Articles published on Arousal
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- New
- Research Article
- 10.1016/j.aap.2026.108504
- Jun 1, 2026
- Accident; analysis and prevention
- Tianyuan Han + 3 more
Human-inspired emotion and attention encoding for autonomous vehicles' decision-making: a lane-change timing optimization case.
- New
- Research Article
- 10.1037/xge0001946
- May 18, 2026
- Journal of experimental psychology. General
- Ashley E Symons + 3 more
Computational models of auditory salience predict that acoustic change and divergence from prediction increase the salience of sound streams. Confirming these predictions, prior research has shown that acoustic change and unpredictable sound features are linked to increases in physiological arousal and disruption of concurrent task performance. However, it remains unclear whether linguistic features, such as phonemic and lexical/semantic surprisal, help drive attentional orienting or whether instead attentional capture takes place prior to linguistic analysis. To address this question, we introduce a new technique for assessing attentional capture by naturalistic task-irrelevant speech. In this paradigm, participants tap to a metronome while ignoring a spoken passage from an audiobook. Salient features of the task-irrelevant speech capture attention, increase arousal, and expand subjective time, leading to shifts in tap timing. We show that distortions of subjective time are driven not only by acoustic change but also by phonemic surprisal. Thus, attentional orienting to sound takes place after the initial stages of linguistic analysis. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
- New
- Research Article
- 10.1097/j.pain.0000000000003996
- May 13, 2026
- Pain
- Maya Joshi Delity + 9 more
Indices of physiological arousal and sympathetic nervous system activity provide important information about pain that can supplement verbal reports. Numerous studies focus on electrodermal activity, which is easy to measure and can provide insights on relationships between pain and arousal through the quantification of skin-conductance response (SCR). Despite SCR's value, there is no standard way to quantify SCR in response to noxious stimulation, and conclusions may vary depending on analytic approaches. We used a multiverse analysis to evaluate associations between SCR and pain across 8 studies of thermal pain in healthy volunteers (total n = 567). For each data set, SCRs were quantified using 5 common analysis approaches (preprocessing only; manual scoring; automated scoring; model-based analysis; physiological pain classifier), leading to 18 distinct SCR measures. Associations with pain and temperature were strongest when automated scoring was combined with manual artifact detection, regardless of model comparison approach, study type, and whether pain was rated continuously or categorically. More specifically, Bayesian and model-based comparisons revealed the strongest associations with pain when the software Ledalab quantified the sum of amplitudes on each trial and we excluded trials with artifacts. We apply these findings across data sets both with and without psychological interventions to show that subjective pain statistically mediates associations between temperature and heat-evoked SCR, and that SCR is modulated by pain-predictive cues regardless of verbal instruction. This work advances a simple analysis pipeline that can be adopted in future pain studies to improve efficiency and reproducibility and aid the development of objective pain biomarkers.
- New
- Research Article
- 10.1093/sleep/zsag123
- May 8, 2026
- Sleep
- Julian Amacker + 9 more
To characterize source-level cortical oscillatory dynamics before and during disorders of arousal (DoA) compared with physiological motor arousals in children and adults. Nineteen children (10.9 ± 3.0years) and 22 adults (30.3 ± 5.2years) with DoA underwent 256-channel high-density EEG with video-polysomnography. Source-space spectral analysis in delta (0.5-4Hz) and beta (18-30Hz) bands was computed during stable slow-wave-sleep (-3 to -2minutes before movement onset) and from -5seconds to +15seconds around movement onset for 84 DoA episodes and 146 physiological motor arousals. Linear mixed-effects models with permutation-based cluster correction were applied. Four reproducible cortical hallmarks emerged across age groups: (i) a widespread pre-onset increase in beta and delta relative to slow-wave-sleep; (ii) sustained frontal delta enhancement over anterior cingulate, dorsomedial and ventromedial prefrontal, frontopolar, and orbitofrontal cortices; (iii) concurrent centro-parietal delta suppression spanning posterior cingulate, precuneus, superior parietal, sensorimotor, and supplementary motor regions; and (iv) persistent bilateral beta enhancement. Compared with physiological arousals, DoA arose from a "sleepier" background (higher delta, lower beta) and displayed greater beta coexisting with frontal delta persistence. Children showed broader pre-onset delta effects and more diffuse post-onset persistence, whereas adults exhibited a more anteriorly confined pattern. DoA display a reproducible, age-invariant cortical signature, consistent with a spatially organized failure of arousal integration: posterior sensorimotor and awareness circuits partially reactivate, while anterior executive and emotion-regulatory regions remain sleep-like. These spatiotemporal fingerprints position hd-EEG source analysis as a translational tool for mechanistically informed diagnostic and therapeutic development.
- New
- Research Article
- 10.1080/02699931.2026.2662478
- May 8, 2026
- Cognition and Emotion
- Marja-Liisa Halko + 4 more
ABSTRACT Political and economic challenges, amplified by social media algorithms, are increasingly polarising how people receive and evaluate information. This study examines how political views and immediate emotional reactions shape the perceived trustworthiness of information. We conducted a preregistered laboratory experiment in which participants evaluated politically charged statements while their emotional responses were assessed in real time. Facial expressions were recorded to identify seven discrete emotions, while galvanic skin response and heart rate were measured to capture physiological arousal and reaction intensity. Consistent with expectations and prior research, we observed a clear political confirmation bias: ideologically congruent statements were rated as more trustworthy, with the strongest effect among the most conservative participants. Increases in anger and sadness were positively associated with trust ratings across the sample, whereas joy was linked to reduced confirmation bias. Among conservatives, multiple emotions predicted overall trust and the extent of confirmation bias. Machine-learning models incorporating physiological data likewise identified anger and joy as the most informative emotional predictors; however, physiological measures did not improve predictive performance beyond the baseline model, contrary to our expectation. By integrating behavioural and real-time physiological measures, the findings highlight how emotional and cognitive processes interact to shape trust in political information.
- Research Article
- 10.1080/13284207.2026.2659022
- May 3, 2026
- Clinical Psychologist
- Jake Kalleske + 1 more
ABSTRACT Objective Disturbed sleep following trauma exposure is associated with increased intrusive memory frequency and intrusion-related distress – possible precursors to Posttraumatic Stress Disorder (PTSD). However, the relationship between sleep disturbance prior to trauma and subsequent PTSD symptoms has received less attention. We examined whether disturbed sleep prior to an analogue trauma predicted post-trauma intrusive memory frequency and characteristics. Method Undergraduate university students (N = 76) recorded their sleep quantity and quality over four days before viewing a Trauma Film designed to elicit intrusive memories. Results There were no significant associations between pre-film sleep quantity and intrusion frequency, vividness, intensity or self-reported estimates of physiological arousal associated with intrusions across the three days following the film. Higher self-rated difficulty getting to sleep predicted higher self-reported estimates of physiological arousal associated with post-film intrusions. Conclusions The findings of this study emphasise the importance of nuanced and multivariate assessment of pre-trauma risk factors for post-trauma intrusive memories.
- Research Article
- 10.1016/j.bbr.2026.116115
- May 1, 2026
- Behavioural brain research
- Chloe Crichton Feddo + 2 more
In laboratory settings, human-rat interactions are necessary and frequent, yet the impact of different handlers on the behaviour of the animal is underexplored. This study examined how human behavioural responses - confidence, experience, and physiological arousal - relate to affective indicators in rats, specifically ultrasonic vocalisations (USVs) and behavioural responses. 50-kHz USVs, associated with positive affect, were significantly higher post-handling compared to during handling, but no aversive 22-kHz calls were observed. Correlation analyses found that rat behavioural distress scores were positively associated with handler behavioural distress scores and negatively associated with handler's confidence. Heart rate increased during handling, particularly among moderately experienced handlers (1-5 years), but was not associated with rats' behavioural distress measures. Experience was positively correlated with confidence but not directly associated to rat behaviour or handlers heart rate. These findings suggest that observable human behaviour, rather than physiological arousal or years of experience, can potentially influence rats' emotional responses with the potential implications for animal welfare and scientific outcomes.
- Research Article
- 10.1109/tvcg.2026.3680575
- May 1, 2026
- IEEE transactions on visualization and computer graphics
- Jonathan Tschanter + 3 more
Social Virtual Reality (SVR) allows users to meet and build relationships through embodied avatars and real-time interaction in virtual spaces. While embodiment can strengthen social connections and presence, it can also intensify negative encounters, making SVR particularly vulnerable to harassment. Despite frequent reports of verbal, visual, and "physical" violations in SVR, little is known about how harassment reshapes users' self-perception, including their sense of embodiment, self-identification, closeness, and avatar customization preferences. We conducted a controlled experiment with 52 participants who experienced either a neutral or a harassment condition in a scenario modeled after real SVR incidents. Participants perceived the harassing peer as significantly more negative, annoying, and disturbing than the neutral peer. Contrary to prior reports, harassment did not significantly affect well-being measures, including emotional state, self-esteem, and physiological arousal, within this controlled scenario. However, participants reported stronger bodily change, attributed more of their own attitudes and emotions to their avatars, and increased interpersonal distance when personal space was invaded. Self-reported coping strategies included ignoring, stepping back, using humor, and retaliating. Notably, avatar customization preferences shifted across conditions. Participants in the neutral condition favored personalized avatars, whereas those in the harassment condition more frequently preferred anonymity in public spaces. Together, these findings demonstrate that harassment in SVR not only exploits embodiment but also reshapes self-perception. We further contribute methodological insights into how harassment can be ethically and reproducibly studied in controlled SVR-like experiments.
- Research Article
- 10.1016/j.psychres.2026.117048
- May 1, 2026
- Psychiatry research
- Margarid R Turnamian + 3 more
Evaluating emotional clarity and concordance in ambulatory physiological data and ecological momentary assessments in an adolescent clinical sample.
- Research Article
- 10.1061/jccee5.cpeng-7045
- May 1, 2026
- Journal of Computing in Civil Engineering
- John J Sohn + 4 more
Falls are a critical health and safety issue, causing over 46,000 deaths, 8.5 million injuries, and $190 billion in costs annually in the United States. To effectively prevent falls, assessing fall risk is essential to direct interventions such as jobsite or home modifications or physical training programs. Current fall risk assessments mainly rely on wearable inertial measurement unit (IMU)-based methods, which accomplish the assessment by monitoring abnormal body movements when exposed to slip, trip, and fall (STF) hazards. However, wearable IMU-based methods often face a significant challenge in distinguishing body movement induced by STF hazard exposure versus other intended or unintended actions while walking (transitional walking), such as bending and jumping. Both STF hazard exposure and transitional walking similarly induce large abnormal motion patterns, leading to a high likelihood of false positives. To overcome this challenge, this study aimed to examine the feasibility of monitoring physiological arousal via a wearable electrodermal activity (EDA) sensor to differentiate between body movement induced by STF hazard exposure and transitional walking. Because the EDA sensor reliably indicates arousal changes during stress-inducing events, it may help distinguish arousal changes caused by STF hazard exposure—a common type of stressor—from those due to nonhazardous walking. Specifically, this study focuses on daily walking in the built environment to confirm the potential of integrating EDA in typical walking scenarios encountered in everyday routines. To examine this feasibility, EDA data were collected while participants walked an in-lab and outdoor predetermined route. Friedman’s tests and multivariable modeling determined whether the arousal levels differ significantly among regular walking, transitional walking, and STF hazard exposure. The results indicate that STF hazard exposure is accompanied by a significantly higher mean arousal level relative to regular walking and transitional walking (p<0.05). This finding suggests that sensing of physiological arousal via a wearable EDA sensor helps differentiate between STF hazard exposure and other walking activities.
- Research Article
- 10.1016/j.bpsgos.2026.100720
- May 1, 2026
- Biological psychiatry global open science
- Julia C Welsh + 6 more
Functional magnetic resonance imaging (fMRI) aims to identify biomarkers of neuropsychiatric illnesses, including substance use disorders; however, fMRI's clinical utility remains limited. One underexplored aspect of the fMRI signal is the systemic low-frequency oscillation (sLFO), a global physiological signal historically treated as noise but linked to vascular and autonomic function. Across 4 independent datasets, we used Regressor Interpolation at Progressive Time Delays analyses to extract the sLFO from resting-state and task-based fMRI data. We evaluated relationships between sLFO amplitude and acute and chronic indices of nicotine use. We further assessed the effects of nicotine and methylphenidate on the sLFO and related task performance. In individuals who smoked tobacco, higher average sLFO amplitude during cigarette cue exposure was negatively associated with nicotine dependence (n = 64; r = -0.32, p = .009), whereas a rise in the sLFO across the task was negatively associated with greater cue-induced craving (r = -0.31, p = .014). sLFO amplitude was reduced during chronic nicotine use versus abstinence (n = 65; p < .001). Relative to placebo, acute single-dose methylphenidate administration also reduced the sLFO in healthy control participants (n = 58; p = .001). Both acute methylphenidate- and nicotine-induced reductions in sLFO amplitude were associated with improved cognitive task performance. These findings demonstrate that the sLFO encodes biologically meaningful information related to substance use, consistent with its role as an index of physiological arousal. Importantly, because the sLFO can be extracted directly from existing fMRI datasets, it offers a powerful and complementary approach to enhance the clinical relevance of fMRI research beyond substance use.
- Research Article
- 10.3389/frvir.2026.1780297
- Apr 14, 2026
- Frontiers in Virtual Reality
- Daniel Phillips + 1 more
Immersive virtual reality is increasingly used to evaluate spatial and environmental design scenarios, yet most studies rely on post-experience surveys that summarize experience retrospectively and obscure how responses unfold during exposure. This study demonstrates how integrating wearable biometric sensing with immersive virtual reality can extend spatial research by capturing temporally resolved, embodied responses to environmental variation. We conducted a controlled virtual reality experiment featuring three urban spatial typologies (residential, institutional, and urban core), each containing four sequential biodiversity treatments ranging from no to high biodiversity. Heart rate and galvanic skin response were recorded continuously and analyzed as within-subject deviations from baseline, then segmented according to spatial typology and treatment. Aggregate survey responses were used to characterize reflective post-experience perceptions of biodiversity, naturalness, inviting quality, and overall liking. Results show that physiological arousal does not scale linearly with either perceived biodiversity or stated preference: moderate biodiversity conditions often elicited elevated heart rate alongside peak liking, while high biodiversity conditions sometimes produced heightened arousal accompanied by reduced liking. An illustrative within-subject comparison demonstrates how biometric data reveal experiential inflection points that are not evident from survey responses alone. Rather than treating biometric measures as validation tools, this work positions immersive virtual reality combined with biometric sensing as an embodied response instigator that complements reflective evaluation and offers new methodological possibilities for spatial design research.
- Research Article
- 10.1093/jsxmed/qdag063.151
- Apr 7, 2026
- The Journal of Sexual Medicine
- K Clephane + 1 more
Abstract Introduction While topical (exogenous) estrogens and androgens have been a focus of treatment for vaginal pain, little is known about how the dynamics of vaginal arousal may contribute to activity of endogenous sex steroid hormones within the vaginal environment. Previous research suggests sexual arousal influences the concentration of testosterone within cervicovaginal fluid; however, it is unclear whether estrogens respond similarly. There is reason to expect that vaginal sexual arousal may activate mechanisms within the vaginal tissue that increase absorption of both testosterone and estradiol from the mucosal layer into the tissue beneath. Objective This project aims to characterize the influence of vaginal arousal on the presence of estradiol and testosterone in the cervicovaginal fluid and changes from pre- and post-arousal, and the within-person stability of these effects over time (3 weeks). Methods Analyses are drawn from an ongoing randomized trial in which participants completed 3 in-lab sessions spaced 3 weeks apart, in which they provided samples of cervicovaginal fluid before and after watching a brief (~7 minutes) erotic video. During the erotic video, participants’ vaginal blood flow (ie, physiological sexual arousal) was measured using a vaginal photoplethysmograph (VPP) and then cleaned to assess vaginal pulse amplitude (VPA). For each fluid sample, participants insert a disposable menstrual cup, which sits loosely around the cervix, for about 10 minutes. After the post-arousal menstrual cup was removed, participants complete a survey battery that includes demographics and measures of sexual function and sexual desire. Between in-lab sessions 2 and 3, participants are asked to masturbate at least 4 different days each week for 3 weeks. Results Similar to changes observed in cervicovaginal testosterone, concentrations of cervicovaginal estradiol significantly decreased from pre- to post-arousal concentrations (V = 13248.0, p &lt; .001). Preliminary analyses examining a subset of available data (n = 51) suggest that different indicies of arousal predict changes in estradiol and testosterone. While no measurements of arousal predicted the change in estradiol (VPA %change (t(54.40) = -0.21, p = .831); time at maximum arousal (t(45.33) = -0.30, p = .766); time to reach maximum arousal (t(60.93) = 0.72, p = .476), time spent at their maximum arousal was a marginally significant predictor of change in testosterone concentrations (t(45.42) = -1.83, p = .074). Analyses will be presented at the meeting that will determine whether this effect is significant with the final data (117). Overall, sample weight significantly predicted both estradiol and testosterone concentrations (β ^=1.04, 95% CI [0.46,1.63], t(105.26) = 3.48, p &lt; .001; β ^=0.86, 95% CI [0.52,1.19], t(125.15) = 5.01, p &lt; .001, respectively). Conclusions Though further work is needed to confirm the role of sexual arousal in sex steroid hemodynamics within vaginal tissue, it seems the vaginal blood differently impact cervicovaginal estradiol and testosterone. Differentiation among these sex steroids during sexual arousal may be useful for informing exogenous sex steroid application for postmenopausal women. Specifically, if masturbation or sexual activity facilitates absorption of endogenous testosterone absorption into the vaginal tissue, this may function over the longer term as a protective factor for tissue integrity. Disclosure Yes, this is sponsored by industry/sponsor: Sexual Wellness Institute - Vaginal Biome Science. Clarification: Industry funding only - investigator initiated and executed study.
- Research Article
- 10.1038/s41398-026-03990-y
- Apr 4, 2026
- Translational psychiatry
- M Weiß + 8 more
Social interactions play a central role in regulating affect and physiological arousal, with familiar and supportive relationships often associated with reduced anxiety and adaptive autonomic responses. However, it remains unclear whether individuals with depression benefit similarly from these so-called social buffering effects in everyday life. The present study examined momentary anxiety and cardiovascular responses (heart rate [HR] and heart rate variability [HRV]) during real-life social interactions in patients suffering from depression (N = 57) and matched healthy controls (N = 57). Participants reported on the familiarity and the gender of social interaction partners and the interaction context across five days, while a subsample also wore ambulatory electrocardiogram sensors. Across the patient and control group, higher interaction partner familiarity was associated with reduced state anxiety. However, only controls reported lower social interaction anxiety with increasing familiarity, whereas this pattern was not observed in patients. State social interaction anxiety was higher in controls when they interacted with female interaction partners, while there were no differences for patients. Regarding autonomic responses, patients exhibited higher baseline and state HR and lower baseline and state HRV compared to controls, consistent with autonomic dysregulation. We also observed lower HRs in opposite-gender interactions among controls but not among patients. Overall, these findings suggest that familiar social interactions are associated with lower levels of general state anxiety in both patients with depression and healthy controls, whereas social interaction anxiety and autonomic responses appear to show weaker associations with familiarity or the gender of interaction partners in patients. This research offers insights into how everyday social environments might support emotion regulation in clinical populations.
- Research Article
- 10.1111/jmft.70125
- Apr 1, 2026
- Journal of marital and family therapy
- Angela B Bradford + 2 more
This study investigated whether therapists' physiological regulation influences clients' autonomic responses during the first session of couple therapy and whether couples' physiology influences each other's. Drawing on polyvagal, attachment, and interpersonal neurobiology theories, we examined physiological linkages in therapy triads. Thirty-three heterosexual married couples participated in a 50-min session, during which respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), and pre-ejection period (PEP) were recorded from both partners and their therapist. Using dynamic structural equation modeling within an actor-partner interdependence framework, analyses focused on lagged effects across the session's beginning, middle, and end. Results showed clients exhibited strong physiological inertia across all measures, suggesting autonomic rigidity in early therapy. Therapist EDA predicted husbands' EDA early in the session, while wives' EDA predicted husbands' EDA later in the session. No directional effects were found for RSA or PEP. Clinical implications of these subtle therapist and spousal influences on physiological arousal are discussed.
- Research Article
- 10.1177/02762374261437036
- Apr 1, 2026
- Empirical Studies of the Arts
- Lisha Qu
Digital Chinese landscape painting can be enhanced through multisensory fusion, yet culturally adapted cross-modal mappings and real-time adaptation remain under-tested. This laboratory, between-subjects virtual reality experiment (N = 80) compared a visual-only condition with a multisensory condition delivering synchronized auditory, haptic, and olfactory cues, with cue mapping implemented as culturally congruent or deliberately incongruent. Outcomes included standardized immersion/presence measures and affect ratings, behavioral logs of interaction and exploration (including time-on-task and coverage), and physiological indices of arousal derived from electrodermal activity and photoplethysmography-based pulse metrics, assessed immediately after exposure and at one-week and one-month follow-ups. Culturally congruent multisensory cueing produced higher immersion/presence and engagement than visual-only presentation and the incongruent multisensory format, alongside more frequent and diverse interaction behavior, longer time-on-task, and broader exploration of the virtual scenes. Self-reported emotion showed higher positive valence and arousal under congruent cueing with convergent physiological arousal patterns, and differences remained observable at follow-up assessments.
- Research Article
- 10.1016/j.actpsy.2026.106551
- Apr 1, 2026
- Acta psychologica
- Qiuya Zhang + 1 more
Language in interpreting: Multidimensional evidence on emotional states, cognitive load, and their correlation.
- Research Article
- 10.1177/13591053261433384
- Mar 30, 2026
- Journal of health psychology
- Chern Yi Marybeth Chang + 4 more
Difficulties regulating emotions and physiological arousal can heighten stress and anxiety in young adults, lowering quality of life (QoL). This pre-registered study examined whether maladaptive emotion regulation (e.g. expressive suppression) relates to greater emotional and arousal dysregulation (e.g. reduced heart rate variability, HRV) and poorer QoL. 101 young adults (21.1 ± 1.9 years; 73.3% female) in Malaysia completed questionnaires on emotion regulation, stress, anxiety, and QoL, while heart rate was recorded at rest and during exposure to emotion-inducing stimuli. Bootstrapped correlation and mediation analyses revealed that greater emotional dysregulation was associated with lower use of cognitive reappraisal, higher stress/anxiety, and poorer QoL. Cognitive reappraisal related to lower stress/anxiety and better QoL, whereas expressive suppression related to higher anxiety and poorer psychological QoL. Among frequent reappraisers, reduced stress and anxiety predicted better QoL. Promoting cognitive reappraisal may improve wellbeing and help young people cope with emotional challenges.
- Research Article
1
- 10.3390/buildings16071328
- Mar 27, 2026
- Buildings
- Guanjie Huang + 1 more
Traditional Post-Occupancy Evaluation (POE) is static and incompatible with dynamic systems like Digital Twins, creating a digital gap in managing health-oriented urban environments, especially in Urban Underground Spaces (UUS). This paper bridges this gap with a deep learning framework that automates the continuous prediction of human physiological arousal. We created a novel multimodal dataset from in situ experiments, synchronizing first-person video, environmental data, and Galvanic Skin Response (GSR) as a real-time physiological arousal proxy. Our dual-branch spatial–temporal model fuses these data streams to predict GSR with high accuracy (Pearson’s r = 0.72), effectively mapping objective environmental inputs to continuous human physiological dynamics. This framework provides an automated, human-centric analysis engine for urban planning, design validation, and real-time building management. It establishes a foundational ‘human dynamics layer’ for urban Digital Twins, evolving them into predictive tools for simulating human-environment interactions and embedding physiological perception into intelligent urban systems.
- Research Article
- 10.3390/nu18071070
- Mar 27, 2026
- Nutrients
- Jaworski Mariusz + 1 more
Body-focused repetitive behaviors (BFRB), including compulsive skin picking, are observed in patients with anorexia nervosa (AN). However, their functional significance remains unclear. AN is characterized by chronic energy restriction and altered interoceptive processing, which may contribute to persistent internal tension beyond overt eating symptoms. This study aimed to explore the functional meaning of compulsive skin picking as a potential behavioral marker of emotional and interoceptive dysregulation relevant to clinical assessment and treatment planning. A qualitative descriptive study was conducted among 33 hospitalized patients with AN who reported recurrent skin picking leading to tissue damage. Patients were undergoing structured nutritional rehabilitation. Individual semi-structured interviews were performed. Patients with AN described a consistent emotional and physiological sequence preceding skin picking: increased internal tension followed by short-term relief and subsequent self-directed negative emotions. Episodes occurred in contexts of emotional overload, understimulation, reduced emotional awareness, and, in some cases, hunger- or meal-related stress. Participants described the behavior as partly intentional, serving to reduce tension, but at times occurring almost automatically. It was closely connected with eating-related anxiety and dissatisfaction with the body. The findings indicate that compulsive skin picking in AN may reflect underlying emotional and interoceptive instability, instead of being an unrelated co-occurring symptom. In the broader context of chronic energy restriction, such behaviors may reflect attempts to modulate internally generated physiological arousal. Incorporating routine assessment of BFRB into clinical practice could improve the identification of ongoing emotional instability and support more coordinated multidisciplinary care. Future studies combining qualitative insights with physiological measures would help clarify the mechanisms underlying this association.