Felt Presence in Individuals at Risk for Psychosis: The Role of Interoception

Background: Felt presence (FP) – the sensation of someone nearby without sensory evidence – is common in healthy adults and related to psychosis risk. FP may arise from a misattribution of internal signals to an external source and often occurs when people are alone. Interoception, the ability to perceive one's own bodily signals, may help to distinguish oneself from others. FP could relate to interoception across several dimensions: through reduced signal perception (interoceptive accuracy), altered insight into their perception (interoceptive insight), and/or different self-reported beliefs (interoceptive beliefs). This is the first study that investigates this potential relationship.Method: 55 healthy adults completed the heartbeat counting task (HBCT) to assess interoceptive accuracy and insight under three ‘social’ conditions: self-view (observing oneself on a screen), other-view (being observed by the experimenter on a screen) and baseline (no viewing). Participants also completed the Prodromal Questionnaire-16 (PQ-16), the Inclusion of Other in the Self Scale as a measure of interpersonal closeness, the Multidimensional Assessment of Interoceptive Awareness (MAIA), and the occurrence of felt presence. Results: Psychosis-risk was elevated in individuals with FP, and it was experienced more often in solitude. Overall, the other-view condition reduced both interoceptive accuracy and insight. Distinct interoceptive patterns emerged for FP and psychosis risk: High psychosis-risk was related to lower accuracy, particularly when the felt closeness to others was low. In contrast, individuals with FP showed intact interoceptive insight when the felt closeness to others was low. Both FP and psychosis risk were associated with lower trust in bodily signals and higher tendencies to not distract oneself from bodily sensations. Only FP reported attending to bodily sensations to calm oneself.Conclusion: Interoceptive accuracy was preserved in those with FP but their trust of and insight into their own bodily signals were reduced. This mismatch may lead to misattributing internal signals to external sources, contributing to FP. However, preserved interoceptive accuracy may support self-regulation, potentially offering a protective effect. These results highlight the potential of interoceptive training to enhance resilience in individuals at risk for psychosis.