Abstract
Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.
Highlights
Recent interpretations of the limited impact of psychiatric neuroscience and genetics research on treatment outcomes have argued that the time has come for a pragmatic shift in focus through the identification of biomarkers with a mechanistic focus [1] and pursuit of processes that predict illness course or treatment outcome [2]
To demonstrate the links between interoception and psychopathology, we review findings in several psychiatric conditions emblematic of abnormal interoception: panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa
To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and all associated root terms in Pubmed, Psychinfo and ISI Web of Knowledge (Figure 1, blue line)
Summary
Recent interpretations of the limited impact of psychiatric neuroscience and genetics research on treatment outcomes have argued that the time has come for a pragmatic shift in focus through the identification of biomarkers with a mechanistic focus [1] and pursuit of processes that predict illness course or treatment outcome [2]. It enables accurate measurement of all facets of cardiac interoception: dichotomized dial ratings reflect interoceptive detection, cross correlations between heart rate and dial ratings reflect interoceptive accuracy, different doses provide measures of interoceptive intensity, placebo infusions enable estimates of interoceptive discrimination, and post hoc questionnaires assess the participant’s self-report of the task (e.g., experienced locations of perceived heartbeat sensations, task difficulty/tolerability, likelihood of drug versus placebo administration, etc.)
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