The pathways of interoceptive awareness

Abstract

A network of cortical brain regions including the insula and anterior cingulate cortex (ACC) has been proposed as the critical and sole substrate for interoceptive awareness. Combining lesion and pharmacological approaches in humans, we found the insula and ACC are not critical for awareness of heartbeat sensations. Rather, both somatosensory afferents from the skin and a network including the insula and ACC mediate it. Together these pathways enable the core human experience of the cardiovascular state of the body.

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

“…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].…”

Altered Insula Activity during Visceral Interoception in Weight-Restored Patients with Anorexia Nervosa

“…Neuroanatomical and functional neuroimaging evidence points toward a central role for the insular cortex in the integration and representation of these interoceptive signals (Craig, 2002;Khalsa et al, 2009;Kurth et al, 2010;Simmons et al, 2013). For example, attending to interoceptive sensations activates the region of the dorsal midinsular cortex near the terminus of vagal afferent projections from the viscera (Craig, 2002;Farb et al, 2012;Pollatos et al, 2007;Simmons et al, 2013), and lesions to the insula profoundly disrupt interoceptive awareness (Grossi et al, 2014;Khalsa et al, 2009).…”

“…Neuroanatomical and functional neuroimaging evidence points toward a central role for the insular cortex in the integration and representation of these interoceptive signals (Craig, 2002;Khalsa et al, 2009;Kurth et al, 2010;Simmons et al, 2013). For example, attending to interoceptive sensations activates the region of the dorsal midinsular cortex near the terminus of vagal afferent projections from the viscera (Craig, 2002;Farb et al, 2012;Pollatos et al, 2007;Simmons et al, 2013), and lesions to the insula profoundly disrupt interoceptive awareness (Grossi et al, 2014;Khalsa et al, 2009). Dating back to the dawn of modern psychology, theories have ascribed an important role for the physiological state of the body in the experience of emotion (Damasio, 1994;James, 1890), with more recent accounts highlighting the insula's role in interoception as the link between the body's autonomic state and the subjective experience of emotion, particularly fear and anxiety (Craig, 2002;Paulus and Stein, 2006).…”

Brain Responses to Cardiac Electrical Stimulation: A New EEG Method for Evaluating Cardiac Sensation

“…Chest pain induced by gastrointestinal reflux or acid infusion of the esophagus is indistinguishable from angina in patients with symptomatic coronary artery disease (Mellow et al 1983;Singh et al 1992). Indeed, a feeling of painless cardiac sensation is mediated by the insula and somatosensory cortex (Critchley et al 2004;Khalsa et al 2009), both of which are also activated during esophageal stimulation (Aziz et al 1997(Aziz et al , 2000Kobayashi et al 2010). Thus, it is highly possible that CEPs in response to esophageal and cardiac stimulation share the same afferent neuronal pathway to the brain.…”