Beyond accuracy: interoceptive self-appraisal and the meaning of bodily signals.

For decades, accuracy in detecting internal bodily signals has been considered an important component of emotional experience. Yet this link remains elusive. Across methods and domains, interoceptive accuracy shows inconsistent associations with emotion and psychopathology. We argue this mismatch reflects a hierarchy of interoceptive processing: accuracy measures capture how bodily signals are detected, whereas emotion depends on metacognitive appraisals of what those signals mean, their reliability, and what they imply about the self. We introduce interoceptive self-appraisal (ISA) as a higher-order process through which bodily sensations are interpreted in context and assigned significance. ISA provides a framework for investigating affective vulnerability and developmental pathways to psychopathology. By integrating disparate theories of bodily appraisal, we outline a roadmap for interoception research.