When the Body Stops Reaching the Mind: Interoception as a Mechanism of Dissociation

Dissociation has long been understood through top-down models — cognitive avoidance, emotional overload, cortical inhibition. This systematic review from Binghamton University and Emory asks a different question: what if dissociation is partly a bottom-up failure? What if the body's signals stop reaching conscious processing — and the result is not detachment by choice, but detachment by broken input?

The interoception-dissociation hypothesis

The review examines two research designs: baseline comparisons (dissociative patients vs. controls on interoceptive tasks) and lab inductions (measuring interoception before and after experimentally triggering dissociative states). The finding is consistent across both: people with dissociative symptoms show altered interoceptive processing. But the direction is not simple.

Some studies find reduced interoceptive accuracy — the heartbeat counting task shows these individuals are worse at perceiving their own physiology. Others find preserved accuracy but altered sensibility (self-reported awareness) or deficient metacognitive calibration. This tripartite distinction — accuracy, sensibility, awareness — is borrowed from interoception research and proves crucial here. Dissociation may not erase body signals; it may break the bridge between sensing them and knowing that you sense them.

Why this matters for mechanism research

The predictive processing angle is compelling. Under this framework, dissociation represents a state where the brain's prior expectations override incoming interoceptive signals. The body sends distress cues, but the prediction engine says "no input expected" — and conscious experience follows the prediction, not the signal. This is a testable model with specific neural implications, and it connects dissociation to a broader family of inference failures.

For your practice

For clinicians working with dissociative patients: this review provides neuroscientific grounding for somatic and body-based interventions. If dissociation involves disrupted interoception, then interventions targeting interoceptive awareness — grounding techniques, body scans, SE-informed work — are not just palliative comfort. They may be addressing the mechanism itself. The authors explicitly recommend multimodal interoception assessment in research, but practitioners can already think in three channels: can the patient detect body signals (accuracy)? Do they report awareness of them (sensibility)? And do they know when they are or are not detecting them (awareness)?