Atypical Self-Focus Effect on Interoceptive Accuracy in Anorexia Nervosa.

Olga Pollatos,Beate M Herbert,Till Krauseneck,Manos Tsakiris,Götz Berberich,Michael Zaudig

doi:10.3389/fnhum.2016.00484

Abstract

Background: Interoceptive abilities are known to be affected in anorexia nervosa (AN). Previous studies could show that private self-focus can enhance interoceptive accuracy (IAcc) in healthy participants. As body dissatisfaction is high in AN, confrontation with bodily features such as the own face might have a directly opposed effect in AN. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study.Methods: Fifteen patients with AN from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls, recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task assessing IAcc under two conditions either enhancing (“Self”) or decreasing (“Other”) self-focused attention. Furthermore, body dissatisfaction was assessed by a subscale of the Eating Disorder (ED) Inventory 2.Results: Patients with AN scored higher in IAcc when watching others’ faces as compared to one’s own face while performing the heartbeat perception task. The opposite pattern was observed in controls. IAcc remained reduced in AN as compared to controls in the time-course of cognitive-behavioral therapy, while body-dissatisfaction improved in AN. High body dissatisfaction was related to poorer IAcc in the “Self” condition.Conclusions: Our findings suggest that using self-focused attention reduces IAcc in AN while the opposite pattern was observed in controls. Confronting anorexic patients with bodily features might increase body-related avoidance and therefore decrease IAcc. The current study introduces a new perspective concerning the role of interoceptive processes in AN and generates further questions regarding the therapeutic utility of methods targeting self-focus in the treatment of AN.

Highlights

Anorexia nervosa (AN) is a psychiatric disorder defined by excessive weight loss, fear of gaining weight, a disturbed body image and a rejection of the own body (Klein and Walsh, 2003)
Friederich et al (2010) suggest that observed hyperactivation in insula along with hypoactivation in anterior cingulate may be critical for altered interoceptive processes involved in body self-comparisons in AN as both insula and anterior cingulate are central structures associated with the processing of interoceptive signals
This is in accordance to previous studies (Fassino et al, 2004; Matsumoto et al, 2006; Pollatos et al, 2008; Klabunde et al, 2013) showing that patients with eating disorders (ED) and especially patients with AN have difficulties in interoceptive functions assessed with different methods, e.g., when using questionnaires or behavioral tests targeting accuracy in detecting internal signals such as heartbeat detection

Summary

Introduction

Anorexia nervosa (AN) is a psychiatric disorder defined by excessive weight loss, fear of gaining weight, a disturbed body image and a rejection of the own body (Klein and Walsh, 2003). Friederich et al (2010) suggest that observed hyperactivation in insula along with hypoactivation in anterior cingulate may be critical for altered interoceptive processes involved in body self-comparisons in AN as both insula and anterior cingulate are central structures associated with the processing of interoceptive signals (see e.g., Craig, 2003; Critchley et al, 2004; Seth et al, 2012) This is in accordance to previous studies (Fassino et al, 2004; Matsumoto et al, 2006; Pollatos et al, 2008; Klabunde et al, 2013) showing that patients with eating disorders (ED) and especially patients with AN have difficulties in interoceptive functions assessed with different methods, e.g., when using questionnaires or behavioral tests targeting accuracy in detecting internal signals such as heartbeat detection. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study

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Conclusion