2026 ECNP Congress

PS04-4259

From childhood trauma to dissociation: the role of interoceptive dysregulation in altered self-experience

Ketevan Akhobadze — M. Vashakidze, T. Margalitadze, M. Chelidze · David Tvildiani Medical University, Medicine, Tbilisi, Georgia

2026 ECNP Congress

Introduction: Interoception is a multifaceted system that perceives and processes the body’s internal signals. It maintains emotional homeostasis and involves the ability and will to attend to one’s own feelings and needs. Dysfunctional interoception is seen in numerous psychiatric disorders such as post-traumatic stress disorder (PTSD), major depression (MD), and depersonalization-derealization disorder. Traumatic childhood experiences (TCEs) may be the root of changes in interoception [1], possibly through neurobiological alterations.

Aim: Interoceptive dysfunction is associated with dissociative symptoms in various psychiatric conditions. It is well established that childhood trauma is a risk factor for dissociation, which gives the basis for theories that TCEs might contribute to interoceptive disruption. Understanding this connection can help clinicians identify and target impaired interoception, which could enhance therapeutic approaches and ultimately improve patient outcomes.

Methods: A comprehensive literature review was conducted using PubMed, analyzing studies examining associations between childhood trauma, dissociation, and interoception. The studies involved adult participants aged 18 to 60 years, with an approximately equal number of males and females in most samples.

Results: A cross-sectional study examined 136 participants with diagnoses of PTSD, MD, somatic symptom disorder, and healthy controls. All individuals have gone through at least one TCE. Participants completed assessments of interoceptive processes, including interoceptive accuracy (heartbeat counting tasks (HCT)), as well as interoceptive sensibility and awareness. All three groups reported significantly higher body dissociation than the healthy controls. Interestingly, the study results suggest that trauma was not linked to measurable deficits (in HCT), but to a maladaptive relationship with interoceptive signals [1].

It is theorized that interoception is not just about detecting bodily signals, but also about how the brain predicts and interprets them [3]. In individuals exposed to trauma, these predictions can become shaped by threat, causing bodily signals to be perceived as unsafe or disconnected, even when they are accurately detected. At the molecular level, it is argued that genetically susceptible trauma-exposed individuals may show FKBP5 demethylation, leading to long-term changes in stress hormone regulation [5]. Since interoception also relies on prediction, such stress-related changes may shape expectations about bodily states and contribute to body dissociation, despite intact sensory detection.

Conclusions: The researchers conclude that the primary issue in trauma-related dissociation may be the habitual avoidance of interoceptive signals in everyday life. Therefore, clinical interventions should focus on helping trauma survivors rebuild trust in their bodily sensations to improve emotional regulation [1]. Dysfunctional interoception can be targeted for treatment through the following therapeutic approaches: cognitive behavioral therapy, interoceptive exposure therapy, mindfulness-based approaches, and vagus nerve stimulation [4]. Future research should use multimodal assessments, explore multiple bodily systems, and longitudinal analyses to determine whether interoceptive dysfunction is a cause or a consequence of dissociation [2]. Furthermore, more research is needed in integrating molecular layers, such as epigenetic changes in stress-responsive genes, with different measures of interoception and brain imaging of areas such as the brainstem and insula. This could help explain how early stress becomes biologically embedded and how this may influence interoceptive processing and dissociative symptoms.

References

  1. Schmitz M, Back SN, Seitz KI, Harbrecht NK, Streckert L, Schulz A, et al. The impact of traumatic childhood experiences on interoception: disregarding one’s own body. Borderline Personality Disorder and Emotion Dysregulation. 2023 Feb 15;10(1):5. Available from: https://pubmed.ncbi.nlm.nih.gov/36788573/
  2. McDonald CW, Sleight FG, Mattson RE, Fani N. “I’m not here, this isn’t happening”: Interoception and its role in dissociation – A systematic review. Neuroscience & Biobehavioral Reviews. 2026 Feb 9;184:106582. Available from: https://pubmed.ncbi.nlm.nih.gov/41672259/
  3. Feldman MJ, Bliss-Moreau E, Lindquist KA. The neurobiology of interoception and affect. Trends in Cognitive Sciences. 2024 Feb 22;28(7):643–61. Available from: https://doi.org/10.1016/j.tics.2024.01.009
  4. Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, et al. Interoception and Mental Health: a Roadmap. Biological Psychiatry Cognitive Neuroscience and Neuroimaging. 2017 Dec 28;3(6):501–13. Available from: https://doi.org/10.1016/j.bpsc.2017.12.004
  5. Klengel T, Mehta D, Anacker C, Rex-Haffner M, Pruessner JC, Pariante CM, et al. Allele-specific FKBP5 DNA demethylation mediates gene–childhood trauma interactions. Nature Neuroscience. 2012 Dec 2;16(1):33–41. Available from: https://pubmed.ncbi.nlm.nih.gov/23201972/