Deng H, Wang YQ, Sun YF, Zhou HL, Zhou ZH. Interoceptive aberrations in major depressive disorder: Neural mechanisms, clinical correlates, and targeted interventions. World J Psychiatry 2026; 16(11): 124324 [DOI: 10.5498/wjp.124324]
Corresponding Author of This Article
Zhen-He Zhou, MD, PhD, Chief Physician, Professor, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, No. 156 Qianrong Road, Wuxi 214151, Jiangsu Province, China. zhouzh@jiangnan.edu.cn
Research Domain of This Article
Psychiatry
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review-article
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Deng H, Wang YQ, Sun YF, Zhou HL, Zhou ZH. Interoceptive aberrations in major depressive disorder: Neural mechanisms, clinical correlates, and targeted interventions. World J Psychiatry 2026; 16(11): 124324 [DOI: 10.5498/wjp.124324]
Hui Deng, Ya-Qing Wang, Yi-Fan Sun, Hong-Liang Zhou, Zhen-He Zhou, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi 214151, Jiangsu Province, China
Hong-Liang Zhou, Department of Psychology, The Affiliated Hospital of Jiangnan University, Wuxi 214122, Jiangsu Province, China
Co-first authors: Hui Deng and Ya-Qing Wang.
Co-corresponding authors: Hong-Liang Zhou and Zhen-He Zhou.
Author contributions: Deng H conceptualized the structural framework of the review, conducted literature synthesis, and wrote the original draft; Wang YQ developed the literature search strategy, contributed to literature identification and synthesis, and co-wrote the original draft; Sun YF was substantially involved in the early conceptualization of the review, contributed to the development and refinement of its overall framework, participated in literature synthesis, and critically revised the manuscript for important intellectual content during the writing and revision process; Zhou ZH and Zhou HL jointly supervised the project, provided critical intellectual input, and critically revised the manuscript for important intellectual content, and they contributed equally to this work as co-corresponding authors; all authors reviewed and approved the final version of the manuscript. Deng H and Wang YQ contributed equally to this work and share first authorship.
AI contribution statement: No generative AI or AI-assisted technologies were used in the preparation of this manuscript.
Supported by Wuxi Municipal Health Commission Major Project, No. Z202107; and Wuxi Taihu Talent Project, No. WXTTP 2021.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Zhen-He Zhou, MD, PhD, Chief Physician, Professor, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, No. 156 Qianrong Road, Wuxi 214151, Jiangsu Province, China. zhouzh@jiangnan.edu.cn
Received: June 12, 2026 Revised: August 9, 2026 Accepted: September 15, 2026 Published online: November 19, 2026 Processing time: 140 Days and 4.2 Hours
Abstract
Interoception, the sensing and interpretation of internal bodily signals, supports homeostatic regulation and emotional experience. Findings in major depressive disorder (MDD) remain inconsistent across studies using non-equivalent measures, heterogeneous clinical samples, and predominantly cross-sectional designs. Accordingly, this narrative review compares methods for assessing interoceptive accuracy, sensibility, and awareness; synthesizes behavioral, neurobiological, and clinical findings; and evaluates emerging interventions relevant to interoceptive processing. Current evidence indicates that interoceptive dysfunction in MDD is multidimensional, encompassing task performance, subjective bodily appraisal, metacognitive calibration, and interoception-related neural processing. Variability across these domains appears to reflect not only differences in measurement but also variation in clinical state and illness stage. Consistent with this view, neuroimaging studies suggest stage-related differences in large-scale networks, including lower default mode network activity in early-stage samples and higher activity in chronic-stage samples. From an active-inference perspective, selected findings may be understood in terms of an altered balance between bodily predictions and incoming sensory evidence, whereby negatively biased predictions persist when sensory signals are insufficiently weighted. Emerging intervention studies indicate that selected interoceptive processes are modifiable in some clinical and nonclinical samples, providing a rationale for mechanism-based testing in MDD.
Core Tip: This narrative review reframes the apparently inconsistent interoceptive findings in major depressive disorder (MDD) as a multidimensional pattern, with part of the apparent heterogeneity across studies related to measurement choice and illness stage. By comparing major assessment approaches and integrating behavioral, neurobiological, and clinical evidence, we identify where findings across interoceptive domains converge and diverge, with active inference serving as a heuristic perspective for interpreting selected links across levels of analysis. This synthesis points toward future stage-sensitive, multimodal assessment and more mechanism-informed intervention research in MDD.
