Interoception in Anorexia Nervosa: Exploring Associations With Alexithymia and Autistic Traits

Abstract

Background: Previous research on whether interoception is altered in anorexia nervosa (AN) using the heartbeat tracking task has yielded inconsistent results. However, no previous research has examined whether interoception is associated with alexithymia and autistic traits in AN, conditions which are more prevalent in this population and thought to be related to performance in this task. The aim of this study was to explore whether altered interoception in AN is associated with alexithymia and autistic traits. Methods: We assessed interoceptive accuracy using the heartbeat tracking task in n = 37 people with AN, and n = 37 age and gender matched healthy controls (HC), and explored within the AN group if interoceptive accuracy was related to self-rated alexithymia or autistic traits. We also assessed self-reported interoceptive ability, and the relationship between subjective and actual performance. Results: Heartbeat tracking task performance was not found to be altered in the AN group compared to the HC group. However, confidence ratings in task performance in the AN group were lower compared to the HC group. Unlike the HC group, confidence ratings in the AN group did not correlate with task performance. Within the AN group there was no relationship between interoceptive accuracy, alexithymia, and autistic traits, after controlling for the potential confounders of anxiety and depression. There was a relationship between confidence ratings and illness severity in the AN group. Conclusion: The results found no differences between heartbeat tracking task performance in people with AN compared to HC. There was no association between task performance, alexithymia and autistic traits in AN. Results do suggest that people with AN exhibit lowered confidence in their task performance, and that they may lack insight into this performance compared to HC. The findings are discussed in the context of potential significant limitations of the heartbeat tracking task, with recommendations for future research into interoception in AN.

The role of interoception in the overlap between eating disorders and autism: Methodological considerations

“…Similar results have been observed when considering self-reported attention across interoceptive domains in both adolescents and adults (Brown et al, 2017). Pollatos et al (2008) reported impaired perception of cardiac signals in AN patients; however, several studies have failed to replicate this result (Eshkevari et al, 2014;Kinnaird et al, 2020;Lutz et al, 2019). Kinnaird et al (2020) reported that AN patients believed their accuracy of perception to be impaired, and these beliefs correlated with illness severity.…”

Atypical interoception as a common risk factor for psychopathology: A review

“…Atypical interoception is ubiquitous across psychiatric and neurological conditions. While certain conditions have long been associated with atypical interoception, such as Feeding and Eating Disorders (EDs) including anorexia Nervosa, Bulimia Nervosa, and obesity ( Eshkevari et al, 2014 ; Fassino et al, 2004 ; Kinnaird et al, 2020 ; Klabunde et al, 2013 ; Lapidus et al, 2020 ; Lattimore et al, 2017 ; Lutz et al, 2019 ; Pollatos et al, 2008 ; although see e.g. Ambrosecchia et al, 2017 ; Kinnaird et al, 2020 ), the full range of conditions impacted by interoceptive atypicalities is only just being realised ( Barrett and Simmons, 2015 ; Brewer et al, 2016a ; Brewer, Happé, et al, 2015 ).…”

“…While certain conditions have long been associated with atypical interoception, such as Feeding and Eating Disorders (EDs) including anorexia Nervosa, Bulimia Nervosa, and obesity ( Eshkevari et al, 2014 ; Fassino et al, 2004 ; Kinnaird et al, 2020 ; Klabunde et al, 2013 ; Lapidus et al, 2020 ; Lattimore et al, 2017 ; Lutz et al, 2019 ; Pollatos et al, 2008 ; although see e.g. Ambrosecchia et al, 2017 ; Kinnaird et al, 2020 ), the full range of conditions impacted by interoceptive atypicalities is only just being realised ( Barrett and Simmons, 2015 ; Brewer et al, 2016a ; Brewer, Happé, et al, 2015 ). There is evidence of increased prevalence of atypical interoception in anxiety and panic disorders ( Ehlers and Breuer, 1992 ; Paulus and Stein, 2010 ; Adrián Yoris et al, 2015 ), alcohol and substance abuse ( Jakubczyk et al, 2019 ; Naqvi and Bechara, 2010 ; Paulus and Stewart, 2014 ; Paulus et al, 2009 ; Verdejo-Garcia et al, 2012 ), depression ( Aaronson et al, 2017 ; Dunn et al, 2007 ; Furman et al, 2013 ; Harshaw, 2015 ; Paulus and Stein, 2010 ; Pollatos et al, 2009 ), somatoform disorders ( Schaefer et al, 2012 ), Autism Spectrum Disorder (ASD; Garfinkel et al, 2016a ; Hatfield et al, 2017 ; Mul et al, 2018 ; Nicholson et al, 2019 ), Attention-Deficit/Hyperactivity Disorder (ADHD; Kutscheidt et al, 2019 ), Obsessive Compulsive Disorder (OCD; Lazarov et al, 2010 ; Schultchen et al, 2019 ; see also Stern, 2014 for a discussion), schizophrenia ( Ardizzi et al, 2016 ), depersonalisation/derealisation disorder ( Schulz et al, 2015 ; Sedeño et al, 2014 ; but see Michal et al, 2014 ), personality disorders ( Mussgay et al, 1999 ; although see Hart et al, 2013 ), and those with high levels of psychopathic traits ( Nen...…”

Waiting longer, feeling fatter: Effects of response delay on tactile distance estimation and confidence in females with anorexia nervosa

“…We also include a confidence measure to investigate whether between-group differences in estimation confidence could be found-in line with recent proposals regarding eating disorders and confidence in bodily perception and belief (Fassino et al, 2004;Jenkinson et al, 2018;Kinnaird et al, 2020).…”

“…Other research focuses on the confidence patients exhibit in their perception of their own bodily states. These results suggest that patients exhibit low confidence in their perception of interoceptive sensations such as hunger and heartbeat (Fassino et al, 2004;Jenkinson et al, 2018;Kinnaird et al, 2020).…”