Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory

This document is the Accepted Manuscript version of the following article: Paul M. Jenkinson, Lauren Taylor, Keith R. Laws, ‘Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory’, Journal of Psychosomatic Research, Vol. 110: 38-45, July 2018, under embargo until 19 April 2019. The Version of Record is available online at DOI: https://doi.org/10.1016/j.jpsychores.2018.04.005Objective: An impairment of the ability to sense the physiological condition of the body – interoception – has long been proposed as central to the onset and maintenance of eating disorders. More recent attention to this topic has generally indicated the presence of interoceptive deficits in individuals with an eating disorder diagnosis; however, possible links with specific diagnosis, BMI, age, illness duration, depression, and alexithymia remain unclear from individual studies. This meta-analysis aimed to provide a necessary quantitative overview of self-reported interoceptive deficits in eating disorder populations, and the relationship between these deficits and the previously mentioned factors. Methods: Using a random effects model, our meta-analysis assessed the magnitude of differences in interoceptive abilities as measured using the Eating Disorder Inventory in 41 samples comparing people with eating disorders (n=4308) and healthy controls (n=3459). Follow-up and moderator analysis was conducted, using group comparisons and meta-regressions. Results: We report a large pooled effect size of 1.62 for eating disorders with some variation between diagnostic groups. Further moderator analysis showed that BMI, age and alexithymia were significant predictors of overall effect size. Conclusion: This meta-analysis is the first to confirm that large interoceptive deficits occur in a variety of eating disorders and crucially, in those who have recovered. These deficits may be useful in identifying and distinguishing eating disorders. Future research needs to consider both objective and subjective measures of interoception across different types of eating disorders and may fruitfully examine interoception as a possible endophenotype and target for treatment.Peer reviewe

Interoceptive Ingredients of Body Ownership: Affective Touch and Cardiac Awareness in the Rubber Hand Illusion

This document is the Accepted Manuscript version of the following article: Laura Crucianelli, Charlotte Krahe, Paul M. Jenkinson, Aikaterini (Katerina) Fotopoulou, 'Interoceptive Ingredients of Body Ownership: Affective Touch and Cardiac Awareness in the Rubber Hand Illusion', Cortex, first published online 1 May 2017, available at doi: https://doi.org/10.1016/j.cortex.2017.04.018. © 2017 Elsevier Ltd. All rights reserved.The sense of body ownership represents a fundamental aspect of bodily self-consciousness. Using multisensory integration paradigms, recent studies have shown that both exteroceptive and interoceptive information contribute to our sense of body ownership. Interoception refers to the physiological sense of the condition of the body, including afferent signals that originate inside the body and outside the body. However, it remains unclear whether individual sensitivity to interoceptive modalities is unitary or differs between modalities. It is also unclear whether the effect of interoceptive information on body ownership is caused by exteroceptive ‘visual capture’ of these modalities, or by bottom-up processing of interoceptive information. This study aimed to test these questions in two separate samples. In the first experiment (N = 76), we examined the relationship between two different interoceptive modalities, namely cardiac awareness based on a heartbeat counting task, and affective touch perception based on stimulation of a specialized C tactile (CT) afferent system. This is an interoceptive modality of affective and social significance. In a second experiment (N = 63), we explored whether ‘off-line’ trait interoceptive sensitivity based on a heartbeat counting task would modulate the extent to which CT affective touch influences the multisensory process during the rubber hand illusion (RHI). We found that affective touch enhanced the subjective experience of body ownership during the RHI. Nevertheless, interoceptive sensitivity, as measured by a heartbeat counting task, did not modulate this effect, nor did it relate to the perception of ownership or of CT-optimal affective touch more generally. By contrast, this trait measure of interoceptive sensitivity appeared most relevant when the multisensory context of interoception was ambiguous, suggesting that the perception of interoceptive signals and their effects on body ownership may depend on individual abilities to regulate the balance of interoception and exteroception in given contexts.Peer reviewedFinal Accepted Versio

Investigating the relationship between interoceptive accuracy, interoceptive awareness, and emotional susceptibility

Interoception, the sense of the physiological condition of the body, provides a basis for subjective feelings and emotions. Anterior insular cortex activity represents the state of the body and varies according to personality traits, such as emotional susceptibility (ES)-the tendency to experience feelings of discomfort and vulnerability when facing emotionally-laden stimuli. The accuracy of perceiving one's own bodily signals, or interoceptive accuracy (IAc), can be assessed with the heartbeat perception task (HPT), which is the experimental measure used by most of the existing research on interoception. However, IAc is only one facet of interoception. Interoceptive awareness (IAw) is the conscious perception of sensations from inside the body, such as heart beat, respiration, satiety, and the autonomic nervous system sensations related to emotions, which create the sense of the physiological condition of the body. We developed an Italian version of the recent self-report Multidimensional Assessment of Interoceptive Awareness (MAIA), tested its psychometric properties (reliability, dimensionality, and construct validity), and examined its relationship to ES, as assessed using the Emotional Susceptibility Scale, in a sample (n = 321) of healthy Italian psychology students (293 females, mean age: 20.5 years). In a subgroup of females (n = 135), we measured IAc with the HPT. We used a series of correlation/regression analyses to examine the complex interplay between the three constructs. We provide further evidence for a substantial independence of the IAc and IAw measures, confirming previous reports and current theoretical models that differentiate between IAc and IAw. Our analyses elucidate the complex relationship between distinct dimensions of IAw and ES, highlighting the need for continued efforts to shed more light on this topic

Abstract concepts, language and sociality. From acquisition to inner speech

The problem of representation of abstract concepts, such as “freedom” and “justice”, has become particularly crucial in recent years, due to the increased success of embodied and grounded views of cognition. We will present a novel view on abstract concepts and abstract words. Since abstract concepts do not have single objects as referents, children and adults might rely more on input from others in learning them; we therefore suggest that linguistic and social experience play an important role for abstract concepts. We will discuss evidence obtained in our and other labs showing that processing of abstract concepts evokes linguistic interaction and social experiences, leading to the activation of the mouth motor system. We will discuss the possible mechanisms that underlie this activation. Mouth activation can be due to re-enactment of the experience of conceptual acquisition, which occurred through the mediation of language. Alternatively, it could be due to the re-explanation of the word meaning, possibly through inner speech. Finally, it can be due to a metacognitive process revealing low confidence on the meaning of our concepts. This process induces in us the need to rely on others to ask/negotiate conceptual meaning. We conclude that with abstract concepts words work as social tools: they extend our thinking abilities and push us to rely on others to integrate our knowledge

Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility

Objective: Anxiety is associated with increased physiological reactivity and also increased “interoceptive” sensitivity to such changes in internal bodily arousal. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders. This study explored the link between anxiety, interoceptive sensitivity and hypermobility in a sub-clinical population using neuroimaging and psychophysiological evaluation. Methods: Thirty-six healthy volunteers undertook interoceptive sensitivity tests, a clinical examination for hypermobility and completed validated questionnaire measures of state anxiety and body awareness tendency. Nineteen participants also performed an emotional processing paradigm during functional neuroimaging. Results: We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex. Conclusions: Our findings highlight the dependence of anxiety state on bodily context, and increase our understanding of the mechanisms through which vulnerability to anxiety disorders arises in people bearing a common variant of collagen

Neural hypersensitivity to pleasant touch in women remitted from anorexia nervosa.

Interoception, or the sensing and integration of bodily state signals, has been implicated in anorexia nervosa (AN), given that the hallmark symptoms involve food restriction and body image disturbance. Here we focus on brain response to the anticipation and experience of affective interoceptive stimuli. Women remitted from AN (RAN; N = 18) and healthy comparison women (CW; N = 26) underwent a pleasant affective touch paradigm consisting of gentle strokes with a soft brush administered to the forearm or palm during functional neuroimaging. RAN had a lower brain response relative to CW during anticipation of touch, but a greater response when experiencing touch in the right ventral mid-insula. In RAN, this reduced anticipatory response was associated with higher levels of harm avoidance. Exploratory analyses in RAN also suggested that lower response during touch anticipation was associated with greater body dissatisfaction and higher perceived touch intensity ratings. This reduced responsivity to the anticipation of pleasant affective interoceptive stimuli in association with higher harm avoidance, along with an elevated response to the experience of touch, suggests an impaired ability in AN to predict and interpret incoming physiological stimuli. Impaired interoception may thus impact one's sense of self, thereby supporting observations of disturbed body image and avoidance of affective and social stimuli. Therapeutic approaches that help AN to better anticipate and interpret salient affective stimuli or improve tolerance of interoceptive experiences may be an important addition to current interventions

An interoceptive predictive coding model of conscious presence

We describe a theoretical model of the neurocognitive mechanisms underlying conscious presence and its disturbances. The model is based on interoceptive prediction error and is informed by predictive models of agency, general models of hierarchical predictive coding and dopaminergic signaling in cortex, the role of the anterior insular cortex (AIC) in interoception and emotion, and cognitive neuroscience evidence from studies of virtual reality and of psychiatric disorders of presence, specifically depersonalization/derealization disorder. The model associates presence with successful suppression by top-down predictions of informative interoceptive signals evoked by autonomic control signals and, indirectly, by visceral responses to afferent sensory signals. The model connects presence to agency by allowing that predicted interoceptive signals will depend on whether afferent sensory signals are determined, by a parallel predictive-coding mechanism, to be self-generated or externally caused. Anatomically, we identify the AIC as the likely locus of key neural comparator mechanisms. Our model integrates a broad range of previously disparate evidence, makes predictions for conjoint manipulations of agency and presence, offers a new view of emotion as interoceptive inference, and represents a step toward a mechanistic account of a fundamental phenomenological property of consciousness

Evolution as Connecting First-Person and Third-Person Perspectives of Consciousness

First-person and third-person perspectives are different items of human consciousness.\ud Feeling the taste of a fruit or being consciously part of a group eating fruits call for different perspectives of\ud consciousness. The latter is about objective reality (third-person data). The former is about subjective\ud experience (first-person data) and cannot be described entirely by objective reality.\ud We propose to look at how these two perspectives could be rooted in an evolutionary origin of human\ud consciousness, and somehow be connected.\ud Our starting point is a scenario describing how evolution could have transformed a non self-conscious\ud auto-representation into a conscious self-representation (Menant 2006). The scenario is based on the\ud performance of inter-subjectivity existing among non human primates (Gardenfors 2006). A key item of the\ud scenario is the identification of the auto-representation of a subject with the representations that the subject\ud has of her conspecifics, the latter feeding the former with the meaning: “existing in the environment”.\ud So during evolution, pre-human primates were brought to perceive their auto-representation as existing in\ud the environment. Such process could have generated the initial elements of a conscious self-representation.\ud We take this scenario as providing a possible rooting of human consciousness in evolution.\ud We develop here a part of this scenario by expliciting the inward and outward components of the non\ud self-conscious auto-representation.\ud Inward components are about proprioception and interoception (thirst, pain, …). Outward components cover\ud the sensory information relative to the perception of the body (seen feet, … ) and of its effects on the\ud environment.\ud We consider that the initial elements of a conscious self-representation have been applied to both inward and\ud outward components of the auto-representation. We propose that the application to inward components made\ud possible some first-person information, and that the application to outward components brought up third-person\ud information. Relations between the two perspectives are highlighted.\ud Such approach can root first-person and third-person perspectives in the same slot of human evolution.\ud We conclude by a summary of the above and introduce a possible application of this approach to the concepts\ud of bodily self and of pre-reflexive self-consciousness (Legrand, 2006)

Interoceptive inference, emotion, and the embodied self

The concept of the brain as a prediction machine has enjoyed a resurgence in the context of the Bayesian brain and predictive coding approaches within cognitive science. To date, this perspective has been applied primarily to exteroceptive perception (e.g., vision, audition), and action. Here, I describe a predictive, inferential perspective on interoception: ‘interoceptive inference’ conceives of subjective feeling states (emotions) as arising from actively-inferred generative (predictive) models of the causes of interoceptive afferents. The model generalizes ‘appraisal’ theories that view emotions as emerging from cognitive evaluations of physiological changes, and it sheds new light on the neurocognitive mechanisms that underlie the experience of body ownership and conscious selfhood in health and in neuropsychiatric illness

A game based approach to improve traders' decision-making

Purpose: The development of a game based approach to improving the decision-making capabilities of financial traders through attention to improving the regulation of emotions during trading. Design/methodology/approach: The project used a design-based research approach to integrate the contributions of a highly inter-disciplinary team. The approach was underpinned by considerable stakeholder engagement to understand the ‘ecology of practices’ in which this learning approach should be embedded. Findings: Taken together, our 35 laboratory, field and evaluation studies provide much support for the validity of our game based learning approach, the learning elements which make it up, and the value of designing game-based learning to fit within an ecology of existing practices. Originality/value: The novelty of the work described in the paper comes from the focus in this research project of combining knowledge and skills from multiple disciplines informed by a deep understanding of the context of application to achieve the successful development of a Learning Pathway, which addresses the transfer of learning to the practice environment Key words: Design-based research, emotion-regulation, disposition–effect, financial traders, serious games, sensor-based game