Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders

Abstract

Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample ( n = 51) that was individually matched to MA individuals ( n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa ( n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.

Savor the flavor — a randomized double-blind study on taste-enhanced placebo analgesia in healthy volunteers

“…Several auxiliary analyses were performed to corroborate these finding: In short, no pre-or post-treatment group differences in baseline HR were detected and results were replicated when the repeating the analysis with all participants tested, and (s. Supplementary Results, Table S7). Of note, there was no appreciable relationship between pre-treatment peak CPT HR-response and %AUPC (see: Figure S4) suggesting that peak CPT HR-response are not a surrogate marker of pain, replicating previous findings 28,29 . .…”

Item Reduction, Psychometric and Biometric Properties of the Italian Version of the Body Perception Questionnaire—Short Form (BPQ-SF): The BPQ-22

“…This model had an acceptable fit (χ 2 (736) = 1094.002, p < 0.001; CFI = 0.969, TLI = 0.961, RMSEA = 0.027 (0.024; 0.030)), but it did not show evidence of approximated simple structure, as there were three items with loadings whose confidence interval was entirely over 0.32 on two factors, and there were two factors on which loaded only two items (see Table S2 in the SM). In the final model, the first factor (BPQ-BOA) was loaded by body awareness items (15,18,16,17,12,19,5) and the third factor (BPQ-SUP) by supradiaphragmatic reactivity items (32,27,33,28,39,37,38,34). The second factor (BPQ-BOA/SUB) comprised some items from the body awareness scale and some from the subdiaphragmatic reactivity scale (45,42,14,44,13,46,7), but all tapping into bloating and digestive issues.…”

“…In addition, postural orthostatic tachycardia syndrome patients often exhibit mild to moderate depression and anxiety disorders symptoms [ 5 ] as well as vasovagal syncope patients [ 6 ]. Though the underlying mechanisms behind this association include genetic risks, autonomic nervous system (ANS) dysfunction, increased exteroceptive and interoceptive mechanisms and decreased proprioception have been associated with anxiety [ 7 , 8 ], depression [ 9 , 10 ], post-traumatic stress [ 11 ], autism [ 12 , 13 ], schizophrenia [ 14 ], eating disorders [ 15 , 16 ] and in adults with hypertension [ 17 ]. Though interoception, or the process of sensing, interpreting and integrating internal bodily signals, has been linked to various clinical conditions and several randomized controlled trials found that interventions with interoception were effective in ameliorating symptoms related to anxiety disorders, eating disorders, psychosomatic disorders, and addictive disorders that also encompassed improvements of interoceptive measurements, measures self-reporting ameliorating symptoms are often related to specific illness symptoms only.…”

Validating the visceral sensitivity index in an eating disorder sample

“…Notably, the ASI assesses a more general predisposition to anxiety over bodily sensations and focuses predominantly on cardiac and respiratory sensations. Given new data suggesting that individuals with EDs endorse heightened affective responses to respiratory signals (Lapidus et al, 2020), future research may benefit from exploring the relative contribution of general (ASI‐3) and GI‐specific anxiety sensitivity (VSI) on different aspects of ED psychopathology. In sum, data from our sample of treatment‐seeking individuals with EDs provide initial psychometric support for use of the VSI in this population.…”