Symptom Perception From a Predictive Processing Perspective

Abstract

Bodily symptoms are highly prevalent in psychopathology, and in some specific disorders, such as somatic symptom disorder, they are a central feature. In general, the mechanisms underlying these symptoms are poorly understood. However, also in well-known physical diseases there seems to be a variable relationship between physiological dysfunction and self-reported symptoms challenging traditional assumptions of a biomedical disease model. Recently, a new, predictive processing conceptualization of how the brain works has been used to understand this variable relationship. According to this predictive processing view, the experience of a symptom results from an integration of both interoceptive sensations as well as from predictions about these sensations from the brain. In the present paper, we introduce the predictive processing perspective on perception (predictive coding) and action (active inference), and apply it to asthma in order to understand when and why asthma symptoms are sometimes strongly, moderately or weakly related to physiological disease parameters. Our predictive processing view of symptom perception contributes to understanding under which conditions misperceptions and maladaptive action selection may arise. There is a variable relationship between physiological dysfunction and self-reported symptoms. We conceptualize symptom perception (and misperception) within a predictive processing perspective. In this view, symptom perception integrates sensations and predictions about these sensations. Failures of such integration can produce misperceptions and maladaptive action selection. We use the perception (and misperception) of asthma symptoms as an example. There is a variable relationship between physiological dysfunction and self-reported symptoms. We conceptualize symptom perception (and misperception) within a predictive processing perspective. In this view, symptom perception integrates sensations and predictions about these sensations. Failures of such integration can produce misperceptions and maladaptive action selection. We use the perception (and misperception) of asthma symptoms as an example.

Better Safe Than Sorry: A Common Signature of General Vulnerability for Psychopathology

“…The brain will eventually settle on/infer a posterior model that represents the most likely model of the stimulation. For example, if one is waiting for Jeff in a crowded street, the brain generates neural patterns acting as prior beliefs that will facilitate spotting Jeff in the crowd (example from Pezzulo, Maisto, Barca, & Van den Bergh, 2019, p. 3).…”

Simulating homeostatic, allostatic and goal-directed forms of interoceptive control using Active Inference

“…Furthermore, without an explicit computational model, it is more difficult to distinguish causal dependencies between variables from (mere) correlations among signals. Developing explicit computational models, such as the ones discussed here, may be a valid support to the experimental analysis of allostatic / interoceptive system and the intricate dependencies between peripheral and central signals [17,[27][28][29][30]32].…”

“…Furthermore, and most critically, in virtue of suboptimal precision weighting, the model fails to generate appropriate corrective responses. There is an increasing consensus that the aberrant precision weighting of exteroceptive, proprioceptive and/or interoceptive streams may be an important factor in the explanation of various psychopathological conditions, such as psychosis, chronic fatigue, depression, eating disorders and panic disorders [23,24,[26][27][28][29][30]49]. While some theoretical and computational models have explored these implications by examining the effects of low precision on beliefs and perception (using predictive coding), only few of them explicitly incorporated control (using Active Inference).…”

“…It appeals to the normative imperative of prediction error (more formally, free energy) minimization, to explain a broad range of cognitive and emotional processes, such as perception and attention [12][13][14], goaldirected control [8,15,16], interoceptive processing [11,[17][18][19] and various other aspects of cognitive processing [20][21][22]. Furthermore, Active Inference has been recently used to shed light on various psychopathological conditions, such as psychosis, depression, eating disorders and panic disorders, in terms of aberrant inference [23][24][25][26][27][28][29][30].…”

Bodily Information and Top-Down Affective Priming Jointly Affect the Processing of Fearful Faces

“…The field of interoceptive investigation has recently witness the flourishing of theoretical and computational proposals linking its dysfunctions to several psychopathological conditions such as anorexia nervosa (Barca and Pezzulo, 2018) and bulimia (Klabunde et al, 2017), anxiety and addiction (Paulus et al, 2019), and somatic symptoms perception (Pezzulo et al, 2019).…”