Enhanced Cortical Processing of Cardio-Afferent Signals in Anorexia Nervosa

Objective: To assess cardiac interoception in anorexia nervosa (AN) using a multidimensional
approach. Methods: We assessed the physiological dimensions of cardioception, i.e. the peripheral signal itself (heart rate, HR, and heart rate variability, HRV) and its cortical representation (heartbeat
evoked potentials, HEPs), and the psychological dimensions of interoceptive accuracy (heartbeat
perception) and interoceptive sensibility (confidence ratings). Electroencephalogram (EEG) and
electrocardiogram (ECG) were recorded concurrently during rest and while performing a heartbeat perception task in a sample of 19 female in-patients with AN (DSM-5) and 19 healthy control women (HC).
Results: HEPs, defined as mean EEG amplitude in a time window of 455-595 ms after the Rpeak
of the ECG, were significantly larger in the AN than in the HC group across conditions (p =
.002, d = 1.06). There was a trend toward better heartbeat perception in AN, but no group
differences in HR, HRV, and confidence ratings.
Conclusions: Individuals with AN showed an interoceptive profile of heightened cortical
processing, a trend toward heightened interoceptive accuracy, and unaltered cardiac autonomic
activation and interoceptive sensibility.
Significance: In terms of neurobiological models of AN, enhanced cortical representations of
interoceptive signals might reflect a mechanism, which promotes fasting by alleviating negative
body states.