An interoceptive model of bulimia nervosa: A neurobiological systematic review

Abstract

The objective of our study was to examine the neurobiological support for an interoceptive sensory processing model of bulimia nervosa (BN). To do so, we conducted a systematic review of interoceptive sensory processing in BN, using the PRISMA guidelines. We searched PsychInfo, Pubmed, and Web of Knowledge databases to identify biological and behavioral studies that examine interoceptive detection in BN. After screening 390 articles for inclusion and conducting a quality assessment of articles that met inclusion criteria, we reviewed 41 articles. We found that global interoceptive sensory processing deficits may be present in BN. Specifically there is evidence of abnormal brain function, structure and connectivity in the interoceptive neural network, in addition to gastric and pain processing disturbances. These results suggest that there may be a neurobiological basis for global interoceptive sensory processing deficits in BN that remain after recovery. Data from taste and heart beat detection studies were inconclusive, yet some studies suggest interoceptive disturbances in these sensory domains. Discrepancies in findings appear to be due to methodological differences. In conclusion, interoceptive sensory processing deficits may directly contribute to and explain a variety of symptoms present in those with BN. Further examination of interoceptive sensory deficits could inform the development of treatments for those with BN.

Altered Processing and Integration of Multisensory Bodily Representations and Signals in Eating Disorders: A Possible Path Toward the Understanding of Their Underlying Causes

“…As reported by various authors, individuals with EDs have emotional (Bydlowski et al, 2005 ; Lavender et al, 2015 ), visual (Engel and Keizer, 2017 ; Feusner et al, 2017 ), tactile (Keizer et al, 2011 ; Gaudio et al, 2014 ), proprioceptive (Case et al, 2012 ; Guardia et al, 2012 ) and interoceptive deficits (Badoud and Tsakiris, 2017 ; Klabunde et al, 2017 ).…”

Getting to the heart of the matter: Does aberrant interoceptive processing contribute towards emotional eating?

“…For example, those with anorexia have been shown to have reduced heartbeat perception [ 11 ], yet there is higher gastric satiation [ 52 ] and a heightened neural response during an aversive breathing load [ 53 ]. In those with bulimia, barostat studies show significantly decreased stomach sensitivity to fullness [ 54 ], two out of three studies report no heartbeat perception deficits [ 54 ], while neural activity is increased in anticipation of an aversive breathing load [ 55 ]. As clinical eating disorders are heterogeneous, our aim was to study specific eating behaviour traits in an attempt to shed light on these inconsistencies.…”

An Active Inference Approach to Interoceptive Psychopathology

“…Similarly, several studies have been conducted with eating disorder subjects (Jenkinson et al 2018) and reviewed sensory processing deficits in bulimia (Klabunde et al 2017), general interoceptive appraisal dysfunctions (Brown et al 2017), and reduced interoceptive accuracy (Kunstman et al 2016). Interoceptive dysfunctions of various kinds have also been found in individuals with obsessive compulsive disorder (Yoris et al 2017), borderline personality disorder (Loffler et al 2018), and female sexual arousal disorder (Handy & Meston 2018).…”