Interoception and disordered eating: A systematic review

Martin, Elizabeth; Dourish, C T; Rotshtein, Pia; Spetter, Maartje S.; Higgs, Suzanne

doi:10.1016/j.neubiorev.2019.08.020

Cited by 82 publications

(86 citation statements)

References 145 publications

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“…For example, individuals with AN show evidence of exaggerated perceptual processing of anxiety-associated cardiac and respiratory sensations (e.g., heightened feelings of palpitations and dyspnea) ( Khalsa et al, 2015 ), as well as abnormal neural activation in interoceptive brain regions such as the cingulate and insular cortices ( Kerr et al, 2016 ; Berner et al, 2017 ). However, the evidence for causal influences of interoception on the development and expression of AN and other eating disorders is limited by a lack of basic and clinical studies focusing on mechanistic underpinnings ( Martin et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Reduced Environmental Stimulation in Anorexia Nervosa: An Early-Phase Clinical Trial

et al. 2020

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Reduced Environmental Stimulation Therapy (REST) alters the balance of sensory input to the nervous system by systematically attenuating sensory signals from visual, auditory, thermal, tactile, vestibular, and proprioceptive channels. Previous research from our group has shown that REST via floatation acutely reduces anxiety and blood pressure (BP) while simultaneously heightening interoceptive awareness in clinically anxious populations. Anorexia nervosa (AN) is an eating disorder characterized by elevated anxiety, distorted body representation, and abnormal interoception, raising the question of whether REST might positively impact these symptoms. However, this approach has never been studied in eating disorders, and it is unknown whether exposure to floatation REST might worsen AN symptoms. To examine these possibilities, we conducted an open-label study to investigate the safety and tolerability of REST in AN. We also explored the acute impact of REST on BP, affective symptoms, body image disturbance, and interoception. Twenty-one partially weight-restored AN outpatients completed a protocol involving four sequential sessions of REST: reclining in a zero-gravity chair, floating in an open pool, and two sessions of floating in an enclosed pool. All sessions were 90 min, approximately 1 week apart. We measured orthostatic BP before and immediately after each session (primary outcome), in addition to collecting BP readings every 10 min during the session using a wireless waterproof system as a secondary outcome measure. Each participant’s affective state, awareness of interoceptive sensations, and body image were assessed before and after every session (exploratory outcomes). There was no evidence of orthostatic hypotension following floating, and no adverse events (primary outcome). Secondary analyses revealed that REST induced statistically significant reductions in BP ( p < 0.001; Cohen’s d , 0.2–0.5), anxiety ( p < 0.001; Cohen’s d , >1) and negative affect ( p < 0.01; Cohen’s d , >0.5), heightened awareness of cardiorespiratory ( p < 0.01; Cohen’s d , 0.2–0.5) but not gastrointestinal sensations, and reduced body image dissatisfaction ( p < 0.001; Cohen’s d , >0.5). The findings from this initial trial suggest that individuals with AN can safely tolerate the physical effects of REST via floatation. Future randomized controlled trials will need to investigate whether these initial observations of improved anxiety, interoception, and body image disturbance occur in acutely ill AN populations. Clinical Trial Registration ClinicalTrials.gov ; Identifier: NCT02801084 (April 01, 2016).

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Section: Introductionmentioning

confidence: 99%

Reduced Environmental Stimulation in Anorexia Nervosa: An Early-Phase Clinical Trial

et al. 2020

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“…Another review has indicated the diverse methods used to assess the frequency of eating disorders and the different indicators of morbidity in these studies, also depending on the measurement tools [1,20]. Among the basic psychological factors of people with specific disorders, nutrition researchers most often mention dissatisfaction with the body (described by appearance evaluation, appearance orientation satisfaction with individual areas of the body, body weight, and the fear of gaining weight), emotional dysregulation, interoceptive deficits, maturity fears, low self-esteem, personal and, interpersonal alienation, interpersonal insecurity, perfectionism, and asceticism [2,32,35,[60][61][62][63][64][65][66][67][68][69][70][71][72]. Taking into account the large number of psychological risk factors for eating disorders and the methodological standards for measuring these factors, the authors of this article, while building their own research model, referred to recognized indicators with high statistical validity for measuring eating disorder profiles in terms of psychological features [60].…”

Section: Psychological Risk Factors For Eating Disorders With Cross-cmentioning

confidence: 99%

Psychological Risk Factors for the Development of Restrictive and Bulimic Eating Behaviors: A Polish and Vietnamese Comparison

Izydorczyk

Lipowska

et al. 2021

Nutrients

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The aim of this paper is to identify psychological factors which are culture specific or common predictors for restrictive and bulimic behaviors towards eating for young women raised in different cultures. The study included 661 young women from Poland (n = 233) and Vietnam (n = 428). Subjects filled-in the Eating Disorders Inventory (EDI-3) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), and body measurements were collected to calculate anthropometric indices. Women form Vietnam were less satisfied with their appearance than were their Polish peers, but Vietnamese showed a lower level of preoccupation with being overweight and fear of obesity. Intercultural differences indicate that Vietnamese women show greater intensities for psychological variables, connected with restrictive and bulimic eating behaviors, verified in the research model: low self-esteem, personal alienation, interpersonal insecurity, interpersonal alienation, emotional dysregulation, interoceptive deficits, perfectionism and asceticism, and anxiety.

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“…Furthermore, there may be relevant processes at other levels which could help to explain the links observed between emotional processing and disordered eating. For example, there is substantial evidence to suggest that individuals who engage in B-P have difficulty identifying and interpreting bodily sensations (i.e., reduced interoceptive ability; Martin, Dourish, Rotshtein, Spetter, & Higgs, 2019; alexithymia; Westwood, Kerr-Gaffney, Stahl, & Tchanturia, 2017), which could contribute both to difficulties in regulating emotions (e.g., difficulty differentiating physical emotional arousal patterns) and regulating appetite (e.g., difficulty sensing hunger and satiety). A treatment focusing solely on the emotion regulation component of the problem may therefore neglect the contribution of a greater underlying mechanism.…”

Section: Affect Dysregulation Theorymentioning

confidence: 99%

The Explanation of Eating Disorders: A Critical Analysis

Hawkins-Elder

Ward

2020

Behav. change

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Eating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.

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Interoception and disordered eating: A systematic review

Cited by 82 publications

References 145 publications

Reduced Environmental Stimulation in Anorexia Nervosa: An Early-Phase Clinical Trial

Reduced Environmental Stimulation in Anorexia Nervosa: An Early-Phase Clinical Trial

Psychological Risk Factors for the Development of Restrictive and Bulimic Eating Behaviors: A Polish and Vietnamese Comparison

The Explanation of Eating Disorders: A Critical Analysis

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