Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry?

Abstract

Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.

Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder

“…The insula, associated with interoceptive processing and the processing of one's own bodily symptoms, plays an important role in panic disorder. 9,37,38 Hyperactivation in the anterior insula in our patients is best explained by fear of cardiovascular symptoms. Earlier studies found anxiety severity to correlate positively with insula hyperactivation in response to masked fearful faces in healthy controls and with insula activation in patients with panic disorder during emotional processing of facial affect expressions.…”

Holding the body in mind: Interoceptive awareness, dispositional mindfulness and psychological well-being

“…First, it should be acknowledged that various theorists offer competing definitions of “interoceptive awareness” [5,7,10,11], yet this study drew upon an operationalization of interoceptive awareness consistent with belief in one’s interoceptive tendencies (Mehling, c.f. interoceptive sensibility as discussed in Garfinkel).…”

“…Despite pockets of convergence, the language of interoception continues to evolve and the discussion about the terminology remains ongoing [5,9–11]. Khalsa and Lapidus [10] provide a detailed review of operational alternatives, identifying 10 distinct definitions of interoception. In an effort to promote conceptual and operational synthesis, Garfinkel et al [9,11] offered and investigated a three-dimensional model of interoception, including interoceptive accuracy (accuracy in detecting bodily sensations, such as heartbeats), interoceptive sensibility (self-reported beliefs about interoceptive tendencies), and interoceptive awareness (“metacognitive awareness of interoceptive accuracy”, p.67) [11].…”

Support Vector Machine Analysis of Functional Magnetic Resonance Imaging of Interoception Does Not Reliably Predict Individual Outcomes of Cognitive Behavioral Therapy in Panic Disorder with Agoraphobia

“…Most importantly, interoceptive accuracy is still considered one of the major factors contributing to the development and maintenance of panic disorder (80). …”