Heart Beat Perception in Patients with Depressive, Somatoform, and Personality Disorders

Abstract

According to current concepts of functional psychosomatic disorders, disturbed interoceptive processes are considered relevant causal factors especially in relation to panic disorders and functional cardiac complaints. In our study, heart beat perception was assessed for subgroups of psychosomatic disorders and in comparison to healthy controls. A further issue was the distribution of performance scores across diagnostic subgroups. Special consideration was given to the question of panic patients forming two extreme groups with either better or worse perception than other patient groups. Additionally, a subsample of patients was tested twice in order to establish test-retest-reliability of heart beat perception. Within the whole group of 546 patients, marginally significant differences in heart beat perception scores in the Schandry Mental Tracking Task between subgroups became evident. The detection score of patients with personality disorders was lower compared to patients with functional disorders and healthy controls. Patients with functional heart disorder and panic patients did not have higher perception scores than controls. Effects of medication were taken into account. Only medicated panic patients showed better heart beat perception than unmedicated ones. The distribution of heart beat perception was similar in all groups studied, patients with panic disorders did not differ from the general picture. Time stability after a 4 week interval in 42 patients was sufficiently high to show trait characteristics reaching r = .58. In general, psychosomatic patients are characterized by a tendency towards lower perception scores compared to healthy subjects. Better than normal interoceptive functioning, in contrast to some literature reports, does not seem to play a decisive role in the establishment of functional psychosomatic disorders.

Diminished Interoceptive Awareness in Fibromyalgia Syndrome

“…To control for effects of cognitive performance, RTs obtained in both tasks were also included as covariates in these models. Building on previous studies demonstrating diminished interoceptive awareness in depression, anorexia nervosa and somatoform disorders, [19][20][21][22] our results support the view that poor accuracy in the perception of bodily signals is a common feature of various mental and physical disorders.…”

“…24 FMS symptoms markedly reduce quality of life and psychosocial functioning, and can lead to extensive use of health care systems. 25,26 In particular, the observation of diminished interoception in somatoform disorders 21,22 stimulated investigation of this issue in the context of FMS. These syndromes exhibit considerable overlap; both are characterized by physical symptoms that cannot be sufficiently explained by concurrent organic disease, and a high proportion of patients with somatoform disorders suffer from recurrent pain.…”

“…These studies suggested lower levels of cardiac interoceptive awareness in individuals with depression, 19 eating disorders 20 and somatoform disorders. 21,22 In terms of its role in pathogenetic mechanisms, reduced interoceptive awareness is likely to contribute to alterations in physical symptom perception and emotion processing, which constitute relevant characteristics of the aforementioned diseases. 4,22 The present study is concerned with interoceptive awareness in fibromyalgia syndrome (FMS).…”

Individual differences in the interoceptive states of hunger, fullness and thirst

“…Abnormalities in interoceptive awareness have been documented for anxiety, depression and eating disorders in several studies (e.g., Paulus & Stein, 2010), and for personality disorders in just one (Mussgay, Klinkenbuerg, & Ruddel, 1999). Most studies use the heartbeat detection task and so they warrant mention here because this task correlates with sensitivity to hunger and fullness.…”

Autonomic imbalance is associated with reduced facial recognition in somatoform disorders

“…Concerning possible abnormalities in interoceptive processes in somatoform patients, Mussgay and co-workers [15] could demonstrate lower heartbeat perception in functional patients. This finding is very important as interoceptive processes and the extent of an individual's sensitivity to bodily signals ("interoceptive awareness") are considered to be an essential variable in many theories of emotions such as proposed by James [16], Schachter and Singer [17] or Damasio [18].…”