opposite clinical loadings. A patient who accurately reads bodily signals and a patient who anxiously monitors their body are not scoring high on the same construct, and conflating them muddies both assessment and treatment.
What the scales show
The team validated Dutch versions of two short self-reports in 779 adults. Both are psychometrically sound: internal consistency was high for the Interoceptive Accuracy Scale and very high for the Interoceptive Attention Scale. The clinically important result is in the correlations. Self-reported accuracy, the sense of reading the body correctly, went with less interoceptive confusion and less depression. Self-reported attention, how much a person monitors bodily sensations, went the other way: more interoceptive confusion, more body-focused attention on an independent measure, and more depression. Attention to the body, absent accuracy, looks like the profile of the hypervigilant, symptom-scanning patient rather than the well-regulated one.
That divergence is the whole point, and it is correlational: across this cross-sectional sample, "more body awareness" was not uniformly benign, and whether more attention went with less distress depended on its being coupled to a sense of accurate perception rather than free-floating vigilance. Both scales measure perceived interoception, not behavioural detection, so this is a pattern of correlates, not a demonstrated mechanism.
For your practice
These are two-minute, free self-reports worth adding to intake for anxiety, panic, somatic-symptom, health-anxiety and eating-disorder presentations, in any language once validated equivalents exist. Read them as a pair. High self-reported attention with low self-reported accuracy fits the picture of maladaptive body-monitoring, the panic patient tracking every palpitation, the health-anxiety patient scanning for the next symptom, and it points to a target: reduce vigilance and improve the quality of interpretation, not simply "notice the body more." High accuracy with moderate attention is the regulated profile many interventions aim for. The scales also give you a cheap outcome measure: an intervention that raises accuracy while lowering compulsive attention is moving the right variables. Note that this validation is in a Dutch community sample, so use the English originals for English-speaking patients and treat cut-offs as provisional.
In this data, self-reported attention to the body and self-reported accuracy pull apart: attention without accuracy tracked more distress, not less.
The study validated self-report scales in a non-clinical Dutch community sample, so performance in clinical populations and the equivalence of other-language versions still need testing; self-reported accuracy is not the same as behavioural interoceptive accuracy on a heartbeat task.