Anorexia nervosa as a disorder of the subcortical–cortical interoceptive-self

Abstract

Purpose Anorexia nervosa (AN) is characterized by a diminished capacity in perceiving the physiological correlates of interoceptive sensations, namely bodily self-consciousness. Given the neural division of self-processing into interoceptive-, exteroceptive- and mental-self, we hypothesize neural deficits in the interoceptive-processing regions in AN. Methods To prove this, we reviewed resting state (rs), task and rest-task studies in AN literature. Results Neuronal data demonstrate the following in AN: (i) decreased rs-functional connectivity (rsFC) of subcortical–cortical midline structures (SCMS); (ii) reduced rsFC between medial (default-mode network/DMN and salience network/SN) and lateral (executive-control network/ECN) cortical regions; (iii) decreased rsFC in mainly the regions of the interoceptive-self; (iv) altered activity with overall increased activity in response to sensory/body image stimuli, especially in the regions of the interoceptive-self; (v) lack of a clear task-related distinction between own’s and others’ body image. Conclusion These data may indicate that rs-hypoconnectivity between SCMS, as neural correlate of a reduced intero-exteroceptive integration resulting in self-objectification, might be linked to overall increased activity in interoceptive regions during sensory/body image stimuli in AN, engendering an “anxious bodily self.” Level of evidence I: Systematic review.

From early relational experiences to non-suicidal self-injury in anorexia and bulimia nervosa: a structural equation model unraveling the role of impairments in interoception

“…Neurobiological data reported in previous studies support the proposed model about the centrality of interoception deficits in linking negative early relational experiences, emotional dysregulation, dissociation, and NSSI. Specifically, recent literature underlined modifications in the activity of the interoceptive neural network (consisting of the insula and subcortical structures) in individuals with EDs, suggesting implications at the psychopathological level [ 64 ].…”

The relationship between problematic Instagram use and eating disorders psychopathology: an explanatory structural equation model

“…This last step was modelled as two latent variables: one related to interpersonal difficulties (ID, with loadings on EDI-2 Social Insecurity and Interpersonal Distrust) and the other to ED-specific psychopathology (EDP, with loadings on EDI-2 Drive for Thinness, Bulimia, Body Dissatisfaction and Interoceptive Awareness). For EDP, in addition to the three main EDI-2 subscales (components of the EDI-2 Symptom Index) Interoceptive Awareness was also included, as a dimension considered central in EDs with excellent sensitivity and specificity properties [53,54].…”