Interoception in self-harm and suicide: a scoping review and meta-analysis

Interoception, the capacity to sense and interpret internal bodily signals, has been recognized as relevant to self-harm and suicide, but these associations and their dimensional specificity have not been quantitatively synthesized. This scoping review and meta-analysis aimed to estimate the magnitude of associations between interoceptive dimensions and self-harm (that is, non-suicidal self-injury and self-harm (mixed intent)) and suicidal outcomes (ideation, plans and attempts), and to explore the neural mechanisms implicated in these associations. We searched PubMed, Web of Science, PsycINFO and EMBASE from inception to 1 April 2025. Sixty-six studies (36,934 participants) were included, comprising 63 observational studies (59 cross-sectional and 4 longitudinal/prospective) and 3 intervention studies, of which 41 contributed a study to the meta-analysis. Interoception was classified into four previously validated dimensions: accuracy, sensibility, awareness and 'Other' (or cognitive-emotional evaluation of bodily signals). Interoceptive accuracy demonstrated weak and non-significant associations with self-harm and suicidal outcomes. Interoceptive sensibility showed generally negative associations across outcomes, with increased trust in bodily signals and self-regulation (that is, ability to regulate distress via attention to bodily sensations) associated with lower levels of suicidal ideation, suicide attempts and composite suicidal outcomes, with generally small-to-moderate effect sizes. Interoceptive awareness was not meta-analysed owing to insufficient evidence. Within the 'Other' (or cognitive-emotional evaluation) dimension, interoceptive deficits were positively associated with non-suicidal self-injury and suicidal ideation. Neuroimaging studies implicated altered interoceptive processing in the insula and prefrontal cortex, suggesting shared neural substrates of interoceptive abnormalities and suicide risk, although the evidence remains preliminary. These findings highlight interoception as a potentially informative domain for advancing the understanding of risk processes underlying self-harm and suicidality, and for informing future research on how bodily awareness and regulation relate to self-harm and suicidal risk.