Transdiagnostic expression of interoceptive abnormalities in psychiatric conditions

Abstract

Background: Interoception, the sensing of information about the internal physiological state of the body, is proposed to be fundamental to normal and abnormal affective feelings. We undertook a cross-sectional characterisation of cardiac interoception in patients accessing secondary mental health services to understand how interoceptive abnormalities relate to psychiatric symptoms and diagnoses. Methods: Patients attending adult mental health services (205 female, 101 male) and controls (42 female, 21 male) participated. Clinical diagnoses spanned affective disorders, personality disorders and psychoses. Physiological, bio-behavioural and subjective interoceptive measures included: 1) Basal heart rate and heart rate variability (HRV); 2) cardiac afferent effects on emotional processing (cardiac cycle modulation of ratings of fear vs. neutral faces); 3) perceptual accuracy, confidence, and metacognitive insight in heartbeat detection, and; 4) self-reported sensitivity to internal bodily sensations. We tested for transdiagnostic differences between patients and controls, then for correlations between interoceptive measures and affective symptoms, and for group differences across clinical diagnostic categories. Results: Patients differed from controls in HRV, cardiac afferent effects on emotional processing, heartbeat discrimination accuracy, and heartbeat detection confidence. Anxiety and depression symptom severity correlated particularly with self-reported sensitivity to interoceptive experiences. Significant differences between diagnostic categories were observed for HRV, cardiac afferent effects on emotional processing, and subjective interoception. Patients with schizophrenia relative to other diagnoses intriguingly showed opposite cardiac afferent effects on emotion processing. Conclusions: This multilevel characterisation identified interoceptive differences associated with psychiatric symptoms and diagnoses. Interoceptive mechanisms have potential value for the clinical stratification and therapeutic targeting of psychiatric disorders.

Female sweet likers have enhanced cross-modal interoceptive abilities.

“…Across participants, cardioceptive performance in the heartbeat tracking (M = .600, SEM = .035) and the heartbeat discriminating (M = .576, SEM = .017) tasks were comparable to recent work in non-clinical subgroups (Critchley et al, 2019). For the water load test, mean gastric interoceptive performance was .588 (SEM = .018), similar to values from van Dyck et al (2016).…”

Perceptual insensitivity to the modulation of interoceptive signals in depression, anxiety, and substance use disorders

“…For example, one study found that a serotonergic receptor antagonist reduced activation in regions of the insula associated with interoception 85 , which could pertain to reduced perceptual accuracy. Another study found higher heart rate and lower heart rate variability in individuals on antipsychotic medications, and higher self-reported bodily awareness in individuals on antidepressant medications 74 . Yet another study showed that acute administration of a serotonin reuptake inhibitor increased metacognitive awareness of performance accuracy on a cardiac interoception task 86 .…”

“…47,[70][71][72][73] ). For example, one recent study found that a transdiagnostic patient sample (including affective disorders, schizophrenia, and personality disorders) showed lower subjective interoceptive confidence on both a heartbeat tracking task and a heartbeat discrimination task, as well as lower objective performance on the latter 74 . Other previous cardiac perception studies have reported that depressed individuals exhibit reduced accuracy on a heartbeat counting task [75][76][77] , and that performance is negatively correlated with depressive symptoms 78 as well as associated with both lower positivity and poorer decision-making 75 .…”

The relationship between interoception and agency and its modulation by heartbeats: an exploratory study

“…Haggard, et al explained excessive sense of agency from the standpoint of retrospective inference 2 . In addition, it was demonstrated that the relationship between interocepton and emotional face recognition in schizophrenia was opposite to any other conditions including in healthy people 35 . Further study is required to understand this complex relationship in schizophrenia.…”