[en] Signals from the body’s interior undergo several interoceptive processing steps, from the periphery to the central nervous system, to conscious recognition and evaluation. Alterations in some of these steps have been reported for eating and weight disorders, but systematic comparisons between steps and disorders are necessary to develop targeted interventions. We recorded electrocardiogram and electroencephalogram from adult women with anorexia nervosa (AN; n = 38), bulimia nervosa (BN; n = 35), binge eating disorder (n = 22), obesity (OB; n = 20), and healthy control individuals (n = 46) during resting state and a heartbeat counting task. On the peripheral level, patients with AN, BN, and OB had reduced vagally-mediated heart-rate variability. On the central level, only patients with AN showed increased processing of heartbeats (heartbeat-evoked potentials). On the conscious level, there were no significant group differences in heartbeat-counting performance, beliefs, or insight, but a marked negative evaluation reported by patients with AN and BN. We conclude that fasting could serve to reduce negatively perceived (AN, BN) and increased (AN) bodily sensations. Overeating is not associated with marked alterations in cardiac interoception. The results do not support the notion of general interoceptive deficits, but rather disorder-specific interoceptive profiles.
LUTZ, Annika ; University of Luxembourg > Faculty of Humanities, Education and Social Sciences (FHSE) > Department of Behavioural and Cognitive Sciences (DBCS) > Health and Behaviour
Arend, Ann-Kathrin; Department of Psychology, Division of Clinical Psychology and Health Psychology, Paris-Lodron University Salzburg, Salzburg, Austria ; Centre for Cognitive Neuroscience, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
Voderholzer, Ulrich; Department of Psychiatry and Psychotherapy, University Hospital of the LMU Munich, Munich, Germany ; Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany ; Schön Klinik Roseneck, Prien am Chiemsee, Germany
VÖGELE, Claus ; University of Luxembourg > Faculty of Humanities, Education and Social Sciences (FHSE) > Department of Behavioural and Cognitive Sciences (DBCS) > Health and Behaviour
Blechert, Jens; Department of Psychology, Division of Clinical Psychology and Health Psychology, Paris-Lodron University Salzburg, Salzburg, Austria ; Centre for Cognitive Neuroscience, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
External co-authors :
yes
Language :
English
Title :
Interoceptive profiles of eating and weight disorders.
Bruch H Psychological aspects of overeating and obesity Psychosomatics 1964 5 269 274 14235740
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Publishing, 2013).
World Health Organization. International Classification of Diseases, Eleventh Revision (ICD-11). (2019). https://icd.who.int/browse11
Martin E Dourish CT Rotshtein P Spetter MS Higgs S Interoception and disordered eating: A systematic review Neurosci. Biobehav Rev. 2019 107 166 191 31454626
Khalsa SS et al. Interoception and mental health: A roadmap Biol. Psychiatry Cogn. Neurosci. Neuroimaging 2018 3 501 513 29884281
van Dyck Z et al. Gastric interoception and gastric myoelectrical activity in bulimia nervosa and binge-eating disorder Int. J. Eat. Disord 2021 54 1106 1115 32400920
Ortmann J et al. Development and initial validation of a self-report measure to assess eating disorder-specific interoceptive perception Psychol. Assess. 2024 36 162 174 37971821
Vögele C Lutz APC Gibson LE Agras WS Robinson A Mood, emotions and eating disorders The Oxford Handbook of Eating Disorders 2018 Oxford University Press 155 186
Füstös J Gramann K Herbert BM Pollatos O On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal Soc. Cogn. Affect. Neurosci. 2013 8 911 917 22933520
Meule A et al. Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa Eat. Disord 2021 29 175 191
Kaye WH Wierenga CE Bailer UF Simmons AN Bischoff-Grethe A Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa Trends Neurosci. 2013 36 110 120 23333342
Herbert BM Muth ER Pollatos O Herbert C Interoception across modalities: on the relationship between cardiac awareness and the sensitivity for gastric functions PLoS One 2012 7 e36646 2012PLoSO..736646H 10.1371/journal.pone.0036646 22606278 3350494
Boswell JF Anderson LM Anderson DA Integration of interoceptive exposure in eating disorder treatment Clin. Psychol. 2015 22 194 210
Schaefer M Egloff B Gerlach AL Witthöft M Improving heartbeat perception in patients with medically unexplained symptoms reduces symptom distress Biol. Psychol. 2014 101 69 76 25038304
Kristeller J Wolever RQ Sheets V Mindfulness-Based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial Mindfulness 2014 5 282 297
Suksasilp C Garfinkel SN Towards a comprehensive assessment of interoception in a multi-dimensional framework Biol. Psychol. 2022 168 108262 10.1016/j.biopsycho.2022.108262 35026353
Forkmann T et al. Making sense of what you sense: disentangling interoceptive awareness, sensibility and accuracy Int. J. Psychophysiol. 2016 109 71 80 27702644
Schandry R Bestler M Montoya P On the relation between cardiodynamics and heartbeat perception Psychophysiology 1993 30 467 474 8416073
Rominger C Weber B Aldrian A Berger L Schwerdtfeger AR Short-term fasting induced changes in HRV are associated with interoceptive accuracy: evidence from two independent within-subjects studies Physiol. Behav. 2021 241 113558 34411572
Strüven A Holzapfel C Stremmel C Brunner S Obesity, nutrition and heart rate variability Int. J. Mol. Sci. 2021 22 4215 10.3390/ijms22084215 33921697 8072942
Peschel SKV et al. A systematic review on heart rate variability in bulimia nervosa Neurosci. Biobehav Rev. 2016 63 78 97 26828568
Peyser D Scolnick B Hildebrandt T Taylor JA Heart rate variability as a biomarker for anorexia nervosa: A review Eur. Eat. Disord Rev. 2021 29 20 31 32975349
Vögele C Hilbert A Tuschen-Caffier B Dietary restriction, cardiac autonomic regulation and stress reactivity in bulimic women Physiol. Behav. 2009 98 229 234 19497332
Christensen KA Feeling NR Rienecke RD Meta-analysis and systematic review of resting-state high-frequency heart rate variability in binge-eating disorder J. Psychophysiol. 2023 37 50 63
Schandry, R., Sparrer, B. & Weitkunat, R. From the heart to the brain: Study of heartbeat contingent scalp potentials. Int. J. Neurosci.30, 261–275 (1986).
Park HD Blanke O Heartbeat-evoked cortical responses: underlying mechanisms, functional roles, and methodological considerations Neuroimage 2019 197 502 511 31051293
Schandry R Montoya P Event-related brain potentials and the processing of cardiac activity Biol. Psychol. 1996 42 75 85 8770371
Richter F et al. Behavioral and neurophysiological signatures of interoceptive enhancements following vagus nerve stimulation Hum. Brain Mapp. 2021 42 1227 1242 33325575
Schulz, A. et al. Short-term food deprivation increases amplitudes of heartbeat-evoked potentials. Psychophysiology52, 695-703 (2015).
Coll MP Hobson H Bird G Murphy J Systematic review and meta-analysis of the relationship between the heartbeat-evoked potential and interoception Neurosci. Biobehav Rev. 2021 122 190 200 33450331
Lutz APC et al. Enhanced cortical processing of cardio-afferent signals in anorexia nervosa Clin. Neurophysiol. 2019 130 1620 1627 31323488
Lutz APC van Dyck Z Schulz A Vögele C Interoception in bulimia nervosa: evidence at cortical and self-report levels Psychophysiology 2019 56 S117
Cambi S Solcà M Micali N Berchio C Cardiac interoception in anorexia nervosa: A resting-state heartbeat-evoked potential study Eur. Eat. Disord Rev. 2024 32 417 430 38009624
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 31270764 6797703
Robinson E Foote G Smith J Higgs S Jones A Interoception and obesity: a systematic review and meta-analysis of the relationship between interoception and BMI Int. J. Obes. 2021 45 2515 2526
Pollatos O et al. Reduced perception of bodily signals in anorexia nervosa Eat. Behav. 2008 9 381 388 18928900
Klabunde M Acheson DT Boutelle KN Matthews SC Kaye WH Interoceptive sensitivity deficits in women recovered from bulimia nervosa Eat. Behav. 2013 14 488 492 24183142
Kinnaird, E., Stewart, C. Tchanturia, K. Interoception in anorexia nervosa: exploring associations with alexithymia and autistic traits. Front Psychiatry 11, 64. https://doi.org/10.3389/fpsyt.2020.00064 (2020).
Herbert BM et al. Effects of short-term food deprivation on interoceptive awareness, feelings and autonomic cardiac activity Biol. Psychol. 2012 89 71 79 21958594
Richard A et al. Associations between interoceptive sensitivity, intuitive eating, and body mass index in patients with anorexia nervosa and normal-weight controls Eur. Eat. Disord Rev. 2019 27 571 577 30968474 6767487
Wittchen, H. U., Zaudig, M. Fydrich, T. Strukturiertes Klinisches Interview für DSM-IV (SKID-I Und SKID-II) (Hogrefe, 1997).
Hilbert, A. & Tuschen-Caffier, B. Eating Disorder Examination - Deutschsprachige Übersetzung (Verlag für Psychotherapie, 2006).
Laux, L., Glanzmann, P., Schaffner, P. Spielberger, C. D. STAI - Das State-Trait-Angstinventar - Manual (Beltz Testgesellschaft, 1981).
Grunert SC Ein inventar Zur erfassung von Selbstaussagen zum Ernährungsverhalten Diagnostica 1989 35 167 179
Schandry R Heart beat perception and emotional experience Psychophysiology 1981 18 483 488 7267933
Cohen P Cohen J Aiken LS West SG The problem of units and the circumstance for POMP Multivar. Behav. Res. 1999 34 315 346
Weineck F Messner M Hauke G Pollatos O Improving interoceptive ability through the practice of power posing: A pilot study PLoS One 2019 14 e0211453 10.1371/journal.pone.0211453 30730938 6366763
Bradley MM Lang PJ Measuring emotion: the Self-Assessment manikin and the semantic differential J. Behav. Ther. Exp. Psychiatry 1994 25 49 59 7962581
Blechert J Peyk P Liedlgruber M Wilhelm FH ANSLAB Integrated multichannel peripheral biosignal processing in Psychophysiological science Behav. Res. Methods 2016 48 1528 1545 26511369
Gray, M. A. et al. A cortical potential reflecting cardiac function. Proc. Natl. Acad. Sci. U. S. A. 104, 6818–6823 (2007).
Luck, S. J. An Introduction To the Event-Related Potential Technique (MIT Press, 2014).
Kerr KL et al. Altered Insula activity during visceral interoception in weight-restored patients with anorexia nervosa Neuropsychopharmacology 2016 41 521 528 26084229
Pollatos O Kirsch W Schandry R Brain structures involved in interoceptive awareness and cardioafferent signal processing: A dipole source localization study Hum. Brain Mapp. 2005 26 54 64 15852466 6871699
Oberndorfer T et al. Greater anterior Insula activation during anticipation of food images in women recovered from anorexia nervosa versus controls Psychiatry Res. 2013 214 132 141 23993362
Strigo IA et al. Altered Insula activation during pain anticipation in individuals recovered from anorexia nervosa: evidence of interoceptive dysregulation Int. J. Eat. Disord 2013 46 23 33 22836447
Khalsa SS et al. Altered interoceptive awareness in anorexia nervosa: effects of meal anticipation, consumption and bodily arousal Int. J. Eat. Disord 2015 48 889 897 25712775 4898968
Bell K Coulthard H Wildbur D Self-disgust within eating disordered groups: associations with anxiety, disgust sensitivity and sensory processing Eur. Eat. Disord Rev. 2017 25 373 380 28635077
Zucker NL et al. Subjective experience of sensation in anorexia nervosa Behav. Res. Ther. 2013 51 256 265 23523866 3955712
Brown TA et al. Validating the visceral sensitivity index in an eating disorder sample Int. J. Eat. Disord 2021 54 986 994 33448442
Cheng YC Su MI Liu CW Huang YC Huang WL Heart rate variability in patients with anxiety disorders: A systematic review and meta-analysis Psychiatry Clin. Neurosci. 2022 76 292 302 35340102
Koch C Wilhelm M Salzmann S Rief W Euteneuer F A meta-analysis of heart rate variability in major depression Psychol. Med. 2019 49 1948 1957 31239003
Khalsa SS et al. Interoceptive anxiety and body representation in anorexia nervosa Front. Psychiatry 2018 9 444 10.3389/fpsyt.2018.00444 30298026 6160545
Brown TA et al. Psychometric evaluation and norms for the multidimensional assessment of interoceptive awareness (MAIA) in a clinical eating disorders sample Eur. Eat. Disord Rev. 2017 25 411 416 28714581
Pitts S et al. Assessment of the heartbeat evoked potential as a neurofeedback parameter in interoceptive-attention tasks Biol. Psychiatry 2023 93 S97
Merwin RM Zucker NL Lacy JL Elliott CA Interoceptive awareness in eating disorders: distinguishing lack of clarity from non-acceptance of internal experience Cogn. Emot. 2010 24 892 902
Eggart M Lange A Binser MJ Queri S Müller-Oerlinghausen, B. Major depressive disorder is associated with impaired interoceptive accuracy: A systematic review Brain Sci. 2019 9 131 10.3390/brainsci9060131 31174264 6627769
Desmedt O et al. Do Schulz et al.’s (2021) findings support the validity of the heartbeat counting task? Joint conclusion to commentaries Biol. Psychol. 2023 184 108694 10.1016/j.biopsycho.2023.108694 37775032
Whitehead WE Drescher VM Heiman P Blackwell B Relation of heart rate control to heartbeat perception Biofeedback Self Regul. 1977 2 371 392
