Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness

Sarah Garfinkel was a postdoctoral researcher and then lecturer at the Brighton and Sussex Medical School Department of Psychiatry and at the University of Sussex's Sackler Centre for Consciousness Science (she moved to UCL Institute of Cognitive Neuroscience in 2020). Anil Seth, Adam Barrett, and Keisuke Suzuki were all at the Sackler Centre on the consciousness-science and computational side; Hugo Critchley, the senior author, bridged Brighton and Sussex Medical School with the Sackler Centre. The all-Sussex collaboration is consistent — the paper is the Sussex methodological refinement of Critchley's UCL-era 2004 framework, written by the group that had been working alongside him on the inference frame after his 2006 move to Brighton.

Published in Biological Psychology — a Reed Elsevier journal with a long history in psychophysiology — in January 2015, the piece is a primary empirical paper proposing a three-way distinction between interoceptive accuracy (the heartbeat-detection-task score), interoceptive sensibility (subjective self-report of one's own interoceptive ability), and interoceptive awareness (the metacognitive correspondence between the two — whether one's confidence tracks one's actual accuracy). The empirical work uses a normative sample of 80 subjects and shows that the three dimensions dissociate: a person can be objectively accurate but subjectively oblivious, or subjectively confident but objectively poor. The framework was then canonicalised in the 2018 Khalsa Roadmap.

The piece sits as the methodological pivot of the post-2004 interoception literature. Where Critchley 2004 gave the field a single number per subject — the heartbeat-detection-task score — Garfinkel and colleagues showed that single number was hiding three orthogonal constructs, and that earlier studies conflating interoceptive awareness with interoceptive accuracy had probably mismeasured what they thought they were measuring. The post-2015 clinical literature uses the distinction routinely; pre-2015 results have to be re-read with the three-way distinction in mind to know which construct each study actually addressed.

The stake is methodological. None of the authors had a commercial position; the paper is a refinement of a research programme each of them was building at Sussex. This is the rare methodological-refinement paper that genuinely cleaned up a literature: pre-2015 interoceptive awareness was an ambiguous term doing too much work; post-2015 the three-way distinction made the field's measurements interpretable. Read it for the framework; chase the Roadmap for the consensus-statement context.