Altered interoceptive awareness in anorexia nervosa: Effects of meal anticipation, consumption and bodily arousal
Open accessAbstract
OBJECTIVE: Impaired interoceptive awareness (IA), the subjective perception of internal body sensations, has been proposed as a vulnerability or maintaining factor in anorexia nervosa (AN). We examined whether IA of heartbeat and breathing sensations was impaired in AN across a range of arousal levels, and whether it was influenced by meal anticipation and consumption. METHOD: IA was assessed using randomized, double-blinded, bolus intravenous infusions of isoproterenol, a peripheral beta-adrenergic sympathetic agonist, and saline. Fifteen women with AN and 15 age-, and sex- matched healthy comparisons (HC) were evaluated before and after consumption of a 1,000 Calorie meal. During each infusion participants rated their moment-to-moment intensity of heartbeat and breathing sensations with a dial. To measure IA we evaluated interoceptive detection thresholds, retrospective ratings of palpitation and dyspnea intensity, and interoceptive accuracy via correlations between subjective dial ratings and observed heart rate responses. RESULTS: Contrary to prediction the AN group was more likely to report detection of interoceptive sensations across all conditions, an effect driven by false discriminations at low arousal levels. Concordant with prediction, meal anticipation was associated with intensified interoceptive sensations, particularly dyspnea. There were no differences in interoceptive accuracy. DISCUSSION: This represents the first demonstration of interoceptive prediction errors in AN. Although IA is unimpaired at high arousal levels in AN, prediction signals are abnormal at low arousal levels, especially during meal anticipation. Altered interoceptive prediction signaling during meal anticipation could contribute to phenotypes of high anxiety in AN or alternatively, might be explained by enhanced meal associated anxiety.
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Dysfunction of interoception is increasingly recognized as an important component of anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders.
“Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders.”
From Interoception and Mental Health: A Roadmap. (2018) · cites this paper as [72]
The Introduction (page not supplied) describes impaired interoceptive awareness as a possible vulnerability or maintaining factor in anorexia nervosa and says it is broadly recognized as clinically relevant there. The Limitations section (page not supplied) discusses anxiety and depression but calls their effects on interoceptive accuracy conflicting. Our copy does not extend the claim to addictive or somatic symptom disorders. (LLM, conf=0.85)
Experimental — accuracy not yet measuredInteroceptive perception is strongly shaped by expectations.
“This view is supported by findings that interoceptive perception is strongly shaped by expectations (41,72,92,93) and by theoretical arguments that suggest Bayesian inference as a unifying principle for interoception and exteroception (37,91).”
From Interoception and Mental Health: A Roadmap. (2018) · cites this paper as [72]
The Discussion reports that people with anorexia nervosa had difficulty separating actual interoceptive sensations from anticipated ones, particularly at low bodily arousal. This supports an effect of expectations in that population and condition, but not the unqualified claim that interoceptive perception is strongly shaped by expectations in general. Page numbers were not provided for these passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEating disorders show behavioral and neural abnormalities in interoceptive processing, particularly in the context of caloric anticipation.
“Eating disorders show behavioral and neural abnormalities in interoceptive processing, particularly in the context of caloric anticipation (72,98–100), although it remains unclear whether this is due to altered afferent signaling, altered central sensory processing, abnormal temperament, and/or metacognition.”
From Interoception and Mental Health: A Roadmap. (2018) · cites this paper as [72]
The Abstract Results report altered interoceptive reports during meal anticipation in anorexia nervosa, and the Introduction describes prior neuroimaging findings of altered anticipatory responses. The evidence concerns anorexia nervosa specifically, not eating disorders generally; this study also did not itself measure neural responses. (LLM, conf=0.84)
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Interoception and Mental Health
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Self-citation
- Authors
- Khalsa, S. S., Craske, M. G., Li, W., Vangala, S., Strober, M., & Feusner, J. D.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Khalsa, Sahib S.
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2015-02-24
- Volume
- 48
- Issue
- 7
- Pages
- 889-897
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC4898968
- OpenAlex
- W2119880453
- Cited by
- 191
- References
- 42
- Citations by year
- 2026: 15 · 2025: 24 · 2024: 22 · 2023: 18 · 2022: 18 · 2021: 24 · 2020: 27 · 2019: 12 · 2018: 7 · 2017: 15 · 2016: 8 · 2015: 1
- FWCI
- 12.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (3R01MH093535- 02S2)
- National Center for Advancing Translational Sciences (UL1TR000124)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- anorexia nervosa, interoceptive awareness, meal ingestion, heartbeat perception, dyspnea, palpitations, isoproterenol infusion, interoceptive accuracy, anxiety
- MeSH terms
- Anorexia Nervosa, Arousal, Awareness, Female, Humans, Perception, Retrospective Studies, Young Adult
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