The Relationship Between Interoception and Anxiety Disorders in Adult Clinical Populations – A Systematic Review and Narrative Synthesis

Interoception, defined as the perception of internal bodily states, has emerged as a key mechanism implicated in the development and maintenance of anxiety disorders. This systematic review synthesises evidence on the relationship between interoception and anxiety in adult clinical populations, with a specific focus on how distinct interceptive dimensions (i.e., accuracy, attention, and beliefs) relate to different anxiety presentations. A systematic search was conducted across PsycINFO, PubMed, and Web of Science (last updated April 2025). Thirty-seven studies met inclusion criteria, across multiple anxiety disorders including generalised anxiety disorder (GAD), panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and social anxiety disorder. Included studies employed self-report, behavioural, and neuroimaging measures across cardiac, respiratory, and gastrointestinal axes. Evidence supports disorder-specific interoceptive profiles. Panic disorder and GAD were most consistently associated with heightened interoceptive attention and altered accuracy, particularly during threat-related tasks. PTSD and OCD were more strongly linked to maladaptive interoceptive beliefs, including low body trust and diminished belief in one's capacity to regulate attention to internal sensations. Neuroimaging findings indicated altered functional connectivity within interoceptive brain networks. Notably, over half the included studies (n = 18) were published within the past five years, reflecting accelerating interest in this area. While interoception appears as a transdiagnostic dimension relevant across anxiety disorders, the current evidence base is mixed and shaped by methodological variability. Nonetheless, emerging interoceptive patterns support the potential clinical utility of targeting interoceptive processes. Greater standardisation and cross-cultural considerations are needed to guide future research and clinical translation.