No gender difference in cardiac interoceptive accuracy: Potential psychophysiological contributors in heartbeat counting task

Gender differences in interoceptive awareness-awareness of internal bodily signals such as heartbeat perception-have been suggested, with some findings indicating behaviourally reduced but subjectively enhanced awareness in women, though these findings are still contentious. This study aimed to comprehensively examine gender differences in three aspects of interoceptive awareness: behavioural accuracy, subjective confidence, and relationship between them (i.e., metacognition). We used a modified heartbeat counting task that prohibited estimation strategies and increased the number of trials up to 20. Using data from 74 healthy young adults (39 women and 35 men), we evaluated gender differences and practice effects for each measure via Bayesian linear mixed models, controlling for individual heart rate and trial duration on a trial-by-trial basis. Contrary to previous research, the results revealed no reduced interoceptive accuracy in women; instead, higher interoceptive accuracy score was associated with shorter trial durations and lower heart rates regardless of gender. Moreover, women exhibited underconfidence about their performance, and therefore lower metacognition scores, compared to men. Trial repetitions moderated women's lowered metacognition but did not affect accuracy or confidence. These findings highlight potential physiological and psychological confounding factors in the heartbeat counting task, such as heart rate and reporting style, and emphasise several cautions for studying gender differences in interoceptive awareness.