Altered Insula Activity during Visceral Interoception in Weight-Restored Patients with Anorexia Nervosa
Open accessAbstract
Anorexia nervosa (AN) is a devastating psychiatric illness that is associated with significant morbidity and mortality. Aberrant visceral interoceptive processing within the insula has been hypothesized to be an important mechanism in AN's pathophysiology due to the theoretical link between interoception and emotional experience. We therefore utilized functional magnetic resonance imaging (fMRI) to examine whether altered insula functioning underlies visceral interoception in AN. Fifteen females with restricting-type AN and 15 healthy control females underwent fMRI while performing an interoceptive attention task during which they focused on sensations in their heart, stomach, and bladder. Participants also performed an anxious rumination task while in the scanner. AN participants were weight-restored and free of psychotropic medications. Two distinct regions of the insula-anterior insula and dorsal mid-insula-exhibited a significant (p<0.05) interaction between group and interoceptive modality. The post hoc analyses revealed that in the dorsal mid-insula the interaction was driven by group differences during stomach interoception (p=0.002, Bonferroni corrected), whereas in the anterior insula the interaction was driven by group differences during heart interoception (p=0.03, Bonferroni corrected). In addition, individuals with AN displayed increased activation during anxious rumination in the dorsal mid-insula, and activation in this region during stomach interoception was correlated with measures of anxiety and psychopathology. This relationship between altered visceral interoception and clinical symptoms in AN suggests an important mechanism for the disorder. Additional research is needed to examine whether interventions targeting visceral interoception may increase the efficacy of treatments for AN.
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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 [99]
The Introduction and Discussion link altered interoception in anorexia nervosa with eating-disorder symptoms and anxiety. They do not establish the broader claim for mood, addictive, or somatic symptom disorders; a depressive-disorder study appears in the References, but is not discussed as part of that claim. Page numbers were not supplied in our copy. (LLM, conf=0.88)
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 [99]
The Introduction describes abnormal responses to bodily signals in anorexia nervosa, and the Discussion reports altered insula activity during stomach interoception. But the study examined attention to stomach, heart, and bladder sensations—not caloric anticipation. Its findings also concern anorexia nervosa rather than eating disorders generally (Discussion and Task; page numbers unavailable in our copy). (LLM, conf=0.86)
Experimental — accuracy not yet measuredAlexithymia and differences in conveying emotion in AN may be interlaced with atypical interoception and trauma survival, as well as autism-trauma intersections.
“Alexithymia and differences in conveying emotion in AN may also be interlaced with atypical interoception [96–99] and trauma survival, as well as autism-trauma intersections [100–104].”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [97]
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- Authors
- Kerr, K. L., Moseman, S. E., Avery, J. A., Bodurka, J., Zucker, N. L., & Simmons, W. K.
- Affiliations
- Laureate Institute for Brain Research (US)
- Laureate Psychiatric Clinic and Hospital (US)
- Duke University (US)
- Corresponding author
- Simmons, W Kyle
- Venue
- Neuropsychopharmacology
- Published
- 2015-06-18
- Volume
- 41
- Issue
- 2
- Pages
- 521-528
- ISSN
- 0893-133X (ISSN-L)
- 1740-634X
- PMC
- PMC5130127
- OpenAlex
- W1598274867
- Cited by
- 159
- References
- 50
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 21 · 2023: 16 · 2022: 16 · 2021: 14 · 2020: 13 · 2019: 15 · 2018: 11 · 2017: 16 · 2016: 7
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Neuropsychopharmacology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (RC1MH088678, K01MH096175)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- anorexia nervosa, insula, anterior insula, interoceptive attention, anxiety, psychopathology, weight restoration
- MeSH terms
- Adolescent, Anorexia Nervosa, Attention, Brain Mapping, Cerebral Cortex, Female, Humans, Magnetic Resonance Imaging, Neuropsychological Tests, Proprioception, Body Mass Index, Young Adult
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