Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: Evidence of interoceptive dysregulation

Abstract

Background Recent evidence raises the possibility that symptoms of anorexia nervosa (AN) could be related to impaired interoception. Pain is an interoceptive process with well-characterized neuroanatomical pathways that may overlap to a large degree with neural systems that may be dysregulated in AN individuals, such as the insula. Methods Functional Magnetic Resonance Imaging (fMRI) was used to assess neural substrates of pain anticipation and processing in ten healthy control women (CW) and 12 individuals recovered from AN (REC AN) in order to avoid the confounding effects of malnutrition. Painful heat stimuli were applied while different colors signaled the intensity of the upcoming stimuli. Results REC AN compared to CW showed greater activation within right anterior insula (rAI), dorsolateral prefrontal cortex (dlPFC) and cingulate during pain anticipation, and greater activation within dlPFC and decreased activation within posterior insula during painful stimulation. Greater anticipatory rAI activation correlated positively with alexithymic feelings in REC AN subjects. Conclusions REC AN showed a mismatch between anticipation and objective responses, suggesting altered integration and, possibly, disconnection between reported and actual interoceptive state. Alexithymia assessment provided additional evidence of an altered ability to accurately perceive bodily signals in women recovered from anorexia nervosa.

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

“…Given this literature base, in addition to previous findings and theories suggesting the importance of the anterior insula in AN ( et Strigo et al, 2013), it is interesting that the group differences found in this area occurred during cardiac IA, not anxious rumination. Past evidence indicates the anterior insula may underlie interoceptive prediction (Barrett and Simmons, 2015).…”

Abnormal functional global and local brain connectivity in female patients with anorexia nervosa

“…39,50 Interestingly, studies using heat pain in patients with anorexia nervosa consis tently found decreased posterior insula responses during stimulation. 51,52 According to Craig, 50 afferent representations of the physiologic condition of the body ascend via the lam ina I spino-thalamo-cortical pathway to the posterior and mid insula. Therefore, reduced posterior insular responses to pain in patients with anorexia nervosa are well in line with the current network analysis measures and might help to ex plain the relative insensitivity to pain, which is typical for this disorder.…”

Prediction error and somatosensory insula activation in women recovered from anorexia nervosa

“…Typically, the anterior insula has been associated with that function, including risk prediction, 37 but the posterior insula tracks changes of interoceptive states and somatosensory processes. 38 This is of interest and importance for anorexia nervosa research because of the disorder's (ill or recovered) association with distorted body perception that has been linked to the insula among other brain regions, 39,40 reduced pain perception that has been linked to the posterior insula, 41,42 reduced interoception measured by heart rate detection tasks, 43 and the altered drive to eat. Thus, altered activation in the posterior insula could be a potentially important marker for altered pathophysiology in individuals recovered from anorexia nervosa; however, this needs further study.…”