Understanding anxiety in autistic adolescents: the predictive role of interoceptive beliefs and insight

Abstract

It is well-established that anxiety and sensory differences are common among autistic adolescents. Interoception has been increasingly studied in relation to anxiety, with alexithymia also considered due to its role in emotional processing and its higher prevalence in autistic populations. This study examined the relationships between interoception, alexithymia, and anxiety in 37 autistic adolescents. Participants completed questionnaires assessing autism traits, anxiety, alexithymia, and interoceptive beliefs, along with cardiac interoception tasks measuring interoceptive accuracy and insight. Correlation, regression, and moderated mediation analyses were conducted. Interoceptive beliefs reflecting autonomic reactivity (BPQ-ANSR) significantly predicted anxiety and remained the only interoceptive variable associated with anxiety in regression models. Interoceptive insight and heartbeat counting accuracy were both associated with alexithymia, although alexithymia did not predict anxiety and did not mediate the interoception–anxiety relationship. Moderated mediation analyses showed that autism traits amplified the direct effect of interoceptive beliefs on anxiety. These findings highlight the importance of considering subjective interoceptive beliefs, particularly those perceived as distressing, rather than focusing solely on objective accuracy. They further suggest that interoceptive-affective mismatches may initially manifest as alexithymia during adolescence, potentially serving as a precursor to later anxiety.

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ORCID for Matthew Garner: orcid.org/0000-0001-9481-2226

ORCID for Gaby Pfeifer: orcid.org/0000-0002-8737-1255

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