{"paper_id":"03405eca-3318-4ae7-9fa8-abeb9b3bd4b1","body_text":"1\n1 Processing of inner bodily signals: evidence and insight from adolescence\n2\n3\n4 Silvia Canino 1*, Valentina Torchia2, Erica Dolce1, Irene Ruffo2, Teresa Iona1, \n5 Simona Raimo1, Liana Palermo1*\n6\n7 1. Department of Medical and Surgical Sciences, Magna Graecia University of \n8 Catanzaro, Catanzaro, Italy.\n9 2. Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, \n10 Italy.\n11\n12\n13\n14 * Corresponding author\n15 E-mail: silvia.canino@unicz.it (S.C.); liana.palermo@unicz.it (L.P.)\n16\n17\n18\n19\n20\n21\n22\n23\n24\n25\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n2\n1 Abstract\n2 Interoception, the sense of inner bodily signals, plays a key role in emotional \n3 regulation, cognition and mental health. While its relevance in adulthood has been \n4 extensively explored, less is known about how these abilities develop during \n5 adolescence, a period characterised by significant physical and psychological changes. \n6 This study aimed to investigate three distinct dimensions of interoception — accuracy, \n7 sensitivity and awareness — in adolescents and adults to better understand the \n8 developmental profile of this sense.\n9 Fifty-four adolescents (aged 12–14) and 50 adults (aged 25–34) completed the \n10 Heartbeat Monitoring Task to assess their actual ability to detect heartbeats, their \n11 confidence in this ability, and the confidence-accuracy correspondence, and a \n12 questionnaire on the tendency to focus on bodily sensations. The study also examined \n13 where participants localised bodily sensations during the interoceptive task. \n14 The results revealed no significant differences in interoceptive accuracy between the \n15 two groups. Both age groups exhibited similar body localisation patterns, primarily \n16 focusing on the chest during heartbeat detection. However, adolescents showed \n17 significantly lower metacognitive awareness of their ability to perceive internal bodily \n18 sensations, and higher focus on interoceptive sensations, as reflected in their higher \n19 confidence ratings and questionnaire scores. No significant correlations emerged \n20 among the three interoceptive dimensions in either group, which supports the view that \n21 these dimensions represent independent components of interoception. These findings \n22 suggest that, while basic interoceptive detection may be established by early \n23 adolescence, the capacity to accurately reflect on these internal sensations continues \n24 to mature into adulthood. The mismatch observed between adolescents' heightened \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n3\n1 bodily focus and their limited metacognitive insight may partly help explain why \n2 adolescence is a period of increased vulnerability to mental health difficulties.\n3\n4 Introduction\n5 Interoception, the sense of the physiological condition of the inner body,  is integral to \n6 how we experience and interpret bodily signals [1,2]. This sense encompasses \n7 sensations and representations of physiological signals, such as the heartbeat, itchiness \n8 and air hunger [1]. Research has highlighted the importance of interoception in \n9 emotional regulation, cognition and overall well-being [3-8].\n10 On a conscious level, interoception can be operationalized along three main \n11 dimensions: (i) interoceptive accuracy (IAcc), which refers to performance on \n12 objective tasks like heartbeat detection; (ii) interoceptive sensibility (ISe), which is the \n13 self-evaluated tendency to focus on interoceptive signals, measured through \n14 questionnaires; and (iii) interoceptive awareness (IAw), which is the metacognitive \n15 ability to assess how accurately one perceives internal signals, evaluated through the \n16 correspondence between confidence and actual performance [9]. This taxonomy is \n17 further supported by evidence suggesting differential contributions of these \n18 dimensions on cognition (e.g., [10, 3]) and their different relations with mental health \n19 difficulties (e.g., [11, 12]). \n20 Despite the growing recognition of interoception’s role in shaping psychological \n21 functioning, as highlighted in a seminal review on interoceptive development by \n22 Murphy et al. [13], our understanding of how interoception develops across the \n23 lifespan remains limited. In particular, research explicitly investigating interoception \n24 during typical adolescence is still scarce (for a similar argument, see also [14]). \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n4\n1 Adolescence, however, is a period of life that can be particularly relevant for \n2 interoceptive learning, as it is characterised by significant body changes [13, 15]. \n3 Adolescence is also marked by significant maturation of neural circuits involved in \n4 processing internal bodily signals, influencing how adolescents perceive and respond \n5 to internal states such as hunger, fatigue, and emotional arousal [16]. The maturation \n6 of interoceptive processes during this period seems to be linked to the development of \n7 self-regulation and emotional resilience [17]. Also, disruptions in interoceptive \n8 processing during adolescence can contribute to the onset of mental health disorders, \n9 such as anxiety and depression [6]. \n10 Recent neurophysiological studies have started to explore how interoception manifests \n11 in the adolescent brain. For example, Mai et al. [18] showed that heartbeat-evoked \n12 potentials (HEPs), a neural marker of interoceptive processing, are associated with an \n13 IAcc measure but not with an ISe measure in adolescents, providing objective evidence \n14 of the neurocognitive underpinnings of bodily awareness in this age group.\n15 However, not only have very few studies directly investigated interoceptive \n16 dimensions in samples of healthy adolescents and adults, but the existing evidence is \n17 also mixed (for an overview, see [13, 14]). For example, May et al. [19] reported \n18 different neural activity but no differences at the behavioural level between 16 \n19 adolescents (15-17 yrs), 19 young adults (20-28 yrs) and 19 mature adults (29-55 yrs) \n20 in an interoceptive task probing soft touch. Yang et al. [20], instead, found higher \n21 interoceptive accuracy in a sample of 50  adolescents (12-16 yrs) as compared to a \n22 sample of 50 adults (23-54 yrs), a finding that is in contrast with the idea that there is \n23 a disruption of interoception during adolescence [14]. However, considering that \n24 physiological ageing is associated with a reduction in interoception [13,14, 21] and \n25 that this last study included a sample of adults with a broad age range, it is difficult to \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n5\n1 determine whether adolescents truly performed better on the task, or whether the effect \n2 was due to the inclusion of middle-aged adults in the comparison group.  In this study, \n3 a subsample of participants (35 adolescents and 21 adults) was also given a measure \n4 of ISe (i.e., Multidimensional Assessment of Interoceptive Awareness; [22]), and, in \n5 this case, adolescents showed a lower tendency to actively listen to the body for \n6 insight. \n7 Qualitative findings also suggest that adolescents may experience body awareness in \n8 highly individualised ways, shaped by both bodily changes and psychological \n9 development. For instance, Pérez-Peña et al. [23] found that adolescents and young \n10 adults described their interoceptive experiences as fluctuating and context-dependent, \n11 often reflecting their struggles in interpreting bodily cues during times of emotional \n12 stress or social pressure. Such subjective accounts further emphasize the need to \n13 investigate interoceptive development through both quantitative and qualitative lenses.\n14 Thus, to advance our understanding of interoception development, the current study \n15 investigated multiple interoceptive dimensions during adolescence, analysing possible \n16 differences from the adult pattern of development. To these aims, healthy adolescents, \n17 whose ages ranged between 12 and 14 years, and adults, whose ages ranged between \n18 25 and 34 years, performed a protocol that included measures of IAcc, ISe and IAw. \n19 Adults in this age range represent an optimal comparison group, avoiding confounding \n20 effects related to ageing processes. Indeed, several studies have suggested a regular \n21 decline in several cognitive skills (e.g., speed of processing, working memory, and \n22 long-term memory) starting from the 20s (see [24-26]), including interoceptive \n23 processing (for an overview see [21]).\n24\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n6\n1 Materials and Methods\n2 Participants\n3 Fifty-four typically developing adolescents (33 female participants, 21 male \n4 participants; mean age = 13.3 years, SD =0.75, range 12-14 years) and fifty adults (24 \n5 female participants, 26 male participants; mean age = 27.7 years, SD = 2.6, range 25-\n6 34 years) participated in this study. \n7 A total of 50 adults and 54 adolescents were recruited based on sample sizes used in \n8 previous studies (e.g.,[20]). Additionally, a sensitivity power analysis was performed \n9 in G*Power 3.1.9.7 [27] for a two-sample t test, two-tailed, with α = .05 and desired \n10 power = .80. The analysis showed that the study was powered to detect effects as small \n11 as d = 0.56. Thus, any medium-to-large differences between adolescents and adults \n12 should have been detectable.\n13 All participants were native Italians from an urban context in southern Italy. \n14 Adolescents were recruited from state schools in Calabria (Italy), while young adults \n15 were recruited by word of mouth.\n16 All recruited participants showed normal reasoning ability according to the Italian \n17 norms of the Raven’s Colored Progressive Matrices (RCPM, [28,29]) or of Raven’s \n18 Standard Progressive Matrices  (RSPM, for participants aged from 12 to 13 years; \n19 [30])  and had normal or corrected to normal vision and no history of neurological or \n20 psychiatric conditions.\n21 Before taking part in the study, all adult participants provided written informed \n22 consent. Adolescents' assent was received before the investigation, and their parents \n23 gave written informed consent. Participants were recruited between 9 April  2022 and \n24 22 December 2023. The study was approved by the local ethics committee (Calabria \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n7\n1 Region Ethical Committee, Catanzaro, Italy) in accordance with the criteria laid down \n2 in the 1964 Declaration of Helsinki.\n3\n4 Behavioral Testing\n5 Assessment of the Interoceptive Accuracy\n6 A Heartbeat Monitoring Task (HMT) [31] was used to assess IAcc. Participants, \n7 placed in a comfortable position, were invited to relax, close their eyes, and focus on \n8 bodily sensations, and were told: \"When you hear a voice say \"go\" start counting your \n9 heartbeats silently; when you hear \"stop\", stop counting and tell me the exact number \n10 of heartbeats you counted\". They were also instructed not to move during the task and \n11 not to perform physical manipulations that could facilitate the detection of the pulse \n12 (for example, feeling the beat by testing the pulse). This task was repeated six times, \n13 using, for the adult group, time intervals of 25, 35 and 45 seconds separated by two \n14 standard rest periods of 20 seconds; shorter intervals of 15, 20 and 18 seconds were \n15 used for the adolescents [32].\n16 To be sure that the instructions given to participants were clear, they were given a short \n17 training interval (10 seconds).\n18 Meantime, real heart activity was recorded using a Bluetooth heart rate monitor (Polar \n19 Verity sense, Kempele, Finland), a mobile device that allows easy and non-invasive \n20 recording. The heartbeat signals of each participant were recorded and, through \n21 comparison with their count made by the participant, the IAcc was calculated. For each \n22 trial, an accuracy score was derived (using the formula of Garfinkel et al. [9]): 1 - (|n \n23 real beats - n counted beats|) / ((n real beats + n counted beats)/2). The accuracy scores \n24 obtained were calculated as the average of the six trials, producing an average value \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n8\n1 for each participant [33]. The inclusion of the reported values (n counted beats) within \n2 the denominator prevented an overestimation of the accuracy of performance in people \n3 who showed high variance, particularly when more heartbeats were reported than \n4 recorded [9].\n5 At the end of the task, participants were asked, \"In which part of your body did you \n6 feel your heartbeat during the previous task?\". Then, an image of a body map was \n7 presented (adapted from [34]), and participants were asked to indicate the relevant \n8 body areas by circling them. The image also includes a box above the head with the \n9 label “nowhere”. Nine body districts were identified: head, right ear, left ear, neck, \n10 chest, abdomen, right hand and wrist, left hand and wrist and legs; each body district \n11 was assigned 1 when the participant indicated that a specific part associated with the \n12 perception of the heartbeat. Zero was assigned to those body districts that were not \n13 selected by the participants.\n14\n15 Assessment of the Interoceptive Awareness\n16 IAw was assessed by the correlation between the measure of IAcc and the degree of \n17 confidence in one’s ability to estimate the number of heartbeats in the HMT, expressed \n18 by the participant at the end of each trial, on a scale from 0 to 10, where 0 indicated \n19 “no perception of heartbeat” and 10 indicated “full perception of heartbeat”  (for such \n20 methodology see [9]).\n21\n22 Assessment of the Interoceptive Sensibility \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n9\n1 ISe was evaluated considering measures targeting both momentary, state-like beliefs \n2 (i.e., confidence ratings), and global, trait-like interoceptive beliefs (i.e., ISe \n3 questionnaires; see [35]).\n4 Specifically, for what attains the state-like beliefs, at the end of each  HMT trial, the \n5 participants rated their confidence in their perceived accuracy of response on a scale \n6 from 0 to 10, where 0 indicated “no perception of heartbeat” and 10 indicated “full \n7 perception of heartbeat”. The task included six trials, and a mean confidence score was \n8 computed for each participant by averaging the confidence ratings across the six trials. \n9 Participants also completed an ISe questionnaire. Specifically, adult participants \n10 completed the Self-Awareness Questionnaire (SAQ; [36]), while adolescents \n11 completed the SAQ-C, an adaptation of the SAQ for children and adolescents [37]. \n12 The SAQ and the SAQ-C are self-report questionnaires composed of 35 items \n13 developed specifically to evaluate the frequency of common body feelings. Both \n14 versions have been validated in Italian. Items are clustered into two domains, one \n15 related to visceral feelings (e.g., “I feel my heart beat in my ears”) and the other to \n16 somatosensory feelings (e.g., “I feel my palms sweaty”). \n17 Participants were asked to read each item carefully and to evaluate how often they \n18 experienced the described sensation; responses were reported on a five-point Likert \n19 scale ranging from never to always (0 = never; 1 = sometimes; 2 = often; 3 = very \n20 often; 4 = always). The total score is given by the sum of the responses of all items, \n21 providing a score range of 0 to 140. Higher scores indicate higher levels of ISe.\n22\n23\n24\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n10\n1 Statistical analyses\n2 To verify the normality of data distribution for accuracy scores, we used the Shapiro-\n3 Wilk test. Given the non-normal distribution observed in experimental variables, such \n4 as the score of the heartbeat monitoring task, and considering that the questionnaire \n5 probing interoceptive sensibility (SAQ) used Likert-style response items, providing \n6 ordinal data, non-parametric statistical analyses were performed.   \n7 Specifically, comparisons between the two age groups (adolescents: 12 to 14 years old \n8 vs. adults: 25 to 34 years old)  on IAcc, IAw and ISe scores were performed using the \n9 Mann-Whitney U test. Effect sizes for Mann–Whitney U tests were reported using the \n10 rank-biserial correlation coefficient r rb.\n11 A Chi-squared test was applied to analyse which part of the body was most used during \n12 the IAcc task.\n13 Finally, correlation analyses were conducted to explore the relationship between \n14 various interoceptive dimensions within the adolescent and young adult groups. \n15 Specifically, Spearman’s correlations were performed to examine the associations \n16 between IAcc (Heartbeat Monitoring Task), IAw and ISe (i.e., mean confidence in the \n17 HMT and SAQ total score) scores within each age group.\n18\n19 Results\n20 Descriptive statistics for IAcc, IAw and ISe measures are reported in Table 1.\n21 Concerning IAcc, the Mann–Whitney U tests revealed only a marginal difference \n22 between the group of adolescents and adults in counting their heartbeats (U = 1055, p \n23 = .055; r rb = .22), with adults exhibiting numerically higher IAcc on average (see Table \n24 1). Instaed, adolescents exhibited a statistically significantly lower metacognitive \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n11\n1 awareness of their interoceptive ability compared to adults (U= 981, p= .033; r rb = .23). \n2 Concerning the ISe, the Mann-Whitney U test showed a significant effect of age group \n3 on both the SAQ (U= 843, p < .001; r rb =0.38) and on the average confidence in the \n4 HMT ( U= 911, p = .004; r rb =0.33), with adolescents reporting significantly higher \n5 scores than adults.\n6 Correlation analyses showed no significant associations between the different \n7 interoceptive dimensions in both age groups (for adolescents, see Table 2;  for adults, \n8 see Table 3).\n9 Concerning the two ISe measures, we found no significant associations between the \n10 SAQ and the confidence rating in the HMT,  both in adolescents (ISe-SAQ and Ise-\n11 confidance, r rho = .05, p= .517) and in adults (ISe-SAQ and Ise-confidance, rrho = .104, \n12 p= .471).\n13 A chi-squared goodness of fit test was performed separately for adolescents and adults \n14 to examine which body parts were used most frequently during the IAcc task.\n15 For adolescents, the distribution of selected body parts was significantly different from \n16 a uniform distribution (χ²(9) = 146, p < .001). The most commonly used body part was \n17 the chest (49.35%), followed by the right hand/wrist (14.29%) and the neck (10.39%). \n18 A similar pattern emerged for adults, χ²(9) = 88.0, p < .001, with the chest again being \n19 the most frequently selected body part (36.25%), followed by the right hand/wrist \n20 (17.5%) and left hand/wrist (16.25%).\n21 To compare the distribution of body part selection between the two age groups \n22 (adolescent vs. adults), a Chi-squared test of independence was performed. Body-part \n23 selection did not differ significantly across age groups (χ²(8) = 8.63, p = .374). This \n24 suggests that the body parts used during the HMT was not significantly different \n25 between adolescents and adults.\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n12\n1 Table 1. Descriptive statistics for the interoceptive measures in the groups of \n2 adolescents and adults\n3 Note: HMT, Heartbeat monitoring task; SAQ, Self-Awareness Questionnaire.\n4\n5\n6\n7\n8\nAdolescent group \nInteroceptive \nAccuracy\nInteroceptive\nAwareness\nInteroceptive \nSensibility\nHMT ACCURACY-CONFIDENCE \nCORRELATION\nSAQ CONFIDENCE- \nHMT\nMean\n(SD)\n0.36\n(0.4)\n0.002\n(0.5)\n44.8\n(19)\n7.53\n(1.25)\nMin -Max -0.95 – 0.91 -1 – 0.96 12-94 4.8 – 10\nAdult group \nInteroceptive \nAccuracy\nInteroceptive \nAwareness\nInteroceptive \nSensibility\nHMT ACCURACY-CONFIDENCE \nCORRELATION\nSAQ CONFIDENCE- \nHMT\nMean\n(SD)\n0.50\n(0.4)\n0.24\n(0.4)\n33.3\n(14.3)\n6.57\n(1.6)\nMin- Max -0.54 – 0.95 -0.86 – 0.97 10-73 2.50– 9.33\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n13\n1 Table 2. Spearman correlation coefficients between the interoceptive measures in \n2 the adolescent group\n3 Note: HMT, Heartbeat monitoring task; SAQ, Self-Awareness Questionnaire.\n4\n5 Table 3. Spearman correlation coefficients between the interoceptive measures in \n6 the adult group\n7 Note: HMT, Heartbeat monitoring task; SAQ, Self-Awareness Questionnaire.\n8\n9\n10\nAdolescent group \nInteroceptive \nAccuracy\nInteroceptive \nAwareness\nInteroceptive\nSensibility\nHMT ACCURACY-\nCONFIDENCE \nCORRELATION\nSAQ CONFIDENCE-\nHMT\nInteroceptive \nAccuracy\nrrho\np - -0.07\n.62\n-0.06\n.68\n0.18\n.20\nInteroceptive \nAwareness\nrrho\np\n- - 0.16\n.27\n-0.04\n.81\nAdult group \nInteroceptive \nAccuracy\nInteroceptive \nAwareness\nInteroceptive \nSensibility\nHMT ACCURACY-\nCONFIDENCE \nCORRELATION\nSAQ CONFIDENCE-\nHMT\nInteroceptive \nAccuracy\nrrho\np - 0.17\n.24\n-0.26\n.06\n0.28\n.05\nInteroceptive \nAwareness\nrrho\np\n- - -0.20\n.17\n-0.09\n.55\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n14\n1 Discussion\n2 The study examined interoceptive functioning across three distinct dimensions - \n3 accuracy, sensibility and awareness - in adolescents, with a focus on potential \n4 developmental differences when compared to adults. \n5 While no significant group differences emerged in IAcc, there was a marginal trend \n6 suggesting slightly better performance in adults. More robust was the difference in \n7 IAw, with adults demonstrating significantly higher metacognitive insight into their \n8 bodily signals. On the other hand, adolescents scored higher on both measures of ISe: \n9 the SAQ and on confidence ratings during the heartbeat task. This pattern highlights a \n10 dissociation between the subjective experience of bodily awareness and the \n11 metacognitive ability to evaluate it.\n12 The absence of a clear group difference in IAcc contrasts with previous findings by \n13 Yang et al. [20], who reported a higher level of accuracy in adolescents. This difference \n14 may be due to the broader age range of the adult sample by [20], which included \n15 individuals into middle adulthood, where interoceptive accuracy is thought to decline. \n16 By limiting our adult cohort to 25–34 years, we minimised this age-related confound \n17 and found that heartbeat-counting accuracy is comparable across late adolescence and \n18 early adulthood. Methodological differences (e.g., kind of task) may also have \n19 contributed to the discrepant results.\n20 Regarding IAw, the finding of lower metacognitive insight in adolescents is in line \n21 with developmental models of metacognition (e.g., [38]) and supports the idea that \n22 IAw matures later than the basic ability to detect bodily signals. Conversely, the higher \n23 self-reported ISe in adolescents may reflect the heightened bodily attention \n24 characteristic of adolescence due to pubertal changes [13] or psychosocial factors. This \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n15\n1 finding is also interesting in light of studies that suggested that an exaggerated \n2 interoceptive sensibility can be dysfunctional (see [11]). Indeed, this increased \n3 tendency to notice internal bodily signals may be physiological, but can become fertile \n4 ground for the onset of mental health disorders (e.g., anxiety and depression).\n5 The lack of significant correlations between interoceptive dimensions in both age \n6 groups replicates previous findings (for adolescents see [18]; for adults see [9]), and \n7 lends further support to the three-dimensional model of interoception proposed by [9]. \n8 Our data reinforce the idea that these dimensions are relatively independent and should \n9 not be interpreted as reflecting a unified construct.\n10 In our data, even within each age group, objective performance did not correlate with \n11 subjective sensibility or metacognitive awareness, confirming that metacognitive or \n12 subjective insight into internal states does not necessarily align with actual IAcc. This \n13 underscores the need for a more nuanced approach when assessing interoceptive \n14 abilities. \n15 Additionally, our findings revealed no correlation between the two ISe measures, that \n16 is, the SAQ scores and confidence ratings, within either group, in line with the idea \n17 that these measures probe different ISe aspects [35]. Indeed,  while the SAQ captures \n18 a general, habitual focus on bodily signals, confidence ratings may reflect a \n19 momentary, context-dependent judgment of interoceptive certainty [35]. In \n20 developmental contexts, this is particularly relevant, as adolescents might report \n21 increased general interoceptive sensibility due to physical and emotional changes, \n22 without this necessarily translating into higher confidence in specific interoceptive \n23 tasks.\n24 Regarding body localisation during the IAcc task, both adolescents and adults most \n25 frequently relied on the chest, followed by the wrists and neck. These patterns \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n16\n1 significantly deviated from a uniform distribution, indicating consistent preferences \n2 for certain bodily areas. However, the similarity between age groups in body part \n3 selection suggests that both adolescents and adults use comparable perceptual \n4 strategies when attending to internal sensations. This may reflect shared physiological \n5 or conceptual representations of interoceptive cues, such as the heartbeat, regardless \n6 of developmental stage. \n7 Altogether, the findings contribute to a more comprehensive understanding of \n8 interoception in adolescence. They indicate that while basic detection of bodily signals \n9 may already be well established, the ability to reflect on or interpret these sensations \n10 continues to develop. The observed mismatch between heightened bodily focus (ISe) \n11 and lower metacognitive awareness (IAcc) in adolescents may have implications for \n12 emotional processing and vulnerability to psychological distress.\n13 Given the role of interoception in emotion regulation and psychopathology, these \n14 results suggest that interventions aimed at adolescents could benefit from fostering the \n15 ability to accurately evaluate and understand internal states. \n16 Despite its contributions, this study has some limitations. The cross-sectional design \n17 prevents us from inferring developmental trajectories, and our sample size, although \n18 adequate, could be increased to improve statistical power. The validity of the HMT  \n19 has been questioned, as it may reflect participants’ estimation of their heart rate rather \n20 than their actual ability to feel the heartbeats [39 – 41]. Also, our IAcc and IAw \n21 measures exclusively targeted the cardiac modality.  \n22 Future studies should consider longitudinal designs and additional interoceptive \n23 measures that consider different organ systems, including the cardiac, gastric, and \n24 respiratory systems (for an overview, see [42]), to enhance our understanding of \n25 interoceptive development.\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n17\n1 References\n2 1. Craig AD. How do you feel? Interoception: the sense of the physiological condition \n3 of the body. Nat Rev Neurosci. 2002;3(8):655–66. doi:10.1038/nrn894\n4 2. Garfinkel SN, Critchley HD. Interoception, emotion and brain: new insights link \n5 internal physiology to social behaviour. Commentary on: “Anterior insular cortex \n6 mediates bodily sensibility and social anxiety” by Terasawa et al. (2012). Soc Cogn \n7 Affect Neurosci. 2013;8(3):231–4. doi:10.1093/scan/nss140\n8 3. Canino S, Torchia V, Gaita M, Raimo S, Palermo L. Linking the inner and outer \n9 mental representations of the body to social cognition skills: A systematic review and \n10 meta-analysis. Neuropsychologia. 2024;204:108989. \n11 doi:10.1016/j.neuropsychologia.2024.108989\n12 4. Critchley HD, Garfinkel SN. Interoception and emotion. Curr Opin Psychol. \n13 2017;17:7–14. doi:10.1016/j.copsyc.2017.04.020\n14 5. Füstös J, Gramann K, Herbert BM, Pollatos O. On the embodiment of emotion \n15 regulation: interoceptive awareness facilitates reappraisal. Soc Cogn Affect Neurosci. \n16 2013;8(8):911–7. doi:10.1093/scan/nss089\n17 6. Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, \n18 et al. Interoception and mental health: a roadmap. Biol Psychiatry Cogn Neurosci \n19 Neuroimaging. 2018;3(6):501–13. doi:10.1016/j.bpsc.2017.12.004\n20 7. Raimo S, Martini M, Guariglia C, Santangelo G, Trojano L, Palermo L. Editorial: \n21 Community series in body representation and interoceptive awareness: cognitive, \n22 affective, and social implications. Front Psychol. 2023a;14:1256811. \n23 doi:10.3389/fpsyg.2023.1256811\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n18\n1 8. Tsakiris M, Critchley H. Interoception beyond homeostasis: affect, cognition and \n2 mental health. Philos Trans R Soc Lond B Biol Sci. 2016;371(1708):20160002. \n3 doi:10.1098/rstb.2016.0002\n4 9. Garfinkel SN, Seth AK, Barrett AB, Suzuki K, Critchley HD. Knowing your own \n5 heart: distinguishing interoceptive accuracy from interoceptive awareness. Biol \n6 Psychol. 2015;104:65–74. doi:10.1016/j.biopsycho.2014.11.004\n7 10. Baiano C, Job X, Santangelo G, Auvray M, Kirsch LP. Interactions between \n8 interoception and perspective-taking: current state of research and future directions. \n9 Neurosci Biobehav Rev. 2021;130:252–62. doi:10.1016/j.neubiorev.2021.08.007\n10 11. Garfinkel SN, Tiley C, O'Keeffe S, Harrison NA, Seth AK, Critchley HD. \n11 Discrepancies between dimensions of interoception in autism: implications for \n12 emotion and anxiety. Biol Psychol. 2016;114:117–26. \n13 doi:10.1016/j.biopsycho.2015.12.003\n14 12. Scarpazza C, Zangrossi A, Huang YC, Sartori G, Massaro S. Disentangling \n15 interoceptive abilities in alexithymia. Psychol Res. 2022;86(3):844–57. \n16 doi:10.1007/s00426-021-01538-x\n17 13. Murphy J, Brewer R, Catmur C, Bird G. Interoception and psychopathology: a \n18 developmental neuroscience perspective. Dev Cogn Neurosci. 2017;23:45–56. \n19 doi:10.1016/j.dcn.2016.12.006\n20 14. Carr L, Donaghy R, Brewer R. Interoception across the lifespan. In: Murphy J, \n21 Brewer R, editors. Interoception. Cham: Springer; 2024. doi:10.1007/978-3-031-\n22 68521-7_10\n23 15. Zvolensky MJ, Smits JAJ, editors. Anxiety in health behaviors and physical illness. \n24 Springer; 2007.\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n19\n1 16. Li D, Zucker NL, Kragel PA, Covington VE, LaBar KS. Adolescent development \n2 of insula‐dependent interoceptive regulation. Dev Sci. 2017;20(5):e12438. \n3 doi:10.1111/desc.12438\n4 17. Price CJ, Hooven C. Interoceptive awareness skills for emotion regulation: theory \n5 and approach of mindful awareness in body-oriented therapy (MABT). Front Psychol. \n6 2018;9:798. doi:10.3389/fpsyg.2018.00798\n7 18. Mai S, Wong CK, Georgiou E, Pollatos O. Interoception is associated with \n8 heartbeat-evoked brain potentials (HEPs) in adolescents. Biol Psychol. 2018;137:24–\n9 33. doi:10.1016/j.biopsycho.2018.06.007\n10 19. May AC, Stewart JL, Tapert SF, Paulus MP. The effect of age on neural processing \n11 of pleasant soft touch stimuli. Front Behav Neurosci. 2014;8:52. \n12 doi:10.3389/fnbeh.2014.00052\n13 20. Yang HX, Zhou HY, Wei Z, Wan GB, Wang Y, Wang YY, et al. Multidimensional \n14 interoception and autistic traits across life stages: evidence from a novel eye-tracking \n15 task. J Autism Dev Disord. 2022;52:2644–55. doi:10.1007/s10803-021-05155-w\n16 21. Pfeifer G, Cawkwell S. Interoceptive ageing and the impact on \n17 psychophysiological processes: a systematic review. Int J Psychophysiol. \n18 2025;207:112483. doi:10.1016/j.ijpsycho.2024.112483\n19 22. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A. The \n20 multidimensional assessment of interoceptive awareness (MAIA). PLoS One. \n21 2012;7(11):e48230. doi:10.1371/journal.pone.0048230\n22 23. Pérez-Peña M, Notermans J, Petit J, Van der Gucht K, Philippot P. Body aware: \n23 adolescents' and young adults' lived experiences of body awareness. Psychol Belg. \n24 2024 Aug 12;64(1):108–28. doi:10.5334/pb.1295\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n20\n1 24. Salthouse TA. The processing-speed theory of adult age differences in cognition. \n2 Psychol Rev. 1996;103(3):403. doi:10.1037/0033-295X.103.3.403\n3 25. Park DC, Reuter-Lorenz P. The adaptive brain: aging and neurocognitive \n4 scaffolding. Annu Rev Psychol. 2009;60:173–96. \n5 doi:10.1146/annurev.psych.59.103006.093656\n6 26. Park DC, Lautenschlager G, Hedden T, Davidson NS, Smith AD, Smith PK. \n7 Models of visuospatial and verbal memory across the adult life span. Psychol Aging. \n8 2002;17(2):299–320. doi:10.1037/0882-7974.17.2.299\n9 27. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using \n10 G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. \n11 2009;41:1149–60.\n12 28. Basso A, Capitani E, Laiacona M. Raven's coloured progressive matrices: \n13 normative values on 305 adult normal controls. Funct Neurol. 1987;2(2):189–94.\n14 29. Belacchi C, Scalisi TG, Cannoni E, Cornoldi C. Matrici progressive di Raven \n15 forma colore (CPM-47): manuale d'uso e standardizzazione italiana. Firenze: Giunti \n16 Organizzazioni Speciali; 2008.\n17 30. Picone L, Orsini A, Pezzuti L. Raven's Standard Progressive Matrices: contribution \n18 to Italian standardization for subjects between ages 6 and 18. BPA Appl Psychol Bull. \n19 2017;65(280).\n20 31. Schandry R. Heart beat perception and emotional experience. J Psychophysiol. \n21 1981;18:483–8. doi:10.1111/j.1469-8986.1981.tb02486.x\n22 32. Koch A, Pollatos O. Cardiac sensitivity in children: sex differences and its \n23 relationship to parameters of emotional processing. J Psychophysiol. 2014;51(9):932–\n24 41. doi:10.1111/psyp.12233\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n21\n1 33. Hart N, McGowan J, Minati L, Critchley HD. Emotional regulation and bodily \n2 sensation: interoceptive awareness is intact in borderline personality disorder. J Pers \n3 Disord. 2013;27(4):506–18. doi:10.1521/pedi_2012_26_049\n4 34. Plans D, Ponzo S, Morelli D, Cairo M, Ring C, Keating CT, et al. Measuring \n5 interoception: the phase adjustment task. Biol Psychol. 2021;165:108171. \n6 doi:10.1016/j.biopsycho.2021.108171\n7 35. Suksasilp C, Garfinkel SN. Towards a comprehensive assessment of interoception \n8 in a multi-dimensional framework. Biol Psychol. 2022;168:108262. \n9 doi:10.1016/j.biopsycho.2022.108262\n10 36. Longarzo M, D'Olimpio F, Chiavazzo A, Santangelo G, Trojano L, Grossi D. The \n11 relationships between interoception and alexithymic trait. The Self-Awareness \n12 Questionnaire in healthy subjects. Front Psychol. 2015;6:1149. \n13 doi:10.3389/fpsyg.2015.01149\n14 37. Raimo S, Iona T, Di Vita A, Boccia M, Torchia V, Canino S, et al. The \n15 interoceptive sensibility in middle childhood: the Italian validation of the Self-\n16 Awareness Questionnaire. Eur J Dev Psychol. 2023b;21(1):138–53. \n17 doi:10.1080/17405629.2023.2250121\n18 38. Weil LG, Fleming SM, Dumontheil I, Kilford EJ, Weil RS, Rees G, et al. The \n19 development of metacognitive ability in adolescence. Conscious Cogn. \n20 2013;22(1):264–71. doi:10.1016/j.concog.2013.01.004\n21 39. Addabbo M, Milani L. Measuring interoception from infancy to childhood: a \n22 scoping review. Neurosci Biobehav Rev. 2025 Jun;173:106161. \n23 doi:10.1016/j.neubiorev.2025.106161. PMID:40245971.\n24 40. Corneille O, Desmedt O, Zamariola G, Luminet O, Maurage P. A heartfelt \n25 response to Zimprich et al. (2020), and Ainley et al. (2020)'s commentaries: \n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint \n\n22\n1 acknowledging issues with the HCT would benefit interoception research. Biol \n2 Psychol. 2020;152:107869. doi:10.1016/j.biopsycho.2020.107869\n3 41. Desmedt O, Luminet O, Corneille O. The heartbeat counting task largely involves \n4 non-interoceptive processes: evidence from both the original and an adapted counting \n5 task. Biol Psychol. 2018;138:185–8. doi:10.1016/j.biopsycho.2018.09.004\n6 42. Desmedt O, Luminet O, Walentynowicz M, Corneille O. The new measures of \n7 interoceptive accuracy: a systematic review and assessment. Neurosci Biobehav Rev. \n8 2023;153:105388.\n.CC-BY 4.0 International licensemade available under a \n(which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is \nThe copyright holder for this preprintthis version posted August 3, 2025. ; https://doi.org/10.1101/2025.08.01.668055doi: bioRxiv preprint","source_license":"CC-BY-4.0","license_restricted":false}