The relationship between interoception and anxiety, stress and obsessive-compulsive 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-related disorders. This systematic review synthesises evidence on the relationship between interoception and anxiety in adult clinical populations, with a specific focus on how distinct interoceptive dimensions (i.e., accuracy, attention, and beliefs) relate to different anxiety, stress and obsessive-compulsive presentations. A systematic search was conducted across PsycINFO, PubMed, and Web of Science (last updated April 2025). Thirty-three studies met inclusion criteria across the reviewed clinical conditions, including generalised anxiety disorder (GAD), panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and social anxiety disorder (SAD), employing self-report, behavioural, and neuroimaging measures across cardiac, respiratory, and gastrointestinal axes. Evidence supports both shared and disorder-specific interoceptive profiles. Panic disorder and GAD were most consistently associated with heightened interoceptive attention and altered accuracy, particularly during threat-related tasks. OCD was characterised by maladaptive interoceptive beliefs and elevated attention towards bodily sensations. Evidence for PTSD and SAD was limited, precluding firm conclusions. Neuroimaging findings indicated altered functional connectivity within interoceptive brain networks. Many of the studies 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.