Next Article in Journal
The Role of Social Support and Religiosity in Postpartum Blues: A Cross-Sectional Study
Previous Article in Journal
Dog-Assisted Interventions Reduce Salivary Cortisol in Ukrainian Military Personnel with Post-Traumatic Stress Disorder (PTSD): A Pilot Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Psychiatry International
Volume 7
Issue 3
10.3390/psychiatryint7030102
psychiatryint-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Interoceptive Confusion and Alexithymia: Transdiagnostic Links to Eating Spectrum Symptoms in a Non-Clinical Young Adults’ Sample

by
Mario Miniati
1,
Rebecca Ciacchini
2,3,*,
Laura Lazzarotti
2,
Graziella Orrù
2,
Giorgia Papini
2,4,
Aleandra Viti
2,4,
Laura Palagini
1,
Silvio Presta
1,
Giulia Conversano
2,
Angelo Gemignani
2 and
Ciro Conversano
2
1
Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, 56100 Pisa, Italy
2
Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
3
School of Advanced Studies, University of Camerino, 62032 Camerino, Italy
4
Department of Statistics, Computer Science, Applications “Giuseppe Parenti”, University of Florence, 50121 Florence, Italy
*
Author to whom correspondence should be addressed.
Psychiatry Int. 2026, 7(3), 102; https://doi.org/10.3390/psychiatryint7030102
Submission received: 20 February 2026 / Revised: 27 March 2026 / Accepted: 28 April 2026 / Published: 6 May 2026
Versions Notes

Abstract

Background: Inadequate management of emotional responses, limited access to emotion regulation strategies, and difficulties in emotion regulation may co-occur with alexithymic traits and interoceptive inaccuracy or confusion. These dimensions may influence lifetime eating disorder spectrum manifestations. Objective: To assess, in a general population sample without Axis I psychiatric disorders, alexithymic traits, interoceptive confusion/inaccuracy, and difficulties in emotion regulation, and to explore their associations with eating disorder spectrum manifestations. Method: In this cross-sectional observational study, fifty-two participants aged 18–30 years, recruited via a university bulletin board, were assessed online using the Toronto Alexithymia Scale (TAS-20), Interoceptive Accuracy Scale (IAS), Interoceptive Confusion Questionnaire (ICQ), Eating Attitude Test (EAT-26), and Difficulties in Emotion Regulation Scale (DERS) (protocol #01/2025). Results: Interoceptive confusion (ICQ) showed significant positive correlations with TAS-20, DERS, and EAT-26 total scores. ICQ scores were associated with TAS-20 subscales ‘difficulty identifying feelings’ (DIF) and ‘difficulty describing feelings’ (DDF). Participants with TAS-20 scores > 51 (n = 35; 67.3%) had significantly higher EAT-26 scores on ‘dieting’ (p = 0.043) and ‘bulimia’ (p = 0.017), as well as higher ICQ (p = 0.001) and DERS (p = 0.001) total scores, with smaller differences in the DERS ‘impulse’ subscale (p = 0.037). Conclusions: Preliminary findings suggest a pattern of co-occurring traits characterized by alexithymia, interoceptive confusion, emotional dysregulation, impulsivity, and eating disorder spectrum features, supporting the study hypothesis.

1. Introduction

Alexithymia mainly refers to the difficulty in identifying and describing emotional states and in differentiating feelings from bodily sensations [1,2]. It is also characterized by low levels of imagination and by a cognitive style predominantly oriented towards external factors [1,2,3]. Alexithymic traits have been reported in about 10–13% of the general population [4,5].
In clinical samples, alexithymia is a trans-diagnostic dimension, comorbid with anxiety disorders, mood disorders, post-traumatic stress disorder (PTSD), obsessive–compulsive disorder (OCD), and eating spectrum disorders (EDs) [6,7].
Alexithymia has been categorized in two ways: as a pre-existing dimension or as a maladaptive response to stressful life events (SLEs). Accordingly, it has been hypothesized that there is an existence of a ‘primary alexithymia’, tied to enduring neurofunctional traits, and a ‘secondary alexithymia’, driven by emotional avoidance and numbing, after SLEs [8].
From a neurobiological standpoint, alexithymia traits have been mainly linked to prefrontal circuits, striatal and limbic structures, and interoception circuits, such as the insula and the anterior cingulate cortex, all crucial for bodily representation and for conscious emotional experience [9]. According to this model, alexithymia could be a manifestation of a ‘core impairment’ in processing and integrating somatic signals, thus involving interoception [10,11]. Interoception is a multidimensional construct, including at least three components: interoceptive sensitivity (subjective evaluation and attention to internal signals), interoceptive accuracy (perceptual accuracy relative to objective measures), and interoceptive awareness (metacognitive integration between accuracy and sensitivity) [12,13,14]. Interoceptive alterations or modifications are present in a number of psychological/psychopathological conditions (for example, hyperperception in anxiety/panic; hypoperception in depression), including EDs [15,16]. Interoceptive deficits and confusion may be involved in the structuring and maintenance of body misperception that can reach the intensity of somatic delusions in the most severe cases of restrictive anorexia nervosa (AN-R) [17]. Interoceptive sensitivity and awareness in patients with AN-R might be constantly impaired, whereas alterations in interoceptive accuracy only occur at specific times, such as during and after meals, with an amplification of satiety signals [18,19,20]. An altered perception of hunger and satiety has also been detected in patients with bulimia nervosa (BN), who might perceive satiety only after the ingestion of large amounts of food and fluids, with gastric repletion and a feeling of psychophysical discomfort [21]. Evidence suggests that alexithymic traits and interoceptive deficits are present across the entire spectrum of EDs, irrespective of categorical diagnoses [22,23], even if alexithymia seems to be more typical of AN-R [17,24,25]. In AN-R, alexithymic traits could be evident, with marked difficulties in describing emotions, emotional hyper-control, and altered interoceptive awareness/sensitivity, especially for satiety and post-prandial signal misinterpretation [17,24,25]. Patients with BN may show more difficulties in recognizing bodily sensations from emotions, with binging/purging behaviors consequent to emotion-driven arousal [14,24,26]. Overall, interoceptive dysfunctions may contribute to eating pathology by impairing the ability to correctly interpret internal bodily signals, such as hunger and satiety, thereby promoting maladaptive eating behaviors and emotional dysregulation [13,15,16].
Neurofunctional studies support the involvement of the insula and amygdala in response to food stimuli, consistent with the idea that interoceptive and affective processing are closely intertwined in the overall spectrum of EDs [27].
According to recent literature, emotional dysregulation is linked to interoceptive confusion, impaired emotion identification, and alexithymic traits in patients with EDs [28]. Deficits in emotional awareness/understanding, non-acceptance of emotions, poor impulse control, and limited access to effective regulation strategies are present in EDs, especially when interoceptive dysfunctions and alexithymia traits co-occur [29,30]. Interoceptive deficits and alexithymia may contribute to emotional dysregulation, which promotes the adoption and maintenance of dysfunctional eating behaviors [13,31]. A bodily signal disconnection may be present with a parallel disconnection from emotional experience, fostering dysfunctional behaviors aimed at coping with emotional dysregulation itself [32]. Typical AN-R temperamental traits and behaviors, such as social isolation, cognitive rigidity, reward insensitivity, symmetry-seeking, and perfectionism, can be reframed as the adoption of an emotional hyper-control [33]. A recent meta-analysis supported the hypothesis that maladaptive emotional strategies (avoidance, suppression, rumination) may predict ED symptoms’ severity; conversely, more functional and adaptive strategies (namely, emotional awareness, acceptance, reappraisal, and problem-solving) may exert a protective effect on the occurrence of eating spectrum symptoms, thus reinforcing the idea of a dimensional, transdiagnostic continuum between alexithymic traits, emotional dysregulation, interoceptive deficits and eating spectrum manifestations [34].
However, only a limited number of studies have simultaneously explored the interplay between interoceptive processes, emotional dysregulation, and alexithymic traits in relation to eating disorder spectrum manifestations, particularly in non-clinical populations. This gap limits the understanding of how these dimensions interact as potential transdiagnostic vulnerability factors [25,35].
This study aimed at exploring the inadequate management of emotional responses, together with the limited access to emotion regulation strategies, as potentially related to alexithymia traits and interoceptive inaccuracy/confusion in a sample of healthy subjects. The main hypothesis of our study was that, when present, the above-mentioned dimensions could be related to the lifetime occurrence of eating disorder spectrum signs and symptoms, conceptualized as subclinical eating-related attitudes and behaviors within a dimensional framework, which may be present even in the absence of a full-blown Axis I EDs.

2. Materials and Methods

2.1. Study Design

The study had an observational, single-center, and cross-sectional design. Data collection was conducted using self-administered online questionnaires (Microsoft Forms), with an average completion time of approximately 20 min, allowing multiple sessions. Participants were recruited through an open online announcement posted on a university official bulletin board. Response rate could not be calculated, and all participants provided electronic informed consent for participation and data processing. The study was reported in accordance with the STROBE guidelines for cross-sectional studies, and the completed checklist is provided as Supplementary Materials Table S1 [36]. The University of Pisa’s Bioethics Committee approved the study (# 01/2025, 21 February 2025).

2.2. Participants

The sample consisted of 52 individuals (aged 18–30 years) from a non-clinical convenience sample recruited in an academic setting via a university bulletin board and therefore not representative of the general population. This age range was selected to focus on young adulthood, a developmental period associated with increased vulnerability to eating disorder-related symptoms, as highlighted in the previous literature [37]. Inclusion/exclusion criteria are summarized in Table 1. The absence of current psychiatric disorders was assessed through self-report, due to the anonymous nature of the survey.

2.3. Measures

We administered online the following questionnaires:
  • Socio-demographic Questionnaire: an ad hoc questionnaire collecting information on age, gender, educational level, employment status, interpersonal and family status, and area of residence. Responses were collected using predefined, mutually exclusive categorical options.
  • Toronto Alexithymia Scale (TAS-20) [38,39]: It is a 20-item self-report measure rated on a 5-point Likert scale, assessing alexithymia across three dimensions: Difficulty in Identifying Feelings (DIF), Difficulty in Describing Feelings (DDF), and Externally Oriented Thinking (EOT). Total scores range from 20 to 100, with values above 51 indicating the presence of alexithymic traits. The original instrument has demonstrated good internal consistency (Cronbach’s α = 0.80), test–retest reliability, and a stable three-factor structure, replicated across clinical and non-clinical populations.
  • Interoceptive Accuracy Scale (IAS) [13,40]: In the present study, we used the Italian adaptation from Gaggero et al. that consists of 21 items rated on a 5-point Likert scale ranging from 1 (‘strongly disagree’) to 5 (‘strongly agree’), assessing self-perceived interoceptive accuracy. Total scores range from 21 to 105, with higher scores reflecting greater interoceptive accuracy.
  • Interoceptive Confusion Questionnaire (ICQ) [13,41]: In the present study, we used the Italian adaptation from Gaggero et al. The scale includes 20 items rated on a 5-point Likert scale and evaluates difficulties in interpreting non-affective interoceptive states (e.g., hunger, satiety, body temperature). Total scores range from 20 to 100, with higher scores indicating greater interoceptive confusion.
  • Eating Attitudes Test (EAT-26) [42,43]: It is a screening instrument for eating disorder symptomatology, composed of 26 items and three subscales (dieting, bulimia/food preoccupation, oral control). Total scores range from 0 to 78, with scores ≥20 indicating a potential clinical risk.
  • Difficulties in Emotion Regulation Scale (DERS) [28,44]: It is a 36-item self-report scale rated on a 5-point Likert scale to assess difficulties in emotion regulation. Four dimensions are explored: non-acceptance, goal-directed behaviors, impulse control, and emotional awareness. Total scores range from 36 to 180, with higher scores indicating greater difficulty with emotion regulation.
In our study, TAS-20 and IAS showed very good internal consistency (Cronbach’s α = 0.800 and 0.891, respectively), as well as EAT-26 and DERS (Cronbach’s α = 0.907 and 0.938, respectively). Furthermore, the internal consistency of the ICQ was acceptable but relatively low (Cronbach’s α = 0.673), suggesting limited reliability and warranting cautious interpretation of the related findings.

2.4. Statistical Analyses

Associations between variables and group differences were examined using appropriate statistical tests. Preliminary analyses were conducted to explore potential gender differences in the study variables to assess possible confounding effects. Quantitative variables were summarized with measures of central tendency and dispersion, and categorical variables with frequencies and percentages. The online platform enforced complete responses, eliminating missing data. Normality was assessed via the Kolmogorov–Smirnov test and descriptive indices (mean, median, skewness, kurtosis). Normally distributed quantitative variables were compared using independent t-tests; non-normal tests were assessed via Wilcoxon tests. Nominal variables employed chi-square or Fisher’s exact tests. Correlations used Pearson’s r or Spearman’s ρ, as appropriate. Furthermore, a sensitivity power analysis was conducted using G*Power (version 3.1.9.6) [45] to estimate the minimum effect size detectable with the present sample size. The analysis indicated that, with N = 52, α = 0.05, and 80% power, the study was able to detect correlations of approximately r = 0.38 or larger. A p-value < 0.05 was considered statistically significant.

3. Results

3.1. Socio-Demographic Characteristics

The overall sample consisted of 52 individuals, whose socio-demographic characteristics are summarized in Table 2. The mean age/SD of the overall sample was 24.9 ± 2.4 years (range: 18–30), and females represented 73.1% of the sample (n = 38). No statistically significant differences were observed in the mean age/SD between genders. Similarly, no significant gender-related differences emerged with respect to educational level (χ2 = 0.11), interpersonal status (χ2 = 0.32), employment status (χ2 = 0.37), or area of residence (χ2 = 0.54), indicating homogeneity of the sample.

3.2. Gender Differences

Descriptive statistics and gender differences for interoceptive accuracy (IAS), interoceptive confusion (ICQ), alexithymia (TAS-20), and emotion regulation (DERS) are summarized in Table 3. No statistically significant gender differences emerged across the examined dimensions, except for the TAS-20 ‘Difficulty in Identifying Feelings’ (DIF) subscale, with higher scores among female participants. No significant gender differences were observed for eating-related attitudes as assessed by the EAT-26. Given that, the following analyses have been conducted on the overall sample, without controlling for gender.

3.3. Correlation Analyses

Correlations among total scores are reported in Table 4, and subscale correlations in Table 5. Interoceptive accuracy (IAS) was negatively correlated with interoceptive confusion (ICQ), indicating that higher perceived interoceptive accuracy was associated with lower interoceptive confusion. IAS total scores were not significantly associated with alexithymia, emotion dysregulation, or eating-related attitudes. Conversely, interoceptive confusion (ICQ) showed significant positive correlations with alexithymia (TAS-20), emotion dysregulation (DERS), and eating-related attitudes (EAT-26), suggesting that greater interoceptive confusion is associated with higher levels of emotional processing difficulties and maladaptive eating attitudes. The ICQ total score was significantly correlated with the TAS-20 dimensions ‘Difficulty in Identifying Feelings’ (DIF) and ‘Difficulty in Describing Feelings’ (DDF). Moreover, the ICQ total score was significantly correlated with the EAT-26 Dieting and Bulimia subscales, except for ‘Oral Control’. Among emotion regulation dimensions, the DERS ‘Non-acceptance’ subscale showed the strongest and most consistent associations with eating-related attitudes.

3.4. Eating-Related Attitudes, Interoception, and Emotion Regulation by Alexithymic Traits

Comparisons between participants with and without alexithymia traits, based on the TAS-20 cut-off (≤51 vs. >51), revealed no significant differences in age or gender distribution. Descriptive statistics and group comparisons are reported in Table 6 and Table 7. Participants with alexithymic traits showed significantly higher levels of interoceptive confusion (ICQ) and overall emotion dysregulation (DERS total score), with a specific difference on the DERS Impulse Control subscale. No significant differences were found in interoceptive accuracy (IAS). Regarding eating-related attitudes, subjects with a TAS-20 total score > 51 scored significantly higher on the EAT-26 ‘Dieting’ and ‘Bulimia subscales’, but not on the EAT-26 ‘Oral Control’. The total EAT-26 scores were below the cut-off for ED diagnosis.

4. Discussion

The present findings should be interpreted with caution as they derive from a relatively small, non-clinical sample and a cross-sectional design, which precludes any causal inferences. Moreover, recruitment through a university bulletin board likely resulted in an over-representation of academically affiliated individuals, thereby limiting the generalizability of the results to the broader population.
Within these limits, the study identified a coherent pattern of co-occurring traits characterized by elevated alexithymia traits, interoceptive confusion, emotional dysregulation, impulsivity, and eating disorder spectrum manifestations, broadly supporting our main hypothesis. Notably, no significant gender differences emerged in EAT-26 total scores. This null finding may be attributable to the modest sample size, the strong female predominance (73%), and the overall low levels of eating symptomatology, as is typical in non-clinical populations. In addition, the sensitivity power analysis (r ≈ 0.38) indicated that the study was adequately powered only to detect medium-to-large effects; smaller yet potentially clinically meaningful associations may therefore have remained undetected.
Gender comparisons on the psychological dimensions of interest revealed only one significant difference: females scored higher than males on the TAS-20 ‘Difficulty Identifying Feelings’ (DIF) subscale. This result aligns with previous large-scale epidemiological data [46] and a recent meta-analysis [47] showing greater difficulties in emotion identification and differentiation from somatic sensations among females. These analyses were exploratory and primarily served to rule out potential confounding effects rather than to test a priori hypotheses.
Correlation analyses highlighted interoceptive confusion (ICQ) as the central node of associations. The ICQ total score was significantly correlated with TAS-20, DERS, and EAT-26 scores (except for the ‘Oral Control’ subscale). These patterns suggest that an impaired ability to accurately decode bodily signals may be associated with emotional dysregulation, which in turn may relate to the emergence of eating disorder-related attitudes and behaviors. This interpretation is further supported by the inverse correlation observed between interoceptive accuracy (IAS) and interoceptive confusion (ICQ). The present results are consistent with previous findings from our research group [25] and with a large body of literature linking interoceptive deficits to both alexithymia and eating disorder symptomatology [13].
Interestingly, alexithymia dimensions appeared more strongly related to subjective interoceptive confusion (i.e., everyday difficulties in recognizing hunger, thirst, muscle tension, etc., as measured by the ICQ) than to objective interoceptive accuracy deficits (IAS). This finding contrasts with the accuracy-focused theoretical model proposed by Murphy and colleagues [40,48] and suggests that, at least in non-clinical samples, the subjective experience of bodily confusion may play a particularly relevant role.
At the subscale level, ICQ total scores correlated significantly with the TAS-20 ‘Difficulty Identifying Feelings’ (DIF) and ‘Difficulty Describing Feelings’ (DDF) dimensions. These results replicate previous observations [25] and raise important questions regarding the specific contribution of these alexithymic facets to impaired self-regulation and vulnerability to eating-related manifestations in the general population.
Among the DERS subscales, only ‘Non-acceptance of Emotional Responses’ (DERS-NA) showed consistent and strong associations with all three EAT-26 dimensions (dieting, bulimia, and oral control). This pattern suggests that a negative judgment of one’s own emotional experiences may be particularly relevant to the emergence of eating disorder symptomatology, consistent with prior studies in both the general population [49] and clinical (anorexia nervosa) samples [50]. It is possible that difficulties in accepting emotional reactions may amplify the perception of somatic sensations and promote the use of maladaptive eating behaviors as a means of regulating emotional distress [51,52].
Additional analyses using the TAS-20 cut-off (total score > 51) confirmed this broader pattern: participants meeting the alexithymia threshold scored significantly higher on ICQ, emotion dysregulation, impulsivity, and Dieting/Bulimia subscales compared with those below the threshold. These findings are in line with the sensory-alexithymia-eating subnetwork model recently proposed by Romeo [53].
Several methodological considerations should be noted. First, the internal consistency of the ICQ in the present sample was only marginally acceptable (α = 0.673); therefore, findings involving interoceptive confusion should be interpreted cautiously, as measurement limitations may have influenced the observed associations. Second, all variables were assessed exclusively through self-report instruments, which may have introduced shared method variance and inflated the strength of the relationships. Self-reported interoception is likely to reflect subjective beliefs about bodily states rather than objective perceptual accuracy—an important distinction that may explain why confusion (ICQ) showed stronger associations than accuracy (IAS).
Taken together, the present results support theoretical models positing that alexithymia arises, at least in part, from disrupted integration of bodily signals and emotional awareness. Within this framework, interoceptive confusion emerges as a relevant correlate linking emotional dysregulation and maladaptive eating attitudes. These findings also resonate with neurophenomenological perspectives that emphasize a ‘problematic bodily presence’ (characterized by blurred boundaries between somatic signals and emotional states) as a potential vulnerability factor for dysfunctional eating behaviors.
In non-clinical samples, such configurations may represent subclinical risk profiles, possibly modulated by socio-cultural influences. However, the cross-sectional design of the study does not allow conclusions regarding directionality. Future longitudinal and experimental research will be essential to clarify whether interoceptive alterations precede, follow, or mutually reinforce emotional dysregulation and eating-related symptomatology.

5. Study Limitations

Our study had a cross-sectional design and did not allow for causal inferences among the variables examined. Furthermore, the sample size was small and was assessed entirely with self-administered instruments via an online procedure. A sensitivity power analysis indicated that the present sample size allowed detection of effects of approximately r = 0.38 or larger, suggesting limited sensitivity for smaller effects. The limitations of self-report measures are well known, especially when exploring interoception. Moreover, reliance on self-report instruments may introduce shared method variance, potentially inflating correlations among variables. As noted in previous studies on this specific dimension [54], methodologies for measuring interoception present several difficulties and limitations. The lack of empirical convergence among questionnaires exploring interoception limits the findings’ generalizability. In addition, the recruitment method (online announcement through a university bulletin board) may have introduced selection bias, while the characteristics of the sample (young adults likely affiliated with a university setting) may limit the generalizability of the findings.

6. Concluding Remarks

In summary, the present study identified significant associations between interoceptive confusion, alexithymia, emotional dysregulation, and eating-related attitudes in a non-clinical sample of young adults. Interoceptive confusion emerged as a relevant correlate linking difficulties in emotional awareness and regulation with maladaptive eating-related attitudes. These findings should be considered preliminary and interpreted with caution, given the relatively small sample size, the non-clinical nature of the population, and the cross-sectional design. As such, no conclusions regarding causality or directionality can be drawn. Moreover, the exclusive reliance on self-report measures may have introduced shared method variance, potentially influencing the strength of the observed associations.
Future research should employ longitudinal and experimental designs to better clarify the temporal and causal relationships among these variables and integrate objective measures of interoception to distinguish subjective beliefs from perceptual accuracy.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/psychiatryint7030102/s1, Table S1: STROBE Statement, Checklist of items that should be included in reports of cross-sectional studies.

Author Contributions

Conceptualization: M.M. and C.C.; methodology: M.M., L.L. and G.O.; software: M.M.; formal analysis: M.M. and L.L.; resources: M.M., L.P. and A.G.; data curation: L.L., R.C., G.P., A.V. and G.C.; writing—original draft preparation: M.M., R.C., G.P. and A.V.; writing—review and editing: M.M., R.C., G.P., A.V., G.C. and S.P.; supervision: M.M., L.P. and A.G.; project administration: M.M., C.C. and R.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the University of Pisa’s Bioethics Committee (protocol code n.01/2025 and date of approval 21 February 2025).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical/privacy issues.

Acknowledgments

We thank Angelica Miniati, officially certified at the C1 level by Cambridge Assessment (verification # B8349000), for English revision.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Sifneos, P.E. The Prevalence of “Alexithymic” Characteristics in Psychosomatic Patients. Psychother. Psychosom. 1973, 22, 255–262. [Google Scholar] [CrossRef]
  2. Sifneos, P.E. Alexithymia: Past and Present. Am. J. Psychiatry 1996, 153, 137–142. [Google Scholar] [CrossRef]
  3. Hölzel, B.K.; Carmody, J.; Evans, K.C.; Hoge, E.A.; Dusek, J.A.; Morgan, L.; Pitman, R.K.; Lazar, S.W. Stress Reduction Correlates with Structural Changes in the Amygdala. Soc. Cogn. Affect. Neurosci. 2009, 5, 11–17. [Google Scholar] [CrossRef]
  4. Mattila, A.K.; Salminen, J.K.; Nummi, T.; Joukamaa, M. Age Is Strongly Associated with Alexithymia in the General Population. J. Psychosom. Res. 2006, 61, 629–635. [Google Scholar] [CrossRef] [PubMed]
  5. Franz, M.; Popp, K.; Schaefer, R.; Sitte, W.; Schneider, C.; Hardt, J.; Decker, O.; Braehler, E. Alexithymia in the German General Population. Soc. Psychiatry Psychiatr. Epidemiol. 2008, 43, 54–62. [Google Scholar] [CrossRef]
  6. Zeiler, M.; Wittek, T.; Truttmann, S.; Klang, J.; Kopp, K.; Krauss, H.; Auer-Welsbach, E.; Ohmann, S.; Sackl-Pammer, P.; Werneck-Rohrer, S.; et al. Alexithymia and Emotion Recognition Over the Treatment Course in Adolescents and Emerging Adults With Anorexia Nervosa. Eur. Eat. Disord. Rev. 2025, 33, 1265–1275. [Google Scholar] [CrossRef]
  7. Sirri, L. Prevalence and Correlates of Alexithymia in the General Population. Mediterr. J. Clin. Psychol. 2023, 11, 156. [Google Scholar]
  8. Sagar, R.; Talwar, S.; Desai, G.; Chaturvedi, S.K. Relationship between Alexithymia and Depression: A Narrative Review. Indian J. Psychiatry 2021, 63, 127–133. [Google Scholar] [CrossRef] [PubMed]
  9. Hogeveen, J.; Grafman, J. Alexithymia. Handb. Clin. Neurol. 2021, 183, 47–62. [Google Scholar] [CrossRef]
  10. Goerlich-Dobre, K.S.; Votinov, M.; Habel, U.; Pripfl, J.; Lamm, C. Neuroanatomical Profiles of Alexithymia Dimensions and Subtypes. Hum. Brain Mapp. 2015, 36, 3805–3818. [Google Scholar] [CrossRef]
  11. Moriguchi, Y.; Komaki, G. Neuroimaging Studies of Alexithymia: Physical, Affective, and Social Perspectives. Biopsychosoc. Med. 2013, 7, 8. [Google Scholar] [CrossRef]
  12. Murphy, J.; Brewer, R.; Hobson, H.; Catmur, C.; Bird, G. Is Alexithymia Characterised by Impaired Interoception? Further Evidence, the Importance of Control Variables, and the Problems with the Heartbeat Counting Task. Biol. Psychol. 2018, 136, 189–197. [Google Scholar] [CrossRef]
  13. Gaggero, G.; Bizzego, A.; Dellantonio, S.; Pastore, L.; Lim, M.; Esposito, G. Clarifying the Relationship between Alexithymia and Subjective Interoception. PLoS ONE 2021, 16, e0261126. [Google Scholar] [CrossRef]
  14. Westwood, H.; Mandy, W.; Brewer, R. The Relationship Between Interoception, Alexithymia, Autistic Traits and Eating Pathology in Autistic Adults. J. Autism Dev. Disord. 2025. [Google Scholar] [CrossRef]
  15. Jacquemot, A.M.M.C.; Park, R. The Role of Interoception in the Pathogenesis and Treatment of Anorexia Nervosa: A Narrative Review. Front. Psychiatry 2020, 11, 281. [Google Scholar] [CrossRef]
  16. Adams, K.L.; Murphy, J.; Catmur, C.; Bird, G. The Role of Interoception in the Overlap between Eating Disorders and Autism: Methodological Considerations. Eur. Eat. Disord. Rev. 2022, 30, 501–509. [Google Scholar] [CrossRef] [PubMed]
  17. Miniati, M.; Marazziti, D.; Palagini, L. Is Alexithymia the Link Between Anorexia and Autism Spectrum Disorders? Clin. Neuropsychiatry 2022, 19, 137–149. [Google Scholar] [CrossRef]
  18. Ambrosecchia, M.; Ardizzi, M.; Russo, E.; Ditaranto, F.; Speciale, M.; Vinai, P.; Todisco, P.; Maestro, S.; Gallese, V. Interoception and Autonomic Correlates during Social Interactions. Implications for Anorexia. Front. Hum. Neurosci. 2017, 11, 219. [Google Scholar] [CrossRef] [PubMed]
  19. Schalla, M.A.; Stengel, A. Gastrointestinal Alterations in Anorexia Nervosa—A Systematic Review. Eur. Eat. Disord. Rev. 2019, 27, 447–461. [Google Scholar] [CrossRef] [PubMed]
  20. Poovey, K.; Ahlich, E.; Attaway, S.; Rancourt, D. General versus Hunger/Satiety-Specific Interoceptive Sensibility in Predicting Disordered Eating. Appetite 2022, 171, 105930. [Google Scholar] [CrossRef]
  21. van Dyck, Z.; Schulz, A.; Blechert, J.; Herbert, B.M.; Lutz, A.P.C.; Vögele, C. Gastric Interoception and Gastric Myoelectrical Activity in Bulimia Nervosa and Binge-Eating Disorder. Int. J. Eat. Disord. 2021, 54, 1106–1115. [Google Scholar] [CrossRef] [PubMed]
  22. Nowakowski, M.E.; McFarlane, T.; Cassin, S. Alexithymia and Eating Disorders: A Critical Review of the Literature. J. Eat. Disord. 2013, 1, 21. [Google Scholar] [CrossRef]
  23. Westwood, H.; Kerr-Gaffney, J.; Stahl, D.; Tchanturia, K. Alexithymia in Eating Disorders: Systematic Review and Meta-Analyses of Studies Using the Toronto Alexithymia Scale. J. Psychosom. Res. 2017, 99, 66–81. [Google Scholar] [CrossRef]
  24. Lysaker, P.H.; Chernov, N.; Moiseeva, T.; Sozinova, M.; Dmitryeva, N.; Makarova, A.; Kukla, M.; Myers, E.; Karpenko, O.; Kostyuk, G. Contrasting Metacognitive, Emotion Recognition and Alexithymia Profiles in Bulimia, Anorexia, and Schizophrenia. J. Nerv. Ment. Dis. 2023, 211, 348–354. [Google Scholar] [CrossRef]
  25. Miniati, M.; Lippi, M.; Palagini, L.; Conversano, C.; Orrù, G.; Gemignani, A.; Perugi, G. Is Interoception Deficit Linking Alexithymia and Eating Spectrum Symptoms? Study on a Non-Clinical Sample of Young Adults. Healthcare 2024, 12, 586. [Google Scholar] [CrossRef]
  26. Ottley-Porter, A.; Adams, K.L.; Brewer, R.; Murphy, J. Minimal Impact of Sensation-Related Items on the Association Between Alexithymia and Self-Report Measures of Interoception. Personal. Ment. Health 2025, 19, e70048. [Google Scholar] [CrossRef]
  27. Kerr, K.L.; Moseman, S.E.; Avery, J.A.; Bodurka, J.; Simmons, W.K. Influence of Visceral Interoceptive Experience on the Brain’s Response to Food Images in Anorexia Nervosa. Psychosom. Med. 2017, 79, 777–784. [Google Scholar] [CrossRef] [PubMed]
  28. Gratz, K.L.; Roemer, L. Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. J. Psychopathol. Behav. Assess. 2004, 26, 41–54. [Google Scholar] [CrossRef]
  29. Oldershaw, A.; Lavender, T.; Sallis, H.; Stahl, D.; Schmidt, U. Emotion Generation and Regulation in Anorexia Nervosa: A Systematic Review and Meta-Analysis of Self-Report Data. Clin. Psychol. Rev. 2015, 39, 83–95. [Google Scholar] [CrossRef]
  30. Dingemans, A.; Danner, U.; Parks, M. Emotion Regulation in Binge Eating Disorder: A Review. Nutrients 2017, 9, 1274. [Google Scholar] [CrossRef] [PubMed]
  31. Puttevils, L.; Vanderhasselt, M.-A.; Horczak, P.; Vervaet, M. Differences in the Use of Emotion Regulation Strategies between Anorexia and Bulimia Nervosa: A Systematic Review and Meta-Analysis. Compr. Psychiatry 2021, 109, 152262. [Google Scholar] [CrossRef]
  32. Velkoff, E.A.; Smith, A.R. Temporal Dynamics of Interoceptive Attention and Positive and Negative Affect in Adults Engaging in Disordered Eating and Nonsuicidal Self-Injury. J. Clin. Psychol. 2023, 79, 1842–1856. [Google Scholar] [CrossRef]
  33. Rowsell, M.; MacDonald, D.E.; Carter, J.C. Emotion Regulation Difficulties in Anorexia Nervosa: Associations with Improvements in Eating Psychopathology. J. Eat. Disord. 2016, 4, 17. [Google Scholar] [CrossRef] [PubMed]
  34. Prefit, A.-B.; Cândea, D.M.; Szentagotai-Tătar, A. Emotion Regulation across Eating Pathology: A Meta-Analysis. Appetite 2019, 143, 104438. [Google Scholar] [CrossRef]
  35. Critchley, H.D.; Garfinkel, S.N. Interoception and Emotion. Curr. Opin. Psychol. 2017, 17, 7–14. [Google Scholar] [CrossRef]
  36. Cuschieri, S. The STROBE Guidelines. Saudi J. Anaesth. 2019, 13, S31–S34. [Google Scholar] [CrossRef] [PubMed]
  37. Treasure, J.; Duarte, T.A.; Schmidt, U. Eating Disorders. Lancet 2020, 395, 899–911. [Google Scholar] [CrossRef]
  38. Bagby, R.M.; Parker, J.D.; Taylor, G.J. The Twenty-Item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. J. Psychosom. Res. 1994, 38, 23–32. [Google Scholar] [CrossRef]
  39. Bressi, C.; Taylor, G.; Parker, J.; Bressi, S.; Brambilla, V.; Aguglia, E.; Allegranti, I.; Bongiorno, A.; Giberti, F.; Bucca, M.; et al. Cross Validation of the Factor Structure of the 20-Item Toronto Alexithymia Scale: An Italian Multicenter Study. J. Psychosom. Res. 1996, 41, 551–559. [Google Scholar] [CrossRef] [PubMed]
  40. Murphy, J.; Brewer, R.; Plans, D.; Khalsa, S.S.; Catmur, C.; Bird, G. Testing the independence of self-reported interoceptive accuracy and attention. Q. J. Exp. Psychol. 2020, 73, 115–133. [Google Scholar] [CrossRef]
  41. Brewer, R.; Cook, R.; Bird, G. Alexithymia: A General Deficit of Interoception. R. Soc. Open Sci. 2016, 3, 150664. [Google Scholar] [CrossRef]
  42. Garner, D.M.; Olmsted, M.P.; Bohr, Y.; Garfinkel, P.E. The Eating Attitudes Test: Psychometric Features and Clinical Correlates. Psychol. Med. 1982, 12, 871–878. [Google Scholar] [CrossRef]
  43. Dotti, A.; Lazzari, R. Validation and Reliability of the Italian EAT-26. Eat. Weight Disord. Stud. Anorex. Bulim. Obes. 1998, 3, 188–194. [Google Scholar] [CrossRef]
  44. Sighinolfi, C.; Norcini Pala, A.; Chiri, L.R.; Marchetti, I.; Sica, C. Difficulties in emotion regulation scale (DERS): The italian translation and adaptation. Psicoter. Cogn. Comport. 2010, 16, 141–170. [Google Scholar]
  45. Faul, F.; Erdfelder, E.; Lang, A.-G.; Buchner, A. G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences. Behav. Res. Methods 2007, 39, 175–191. [Google Scholar] [CrossRef] [PubMed]
  46. Moriguchi, Y.; Maeda, M.; Igarashi, T.; Ishikawa, T.; Shoji, M.; Kubo, C.; Komaki, G. Age and Gender Effect on Alexithymia in Large, Japanese Community and Clinical Samples: A Cross-Validation Study of the Toronto Alexithymia Scale (TAS-20). Biopsychosoc. Med. 2007, 1, 7. [Google Scholar] [CrossRef] [PubMed]
  47. Mendia, J.; Zumeta, L.N.; Cusi, O.; Pascual, A.; Alonso-Arbiol, I.; Díaz, V.; Páez, D. Gender Differences in Alexithymia: Insights from an Updated Meta-Analysis. Personal. Individ. Differ. 2024, 227, 112710. [Google Scholar] [CrossRef]
  48. Murphy, J.; Catmur, C.; Bird, G. Classifying Individual Differences in Interoception: Implications for the Measurement of Interoceptive Awareness. Psychon. Bull. Rev. 2019, 26, 1467–1471. [Google Scholar] [CrossRef]
  49. Hadj Ali, A.; Turki, M.; Zribi, A.; Halouani, N.; Ellouze, S.; Aloulou, J. Impact Of Emotion Dysregulation On Eating Behavior Among The Tunisian General Population. Eur. Psychiatry 2024, 67, S107. [Google Scholar] [CrossRef]
  50. Santos, B.M.; Haynos, A.F. Difficulties with Positive Emotion Regulation in Anorexia Nervosa. Eur. Eat. Disord. Rev. 2023, 31, 520–528. [Google Scholar] [CrossRef]
  51. Haynos, A.F.; Fruzzetti, A.E. Anorexia Nervosa as a Disorder of Emotion Dysregulation: Evidence and Treatment Implications. Clin. Psychol. Sci. Pract. 2011, 18, 183–202. [Google Scholar] [CrossRef]
  52. Wang, S.B.; Fox, K.R.; Boccagno, C.; Hooley, J.M.; Mair, P.; Nock, M.K.; Haynos, A.F. Functional Assessment of Restrictive Eating: A Three-Study Clinically Heterogeneous and Transdiagnostic Investigation. J. Abnorm. Psychol. 2021, 130, 761–774. [Google Scholar] [CrossRef] [PubMed]
  53. Romeo, V.M. Sensory Processing Sensitivity, Alexithymia, and Eating Disorder Risk in Adolescents in Alternative Care: A Multi-Informant Network Study. J. Clin. Basic Psychosom. 2025, 025340063. [Google Scholar] [CrossRef]
  54. Desmedt, O.; Heeren, A.; Corneille, O.; Luminet, O. What Do Measures of Self-Report Interoception Measure? Insights from a Systematic Review, Latent Factor Analysis, and Network Approach. Biol. Psychol. 2022, 169, 108289. [Google Scholar] [CrossRef] [PubMed]
Table 1. Inclusion/exclusion criteria.
Table 1. Inclusion/exclusion criteria.
Inclusion CriteriaExclusion Criteria
Age 18–30 yearsAge <18 or >30 years
No current psychiatric disorders under treatment (self-report)Current psychiatric disorders under treatment (self-report)
Online informed consentInability to understand/sign informed consent
Adequate comprehension of the Italian languageInadequate comprehension of the Italian language
Table 2. Socio-demographic variables in the overall sample (n = 52) and sorted by gender.
Table 2. Socio-demographic variables in the overall sample (n = 52) and sorted by gender.
Total
N = 52		M
N = 14		F
N = 38
Age (years) (mean/SD)24.9 ± 2.425.6 ± 3.324.7 ± 2.0
Educationn/%n/%n/%
Middle school1/52 (1.9)-1/38 (2.6)
High school17/52 (32.7)8/14 (57.2)9/38 (23.7)
University degree30/52 (57.7)6/14 (42.8)24/38 (63.2)
Postgraduate degree4/52 (7.7)-4/38 (10.5)
Interpersonal Statusn/%n/%n/%
Single44/52 (84.6)13/14 (92.8)31/38 (81.6)
Married/partnership8/52 (15.4)1/14 (7.2)7/38 (18.4)
Workn/%n/%n/%
Student31/52 (59.7)6/14 (42.8)25/38 (65.8)
Employed13/52 (25.0)4/14(28.6)9/38 (23.7)
Craftsman/woman6/52 (11.5)3/14 (21.4)3/38 (7.9)
Freelancer2/52 (3.8)1/14 (7.2)1/38 (2.6)
Living Arean/%n/%n/%
Urban31/52 (59.7)7/14 (50.0)24/38 (63.2)
Suburban14/52 (26.9)4/14 (28.6)10/38(26.3)
Rural7/52 (13.4)3/14 (21.4)4/38 (10.5)
Table 3. Gender differences on psychological measures.
Table 3. Gender differences on psychological measures.
Total Sample
(N = 52)		Males
(N = 14)		Females
(N = 38)
INTEROCEPTION:Mean/SDMean/SDMean/SD
IAS total score84.7 ± 10.180.8 ± 10.486.2 ± 9.60.088
ICQ total score46.4 ± 9.347.6 ± 7.146.0 ± 10.00.578
ALEXITHYMIA:Mean/SDMean/SDMean/SD
TAS-20 total score55.8 ± 10.551.4 ± 10.257.4 ± 10.30.068
TAS-20 DDF13.5 ± 3.713.0 ± 3.113.7 ± 3.90.559
TAS-20 DIF16.7 ± 6.114.0 ± 5.317.7 ± 6.10.048
TAS-20 EOT25.5 ± 3.424.3 ± 3.725.9 ± 3.10.143
EMOTION REGULATIONMean/SDMean/SDMean/SD
DERS total score 83.6 ± 23.384.0 ± 22.783.4 ± 23.70.943
DERS non-acceptance13.8 ± 6.313.1 ± 6.514.1 ± 6.20.611
DERS Goal-directed behaviors14.6 ± 4.815.0 ± 5.414.5 ± 4.70.759
DERS Impulse control12.8 ± 5.714.2 ± 5.812.3 ± 5.70.304
DERS Emotional awareness13.8 ± 4.414.6 ± 4.813.6 ± 4.30.461
IAS: Interoceptive Accuracy Scale; ICQ: Interoceptive Confusion Questionnaire; TAS-20: Toronto Alexithymia Scale; DDF: Difficulty in Describing Feelings; DIF: Difficulty in Identifying Feelings; EOT: Externally Oriented Thinking; DERS: Difficulties in Emotion Regulation Scale. p-values refer to independent-samples t tests.
Table 4. Correlations between total scores of IAS, ICQ, TAS-20, DERS, and EAT-26.
Table 4. Correlations between total scores of IAS, ICQ, TAS-20, DERS, and EAT-26.
IAS Total ScoreICQ Total ScoreTAS-20 Total ScoreDERS Total ScoreEAT-26 ^ Total Score
IAS total score1−0.471 **−0.066−0.256−0.113
ICQ total score-10.562 **0.433 *0.332 *
TAS-20 total score--10.633 **0.367 **
DERS total score---10.412 **
EAT-26 total score----1
Pearson correlation: p < 0.05 (*), p < 0.01 (**), ^ Spearman correlation: p < 0.05 (*), p < 0.01 (**).
Table 5. Correlations between IAS, ICQ, TAS-20, DERS, and EAT-26 scores.
Table 5. Correlations between IAS, ICQ, TAS-20, DERS, and EAT-26 scores.
IAS Total ScoreICQ Total ScoreTAS-20 DDFTAS-20 DIFTAS-20 EOTDERS
Non Acceptance		DERS
Goal		DERS
Impulse		DERS Awareness^ EAT
Dieting		^ EAT
Bulimia		^ EAT
Oral Control
IAS total score1−0.471 **0.032−0.2570.221−0.004−0.232−0.227−0.166−0.069−0.128−0.137
ICQ total score-10.511 **0.586 **0.1350.1700.2670.411 **0.312 *0.292 *0.415 **0.201
TAS-20 DDF--10.570 **0.379 **0.294 *0.0930.1850.480 **0.2090.263−0.132
TAS-20 DIF---10.325 *0.397 **0.482 **0.601 **0.2460.387 **0.409 **0.177
TAS-20 EOT----10.2580.2460.133−0.0630.1950.1640.031
DERS non acceptance-----10.402 **0.497 **−0.1000.428 **0.289 **0.336 *
DERS goal------10.649 **−0.0600.309 *0.2210.248
DERS impulse-------1−0.0070.2010.2560.215
DERS awareness--------1−0.0270.082−0.098
EAT-26 dieting---------10.642 **0.225
EAT-26 bulimia----------10.187
Pearson correlation: p < 0.05 (*), p < 0.01 (**), ^ Spearman correlation: p < 0.05 (*), p < 0.01 (**).
Table 6. EAT-26 scores in subjects with vs. without alexithymia, according to the TAS-20 cut-off.
Table 6. EAT-26 scores in subjects with vs. without alexithymia, according to the TAS-20 cut-off.
TAS-20 ≤ 51
N = 17
Mean/SD		TAS-20 > 51
N = 35
Mean/SD		p
EAT-26 Total Score8.2 ± 6.212.8 ± 12.50.104
EAT-26 dieting3.8 ± 5.26.5 ± 7.20.043
EAT-26 bulimia3.1 ± 0.44.8 ± 3.30.017
EAT-26 oral control1.2 ± 2.21.4 ± 3.10.880
Table 7. IAS, ICQ, and DERS scores in subjects with vs. without alexithymia, according to the TAS-20 cut-off.
Table 7. IAS, ICQ, and DERS scores in subjects with vs. without alexithymia, according to the TAS-20 cut-off.
TAS-20 ≤ 51
N = 17
Mean/SD		TAS-20 > 51
N = 35
Mean/SD		p
IAS Total Score85.5 ± 10.084.1 ± 10.20.716
ICQ Total Score40.7 ± 8.449.2 ± 8.40.001
DERS Total Score69.2 ± 18.790.5 ± 22.20.001
DERS ‘non acceptance’11.5 ± 5.015.0 ± 6.60.066
DERS ‘goal’13.1 ± 5.115.3 ± 4.60.129
DERS ‘impulse’10.4 ± 4.714.0 ± 5.90.037
DERS ‘awareness’12.1 ± 3.814.7 ± 4.50.053
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Miniati, M.; Ciacchini, R.; Lazzarotti, L.; Orrù, G.; Papini, G.; Viti, A.; Palagini, L.; Presta, S.; Conversano, G.; Gemignani, A.; et al. Interoceptive Confusion and Alexithymia: Transdiagnostic Links to Eating Spectrum Symptoms in a Non-Clinical Young Adults’ Sample. Psychiatry Int. 2026, 7, 102. https://doi.org/10.3390/psychiatryint7030102

AMA Style

Miniati M, Ciacchini R, Lazzarotti L, Orrù G, Papini G, Viti A, Palagini L, Presta S, Conversano G, Gemignani A, et al. Interoceptive Confusion and Alexithymia: Transdiagnostic Links to Eating Spectrum Symptoms in a Non-Clinical Young Adults’ Sample. Psychiatry International. 2026; 7(3):102. https://doi.org/10.3390/psychiatryint7030102

Chicago/Turabian Style

Miniati, Mario, Rebecca Ciacchini, Laura Lazzarotti, Graziella Orrù, Giorgia Papini, Aleandra Viti, Laura Palagini, Silvio Presta, Giulia Conversano, Angelo Gemignani, and et al. 2026. "Interoceptive Confusion and Alexithymia: Transdiagnostic Links to Eating Spectrum Symptoms in a Non-Clinical Young Adults’ Sample" Psychiatry International 7, no. 3: 102. https://doi.org/10.3390/psychiatryint7030102

APA Style

Miniati, M., Ciacchini, R., Lazzarotti, L., Orrù, G., Papini, G., Viti, A., Palagini, L., Presta, S., Conversano, G., Gemignani, A., & Conversano, C. (2026). Interoceptive Confusion and Alexithymia: Transdiagnostic Links to Eating Spectrum Symptoms in a Non-Clinical Young Adults’ Sample. Psychiatry International, 7(3), 102. https://doi.org/10.3390/psychiatryint7030102

Article Metrics

Back to TopTop