Interoception in schizophrenia and its relation to symptomatology, social functioning, and emotion recognition

Self-disturbances are a core feature of schizophrenia (SCZ) and may reflect impairments in interoception, the processing of internal bodily signals. Contemporary models distinguish between interoceptive accuracy (IA), the objective ability to detect bodily signals, and interoceptive sensibility (IS), the subjective appraisal of these signals. Despite their theoretical relevance, both IA and IS remain underexplored in relation to clinically meaningful outcomes such as social functioning in SCZ.

Individuals with SCZ (n = 45) and healthy controls (HC; n = 41) completed a heartbeat counting task across four trial durations (17-41 s) to assess IA and the Multidimensional Assessment of Interoceptive Awareness (MAIA) to assess IS. Participants also completed the Positive and Negative Syndrome Scale (PANSS), Social Functioning Scale (SFS), and an emotion recognition task (ER-40).

A significant task × duration × group interaction was observed for IA, with follow-up analyses indicating lower IA in SCZ relative to HC at the shortest trial duration (d = 0.53). SCZ participants also scored lower on MAIA subscales, Not-Worrying and Trusting. Across measures, both IA and select IS subscales showed modest positive associations with social functioning, particularly in employment and social competence. Associations with PANSS symptoms and facial emotion recognition were limited.

Interoceptive deficits in SCZ may be temporally specific and appear more consistently related to social functioning than to symptom severity or emotion recognition. These findings highlight interoception as a potential contributor to functional outcomes in SCZ.