How Do You Feel when You Can't Feel Your Body? Interoception, Functional Connectivity and Emotional Processing in Depersonalization-Derealization Disorder

Abstract

Depersonalization-Derealization Disorder (DD) typically manifests as a disruption of body self-awareness. Interoception −defined as the cognitive processing of body signals− has been extensively considered as a key processing for body self-awareness. In consequence, the purpose of this study was to investigate whether there are systematic differences in interoception between a patient with DD and controls that might explain the disembodiment symptoms suffered in this disease. To assess interoception, we utilized a heartbeat detection task and measures of functional connectivity derived from fMRI networks in interoceptive/exteroceptivo/mind-wandering states. Additionally, we evaluated empathic abilities to test the association between interoception and emotional experience. The results showed patient's impaired performance in the heartbeat detection task when compared to controls. Furthermore, regarding functional connectivity, we found a lower global brain connectivity of the patient relative to controls only in the interoceptive state. He also presented a particular pattern of impairments in affective empathy. To our knowledge, this is the first experimental research that assesses the relationship between interoception and DD combining behavioral and neurobiological measures. Our results suggest that altered neural mechanisms and cognitive processes regarding body signaling might be engaged in DD phenomenology. Moreover, our study contributes experimental data to the comprehension of brain-body interactions and the emergence of self-awareness and emotional feelings.

Feeling, learning from and being aware of inner states: interoceptive dimensions in neurodegeneration and stroke

“…We used a validated heartbeat detection (HBD) task [5,17,18,44,45] involving three conditions (figure 1). First, participants tapped a keyboard to follow their own heartbeats with no feedback.…”

“…These dimensions rely on distributed networks critically engaging the insular cortex (IC), the anterior cingulate cortex (ACC) and the somatosensory cortex (SC) [2,12], while interactions between interoceptive and high-level functions are mediated by IC projections to the ACC, the orbitofrontal cortex (OFC), the amygdala and the hippocampus (HP) [3,4,11,[13][14][15][16][17][18].…”

Heart evoked potential triggers brain responses to natural affective scenes: A preliminary study

“…The heartbeat is one of the key sources of interoceptive signals related to emotion. Heartbeat detection (HBD) tasks (Khalsa et al, 2008) -the moment-to-moment perception of heartbeat signals -activate the IC and the ACC Couto et al, 2015;Critchley et al, 2004;Pollatos et al, 2005aPollatos et al, , 2007bSedeno et al, 2014). Moreover, performance in these tasks correlates with the volume of the right aICas do negative affective states (Bechara and Naqvi, 2004;Critchley et al, 2004).…”

Comfortably Numb

“…NA was assessed using 11 items from the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988): afraid, lonely, irritable, ashamed, disgusted, nervous, dissatisfied with self, jittery, sad, distressed, and angry with self. Dissociation was assessed using three items (“in contact with true self,” “confused as to who I am,” “and out of touch with myself”), which addressed the dissociation constructs of depersonalization/derealization (i.e., feelings of separation from one's sense of self and disembodiment; Sedeño et al, 2014). NA and dissociation items were rated on a Likert-type scale ranging from 1 ( not at all ) to 5 ( extremely ).…”