Individual differences in sensory and expectation driven interoceptive processes: a novel paradigm with implications for alexithymia, disordered eating and obesity

Abstract

Those with disordered eating and/or obesity often express difficulties in sensing or interpreting what is happening in the body (interoception). However, research is hindered by conceptual confusion, concerns surrounding domain specificity, and an inability to distinguish sensory (bottom-up) and expectation driven (top-down) interoceptive processes. A paradigm was therefore developed from an active inference perspective. Novel indices were computed and examined in those with alexithymia: a personality associated with interoceptive deficits and disordered eating. The paradigm successfully identified individuals driven by sensations rather than expectations: alexithymia was characterized by attenuated prior precision (a larger divergence between pre-prandial and post-prandial satiety, and low expectation confidence), and increased prediction error (a higher correlation between changes in hunger and blood glucose, and greater rebound hunger after a sensory incongruent drink). In addition, those with a higher BMI were less confident and had a larger anticipated satiety divergence. These findings demonstrate the need to move beyond existing paradigms such as the Satiety Quotient and Heartbeat Counting Task which may have limited our understanding of eating behaviour.

Interoceptive differences in elite sprint and long-distance runners: A multidimensional investigation

“…Therefore, the increased confidence in athletes could in fact reflect a metacognitive bias (i.e., the propensity to report overconfidence) rather than a better ability to track their correct and incorrect responses. Indeed, this interpretation is supported by the observation that in the present study athletes and non-athletes did not differ in their heartbeat counting metacognitive awareness, although the limitations of this latter task should be considered [10,23,30].…”

“…Interestingly, once developed, accurate interoceptive representations are said to contribute to maintaining allostasis in response to subsequent physiological perturbations [ 22 , 23 , 25 , 30 ], resulting in a positive feedback loop ( Fig 1 ). Theoretically, having more accurate internal models could also facilitate interoceptive accuracy during distraction, when the ability to attend to ‘bottom-up’ sensory input is compromised ( Fig 1 ).…”

“…Given the limited availability of elite athletes, sample size in our lab-based study (Study 2) is an inevitable concern especially concerning the three-way interaction [ 56 ]. Although we were able to overcome this in Study 1 by conducting the study online this limited us to survey methods which are known to only weakly correlate with objective interoception methods [ 10 , 30 ]. Future research may be able to better deal with this issue by using newly developed interoception tasks such as the Phase Adjustment Task which can be run remotely [ 57 ].…”

“…Whilst this increased awareness could benefit self-regulation during physical exertion, the emotional component of breathlessness anxiety could also be a limiting factor. It is important to note that the domain generality of interoceptive signals is currently debated [ 30 ], and these effects may be limited to ventilatory interoception. In addition, it is unclear whether these effects vary according to the athlete’s sport.…”

The New Measures of Interoceptive Accuracy: A Systematic Review and Assessment

“…We identified three new tasks for gastric interoceptive accuracy: The Water Load Test -II (WLT-II; Dyck et al, 2016), the glucose test (Young et al, 2021), and the gastrointestinal mechanosensory stimulation task (Smith, Mayeli, et al, 2021).…”