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

Background

“Am I hungry? Did I overeat at lunch?” Gastric interoception - the sensing, interpretation, and regulation of signals from the gastrointestinal system - is central to daily behavior and homeostasis. Dysfunctional gastric interoception has been proposed as a maintenance factor in both eating disorders and gastrointestinal symptoms. However, no qualitative research has explored how individuals across these groups, and the general population, subjectively experience gastrointestinal signals, known as gastric interoceptive sensibility. This study aimed to investigate how gastric sensations are sensed, interpreted, and regulated among individuals with eating disorders, gastric disorders, and those without such diagnoses, focusing on identifying shared experiences. Methods: Fifteen semi-structured focus groups (n = 96) were conducted. Transcripts underwent hybrid deductive and inductive thematic analysis. Findings: Four key themes were identified. In “Sensations in the Interoceptive Body”, participants described hunger and fullness as physically aversive or reported an absence of cues related to satiation. “Perceiving the Interoceptive Body” captured the noticing, interpreting, attending to, and reacting to sensations of hunger, satiation, and fullness. In “Affective Experiences of the Interoceptive Body”, participants discussed how these sensations influenced emotional states positively, negatively, or not at all. “Responding to the Interoceptive Body” described participants strategies relating to relief-seeking, compensation, acceptance, distraction, and body checking in response to gastric sensations. Discussion: These findings shed light on the nuanced components of gastric interoceptive sensibility and suggest that individuals vary in how they experience and manage gastric signals. This work may inform interoceptive exposure therapies targeting maladaptive interpretations and regulation strategies in eating and gastrointestinal symptoms.