Interoceptive awareness, positive affect, and decision making in Major Depressive Disorder

Abstract

Background Little work has examined the relation between interoceptive awareness and symptoms of Major Depressive Disorder (MDD). Existing research suggests that depressed individuals exhibit impaired heartbeat perception, though the results of this research have been equivocal. Importantly, depressed participants in these studies have had comorbid anxiety disorders, making it difficult to draw inferences about interoceptive awareness in MDD. The current study addresses this issue by assessing heartbeat perception in depressed women without current anxiety disorders and exploring the relation between interoception and perturbations in both affective intensity and decision making, components of MDD postulated to be related to bodily awareness. Methods Depressed women without concurrent anxiety disorders (n=25) and never-disordered controls (n=36) performed a heartbeat perception task. Participants completed the self-report Affect Intensity Measure (AIM), and decision-making difficulty was assessed in MDD participants using the Structured Clinical Interview for DSM-IV. Results Depressed women exhibited poorer heartbeat perception accuracy than did control participants. Impaired accuracy in MDD participants was associated with reduced positive affectivity and difficulty in decision making. Limitations Our sample was composed exclusively of females and was heterogeneous with respect to treatment status, thereby limiting our ability to generalize results to depressed males and to exclude the contribution of exogenous factors to the observed group differences. Conclusions Results of this study suggest that for depressed individuals without anxiety comorbidities, disrupted perception of bodily responses reduces both the experience of positive arousal and the ability to use interoceptive feedback to inform decision making.

Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression.

“…A number of other regions involved in interoceptive processing and interoceptive-exteroceptive integration (e.g., hippocampus, ACC, mPFC) are nonetheless also reliably modified in depression. Evidence is similarly accumulating that depression involves not only lowered confidence in interoceptive abilities (e.g., Kopp, 2009) but some degree of lowered sensitivity to bodily stimuli, as measured by HBP tasks (e.g., Furman et al, 2013; see Table 4). Anxiety comorbidity nonetheless appears to complicate this relationship (cf.…”

“…Anxiety comorbidity nonetheless appears to complicate this relationship (cf. Furman et al, 2013), given that anxiety is associated with heightened awareness and sensitivity to somatic signals (e.g., Domschke et al, 2010). Although more research is needed to elucidate the prevalence and specific subtypes of ID typical in depression (see Table 1), the evidence reviewed supports the conclusion that depression often involves ID.…”

“…For example, measures of vagal tone such (e.g., HRV and RSA) are reliably associated with anxiety and depression (see Porges, 2011) and the vagus has proven to be a valuable point of intervention for the treatment of refractory cases of depression (see Table 2). In addition, studies employing HBP paradigms are beginning to converge on finding significantly reduced interoceptive sensitivity in depression, when anxiety comorbidity is controlled (see Furman et al, 2013). The latter finding is predicted from neuroimaging results, given that insula GMV correlates with HBP (Critchley et al, 2004) and depression appears to involve reduced insula GMV (e.g., Lai & Wu, 2014; T.…”

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

“…For depression, there is a relationship between this variable in non-clinical populations and poorer performance on the heartbeat detection task (e.g., Pollatos, 2011). Furman, Waugh, Bhattacharjee, Thompson, andGotlib (2013) compared people with major depressive disorder to age/gender matched controls. Heartbeat detection accuracy was poorer in depressed participants (r ¼ 0.32, [n ¼ 61]).…”

The Specificity of Psychological Factors Associated with Binge Eating in Adolescent Boys and Girls

“…There is cross-sectional (Bardone-Cone, Abramson, Vohs, Heatherton, and Joiner 2006;de Zwaan et al 1994) and longitudinal evidence (Leon, Fulkerson, Perry, and Early-Zald 1995;Mackinnon et al 2011) for the association between perfectionism, interoceptive awareness and BE. However, both of these variables are also related to other psychiatric disorders, such as anxiety disorder and depression (Furman, Waugh, Bhattacharjee, Thompson, and Gotlib 2013;Sassaroli et al 2008).…”