Association between interoceptive awareness and symptoms of post-traumatic stress disorder: a meta-analysis

Interoceptive awareness (IA) is increasingly recognized as relevant in trauma-related psychopathology, yet empirical findings on its relationship with posttraumatic stress disorder (PTSD) symptoms remain inconsistent. This systematic review and meta-analysis aimed to synthesize evidence on associations between IA subdomains and PTSD symptom clusters. We included peer-reviewed studies with adult participants, published in six languages, using validated measures for PTSD and IA. Databases searched: Scopus, Embase, PsycINFO, Web of Science, Medline. Risk of bias was assessed using the Joanna Briggs Institute tool for cross-sectional studies. Correlational data were pooled using a random-effects model with Hartung-Knapp adjustment and REML estimator for τ². Eight studies were included in the review, and seven in the meta-analyses (k = 1,239). Using validated measures of PTSD (based on DSM-5 symptom clusters) and IA (nine subdomains from the MAIA and SBC), we performed 35 separate meta-analyses to examine their interrelations, of which ten yielded significant pooled correlations. The strongest observed association was a positive correlation between hyperarousal and Body Dissociation (r = 0.51). Other significant findings included small positive correlations between Noticing and re-experiencing (r = 0.18), avoidance (r = 0.15), and hyperarousal (r = 0.17), and negative correlations between Trusting and re-experiencing (r = –0.11) and hyperarousal (r = –0.18). Findings tentatively suggest IA in PTSD is not uniformly impaired but imbalanced across subdomains, potentially reinforcing trauma-related distress. Limitations include small number of included studies, high risk of bias in most studies, limited subgroup analyses, and incomplete data availability. These findings contribute to a nuanced understanding of PTSD and IA. PROSPERO, CRD42025641337.