When weak imagery is worse than none: Core aphantasia and hypophantasia relate differently to mental health, mediated by subjective interoception

Aphantasia, characterized by absent or reduced visual mental imagery, has been associated with alexithymia and negative mental health outcomes. However, the underlying mechanisms remain unclear. Visual imagery has been proposed as part of an inwardly focused cognitive style that also encompasses interoceptive processing and emotion regulation, suggesting these constructs may be functionally linked. Since mental health is closely tied to interoception, we examined whether interoceptive processing mediates the relationship between imagery ability and mental health. We assessed self-reported imagery vividness (VVIQ), subjective interoceptive accuracy and attention, alexithymia, anxiety, and depression in individuals with aphantasia (n = 153, VVIQ = 16-32) and typical imagers (n = 680, VVIQ = 33-80). Within the aphantasia group, we distinguished core aphantasia (VVIQ 16-23, n = 96) from hypophantasia (VVIQ 24-32, n = 57). The results revealed that individuals with weak imagery (hypophantasia) showed greater alexithymia and worse mental health than those with almost no imagery (core aphantasia), with higher VVIQ predicting poorer outcomes within the aphantasia range. The opposite pattern emerged in typical imagers, where higher VVIQ predicted lower alexithymia and better mental health. Structural equation modeling revealed that these relationships were mediated by alexithymia and the ratio of subjective interoceptive accuracy to attention, with lower ratios (indicating effortful but unsuccessful interoceptive processing) associated with worse outcomes. These findings highlight critical heterogeneity within aphantasia, demonstrating that hypophantasia and core aphantasia have distinct interoceptive and mental health profiles, with implications for understanding the mechanisms linking imagery, bodily awareness, and emotional well-being.