"I feel full with shame": A qualitative perspective on gastric interoceptive sensibility

Background: Dysfunctional gastric interoception has been posited as a maintenance factor for eating disorders and gastrointestinal symptoms. Previous research has yet to use qualitative methods to ask these populations how they subjectively experience signals from their gastric system: gastric interoceptive sensibility. Therefore, the aim of this study was to explore how gastric signals are sensed, interpreted, and regulated in eating disorders, gastric disorders, and control populations. Methods: 15 semi-structured focus groups (n=96) were conducted with participants. Transcripts underwent hybrid deductive and inductive thematic analysis. Findings: 4 main themes were identified. Within 1) Physical experience of hunger, satiation, and fullness, some participants described these states as physically unpleasant. Others described satiation as an absence of any distinct sensations. For 2) Perception of hunger, satiation, and fullness, participants discussed their noticing, interpretation, purposeful attention for, and reactivity to sensations of hunger, satiation, and fullness. Theme 3), the Emotional impact of gastric sensations of hunger, satiation, and fullness, included discussions around how hunger, satiation, and fullness could benefit their emotional state but also harm it, and for some satiation had no impact on their emotional state. For 4) Responses to hunger and fullness, participants reported searching for relief from these states, compensating, accepting, and distracting from fullness, and body-checking. Discussion: The current study informs us of the distinct factors that might be considered part of interoceptive sensibility. It may also inform the development of interoceptive exposure therapies for the treatment of eating disorders and gastric disorders such as irritable bowel syndrome.