This chapter explores the insula’s role in shaping body image through interoception – the neural process of sensing, interpreting, and integrating internal bodily signals to facilitate a coherent sense of self. Drawing on A.D. (Bud) Craig’s hierarchical model, which emphasizes the insula’s integration of sensory input into higher-order self-representations, we examine how disruptions in interoceptive processing may contribute to body image disturbance. This framework is applied to mental health conditions such as anorexia nervosa, body dysmorphic disorder, as well as physical health conditions including phantom limb pain and cancer, highlighting evidence for impaired interoceptive signaling and altered insular cortex function. We propose a mechanistic model describing how such disruptions can affect both sensory processing and the subjective experience of the body, leading to distorted body perception. We conclude with a discussion of future research directions and the potential for interoception-based therapeutic interventions targeting body image disturbance.