The inner world of overactive monitoring: neural markers of interoception in obsessive–compulsive disorder
Open accessAbstract
Background: Obsessive–compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients’ relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition. Method: We administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of two task-relevant electrophysiological markers: the heart evoked potential (HEP) and the motor potential (MP). Results: Behaviorally, OCD patients outperformed controls and panic patients in the HBD task. Moreover, they exhibited greater amplitude modulation of both the HEP and the MP during cardiac interoception. However, they evinced poorer confidence and awareness of their interoceptive skills. Conclusions: Convergent behavioral and electrophysiological data showed that overactive monitoring in OCD extends to the sensing of internal bodily signals. Moreover, this pattern discriminated OCD from panic patients, suggesting a condition-distinctive alteration. Our results highlight the potential of exploring interoceptive processes in the OCD spectrum to better characterize the population's cognitive profile. Finally, these findings may lay new bridges between somatic theories of emotion and cognitive models of OCD.
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Interoceptive abnormalities are noted in psychoses, obsessive-compulsive disorders and eating disorders.
“Interoceptive abnormalities are noted in psychoses (Brosey and Woodward, 2017), obsessive-compulsive disorders (Yoris et al., 2017) and eating disorders (Jenkinson et al., 2018).”
From Physiological feelings (2019) · cites this paper as Yoris et al., 2017
The majority of clinical conditions are associated with reduced interoceptive accuracy, but interoceptive accuracy has been found to be increased in anxiety and panic disorder and in OCD.
“While the majority of clinical conditions are associated with reduced interoceptive accuracy, interoceptive accuracy has been found to be increased in anxiety and panic disorder (for reviews, see Domschke et al., 2010; Paulus and Stein, 2010) and in OCD (Yoris et al., 2017).”
From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Yoris et al., 2017
This greater adverse events load is consistent with research findings that individuals with OCD over-monitor their internal bodily signals [65].
“consistent with research findings that individuals with OCD over-monitor their internal bodily signals, such as heart beats [65].”
From Habit as a therapeutic component in psychological treatment for obsessive-compulsive disorder: A randomised controlled feasibility study. (2026) · cites this paper as [65]
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An Active Inference Approach to Interoceptive Psychopathology
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“Interoceptive abnormalities are noted in psychoses (Brosey and Woodward, 2017), obsessive–compulsive disorders (Yoris et al., 2017) and eating disorders (Jenkinson et al.”
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Self-citationAllostatic interoceptive overload in frontotemporal dementia
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Self-citationAffective interoceptive inference: Evidence from heart‐beat evoked brain potentials
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Brain-heart interactions are modulated across the respiratory cycle via interoceptive attention
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Interoceptive Mechanisms and Emotional Processing
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A synergetic turn in cognitive neuroscience of brain diseases
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Self-citationAllostatic Interoceptive Overload Across Psychiatric and Neurological Conditions
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Self-citationThe Neurocognition of Translation and Interpreting
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Self-citationDimensions of interoception predict premonitory urges and tic severity in Tourette syndrome
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Temporal irreversibility of large-scale brain dynamics in Alzheimer's disease
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Self-citationMotor-system dynamics during naturalistic reading of action narratives in first and second language
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Self-citationTime is body: multimodal evidence of crosstalk between interoception and time estimation
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Self-citationThe relationship between social anxiety and heartbeat evoked potential amplitude
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Interoception, Stress, and Physical Symptoms in Stress-Associated Diseases
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Self-citationMultimodal mechanisms of human socially reinforced learning across neurodegenerative diseases
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Dynamic neurocognitive changes in interoception after heart transplant
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Self-citationIntrinsic timescales and predictive allostatic interoception in brain health and disease
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Self-citationInteroception and Obsessive-Compulsive Disorder: A Review of Current Evidence and Future Directions
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High-dose ondansetron reduces activation of interoceptive and sensorimotor brain regions
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Dimensions of interoception in obsessive-compulsive disorder
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Multicentric evidence of emotional impairments in hypertensive heart disease
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Self-citationObsessive-compulsive tendencies are related to seeking proxies for internal states in everyday life
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The Neurocognition of Translation and Interpreting
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Self-citationAllostatic-interoceptive anticipation of social rejection
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Reduced interoceptive accuracy in patients with obsessive–compulsive disorder: A case-control study
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Stop Thinking! I Can't! Do Attentional Mechanisms Underlie Primary Dysfunctional Breathing?
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Allostatic interoception and brain health: From neurodegeneration to social adversities
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Enhanced external counterpulsation modulates the heartbeat evoked potential
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Impact of interoception and multisensory integration on functional and physical activities in aging
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Cognitive Processes Supporting Interoception and the Influence of Activation States
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Interoceptive Approaches to Embodiment Research
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Exploring the Link Between Interoception and Symptom Severity in Premature Ventricular Contractions
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Neurophysiological dynamics of visceral signals in emotion, self and bodily consciousness
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Exploring brain-heart interactions: advances in physiological signal fusion for healthcare
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Context as a Determinant of Interpersonal Processes: The Social Context Network Model
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“…the CBT + ERP arm reporting a significantly greater adverse events load ( p .001), particularly related to low mood and somatic symptoms, such as nausea and headaches, consistent with research findings that individuals with OCD over-monitor their internal bodily signals, such as heart beats [65].”
Interoceptive Sensibility in Obsessive-Compulsive Behavior Motivated by Incompleteness:
Sashikata, K., & Ozawa, E. (2024) · The Japanese Journal of Educational Psychology · doi:10.5926/jjep.72.169 · Cited by 1 · see citing works
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Snell, L., Garner, M. J., Pfeifer, G., & Morriss, J. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121961 · Cited by 1 · see citing works
Interoception in obsessive-compulsive and major depressive disorders
Recchia, N., Eng, G. K., Harvey, J. R., Moldow, R., Collins, K. A., & Stern, E. R. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1856945 · Cited by 1 · see citing works
Interocepció. Narratív összefoglaló
Ferentzi, E., Tihanyi, B. T., Szemerszky, R., Dömötör, Z., Bárdos, G., & Köteles, F. G. (2018) · Mentálhigiéné és Pszichoszomatika · doi:10.1556/0406.19.2018.014 · Cited by 1 · see citing works
Interoceptive Awareness Among the General Public in Saudi Arabia: A Cross-Sectional Study
Fallata, E. O., Bashekah, K. A., Alqahtani, R. M., Althagafi, S. E., Bardesi, M. H., Adnan, A. M., Alfaqih, M. A., Aljifri, A. M., & Aljifri, H. M. (2023) · Cureus · doi:10.7759/cureus.49771 · Cited by 1 · see citing works
Richter, F., & Zimmer, H. (2020) · Zeitschrift für Neuropsychologie · doi:10.1024/1016-264x/a000286 · Cited by 1 · see citing works
Obsessive Compulsive Disorder: Neurobiology and Treatment
Hoffman, K. L. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820472-6.00161-4
Yoris, A., Deleglise, Á., del Cerro, J. P., Pascariello, G. O., Donnelly-Kehoe, P. A., Cetkovich, M., & Torrente, F. M. (2023) · doi:10.31234/osf.io/8p74c
Self-citationMurayama, K., Tomiyama, H., Ohno, A., Kato, K., Matsuo, A., Hasuzawa, S., Sashikata, K., Kang, M., & Nakao, T. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1227057
No evidence of a relationship between regular physical exercise and cardiac interoceptionPreprint
Yoris, A. (2023) · doi:10.22541/au.169941852.29046574/v1
Self-citationProlegomena to the translating and interpreting brain
(2019) · Benjamins translation library · doi:10.1075/btl.147.c3
(2019) · Benjamins translation library · doi:10.1075/btl.147.refs
(2019) · Benjamins translation library · doi:10.1075/btl.147.note
- Authors
- Yoris, A., García, A. M., Traiber, L., Santamaría-García, H., Martorell, M., Alifano, F., Kichic, R., Moser, J. S., Cetkovich, M., Manes, F., Ibáñez, A., & Sedeño, L.
- Affiliations
- Consejo Nacional de Investigaciones Científicas y Técnicas (AR)
- Instituto de Neurología Cognitiva (AR)
- Favaloro University (AR)
- Michigan State University (US)
- Corresponding author
- Sedeño, L.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-04-04
- Volume
- 47
- Issue
- 11
- Pages
- 1957-1970
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2604761667
- Cited by
- 124
- References
- 97
- Citations by year
- 2026: 13 · 2025: 8 · 2024: 9 · 2023: 17 · 2022: 8 · 2021: 12 · 2020: 14 · 2019: 27 · 2018: 10 · 2017: 6
- FWCI
- 19.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Americanae (AECID Library) (submittedVersion, cc-by-nc-nd)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
- CONICET Digital (CONICET) (submittedVersion, cc-by-nc-sa)
- Funders
- Fundación INECO (15150012)
- Consejo Nacional de Investigaciones Científicas y Técnicas (1130920, 15150012)
- Comisión Nacional de Investigación Científica y Tecnológica (FONDAP-15150012, 1140114, 15150012, 1130920)
- Fondo para la Investigación Científica y Tecnológica (2012-0412, 2012‐1309, PICT 2012)
- Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias (15150012)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- obsessive-compulsive disorder, interoception, heartbeat detection, motor potential, interoceptive awareness, panic disorder
- MeSH terms
- Adult, Evoked Potentials, Female, Heart Rate, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Panic Disorder, Evoked Potentials, Motor, Young Adult, Interoception
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