Alexithymia mediates the relationship between interoceptive sensibility and anxiety

Abstract

A number of empirical and theoretical reports link altered interoceptive processing to anxiety. However, the mechanistic understanding of the relationship between the two remains poor. We propose that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, increases an individual’s vulnerability to anxiety. In order to investigate this, a large sample of general population adults were recruited and completed self-report measures of interoceptive sensibility, trait anxiety and alexithymia. Results confirmed that the positive association between interoceptive sensibility and trait anxiety was partially mediated by alexithymia, such that those most at risk for clinically significant levels of trait anxiety have both significantly higher levels of interoceptive sensibility and alexithymia. A subsequent factor analysis confirmed the independence of the three measures. Altered interoceptive processing in combination with alexithymia, increased the risk for anxiety above and beyond altered interoceptive processing alone. We suggest that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, leaves these sensations vulnerable to catastrophizing interpretation. Interventions that target the attribution of bodily sensations may prove valuable in reducing anxiety.

Dynamic system perspectives on anxiety and depression

“…Adolescents learn to construct and differentiate increasingly fine-tuned feelings as specific emotion categories to summarize experiences more efficiently and precisely, thus increasing emotional granularity or "emotional intelligence" (see Table 7.2; Barrett, 2018;Erbas et al, 2014;Nook et al, 2018;Russell, 1990). Adolescents with heightened interoception and low emotional clarity (i.e., difficulties in attributing these inner sensations to specific emotions) or low granularity (i.e., little emotion differentiation) more often feel unhappy, report social problems, and develop anxiety and depression disorders (Barrett, 2018;Demiralp et al, 2012;Erbas et al, 2014;Kashdan & Farmer, 2014;Mathews et al, 2016;Palser et al, 2018;Sendzik et al, 2017). Being able to put a feeling into words (such as sad or afraid) can already decrease the subjective intensity of the experience (Lieberman et al, 2011).…”

Atypical bodily self-awareness in vicarious pain responders

“…Alexithymia has also been associated with high anxiety [60], adding further complication to current understanding, since alexithymia is typically associated with poor interoceptive accuracy ( [37,38]; see above). Regarding the inter-relation between the three constructs, Palser and colleagues [61] suggest that the relation between interoceptive sensibility and anxiety may be mediated by alexithymia. This provides a partial explanation for previous inconsistencies, where increased interoceptive sensibility may only result in greater anxiety where there is also alexithymia, which may lead to a difficulty connecting bodily sensations to emotional states.…”

Dissociation in How Core Autism Features Relate to Interoceptive Dimensions: Evidence from Cardiac Awareness in Children

“…Inflated confidence in interoceptive judgements on the heartbeat discrimination task was associated with greater SA severity. Heightened interoceptive sensibility has previously been linked to alexithymia, a difficulty with reasoning about one's own affective state (Mul et al 2018), and anxiety (Palser et al 2018b). Previously, a combination of high confidence in interoceptive ability and poor performance has been observed in autistic participants (Garfinkel et al 2016;Palser et al 2018a).…”

“…When more mindfulness-related measures of interoceptive sensibility are used, with a focus on the effective interpretation of interoceptive signals, interoceptive sensibility has been shown to be negatively correlated with alexithymia (Mul et al 2018). Other measures of interoceptive sensibility that tap a more vigilant, anxiety-associated style have a positive relationship with alexithymia (Longarzo et al 2015;Palser et al 2018b), although this has yet to be replicated in an autistic population. It is possible that interoceptive differences vary according to the extent of autistic individuals' socio-emotional difficulties.…”