From the body’s viscera to the body’s image: Is there a link between interoception and body image concerns?

Analysing the factor structure of the MAIA scale for pregnant women: Development of the MAIA-Preg

During pregnancy many elements of the bodily experience change, suggesting that measuring these constructs may require different instruments to those validated in the general population. This study reports an exploratory and confirmatory factor analysis exploration of the Multidimensional Assessment of Interoceptive Awareness (MAIA) in 716 pregnant women (mean gestation 26.4 weeks), from six different datasets who completed the MAIA online. Exploratory factor analysis condensed the questionnaire from a 32- to a 19- item scale, with five factor structure, which best fitted the data. Key subscales of Trust, Attention Regulation, Self-Regulation and Not Distracting remained robust. The one remaining item from the Noticing subscale loaded heavily with the Emotional Awareness subscale. Subscales of Body Listening, Not Worrying and Noticing did not load and therefore were excluded as factors. This led to the development of the scale referred to as the MAIA-Preg, which demonstrated a good fit with a confirmatory factor analysis along with good subscale reliability (ω= 0.73 -0.92), and measurement invariance for second and third trimesters. The MAIA-Preg was also found to be a good fit for separate non-pregnant (N = 396) and postnatal (N = 174) samples and thus provides a reliable and valid measure, providing nuanced information about the bodily experience in perinatal populations, allowing comparisons of changes to interoceptive sensibility the perinatal period.

The Neural Correlates of Body Image Processing in Anorexia Nervosa and Bulimia Nervosa: An Activation Likelihood Estimation Meta-Analysis of fMRI Studies

Body image concerns are key prognostic and pathogenic factors of anorexia nervosa (AN) and bulimia nervosa (BN). This study aimed to investigate the neural mechanisms underlying body image perception across its two domains of estimation and satisfaction in anorexia and bulimia patients and healthy controls (HC). Systematic searches were conducted across eight databases, including PubMed; Cochrane Library; Ovid; Google Scholar; Sage Journals; Scopus; PsycInfo; and ScienceDirect, from database inception until the 23rd of April 2023. The sample pertained to 14 functional magnetic resonance imaging (fMRI) studies and 556 participants, with tasks primarily including image and silhouette-based body estimation and satisfaction paradigms. ALE meta-analysis was conducted to investigate significant clusters of activation foci across the different studies. Shared activations were observed between HC, AN, and BN patients in cortical regions related to object manipulation and recognition, visuospatial awareness, and memory and negative affect regulation. Differential activation in interoceptive and higher-order cognitive or affective control regions likely hold the key to pathological body distortion. This study outlined commonalities and differences in the correlates driving healthy body mapping and eating disorder pathology. Our findings provide pertinent implications for future research, current clinical interventions, and therapeutic outcomes.

The association between body image and psychological outcomes in multiple sclerosis. A systematic review

BACKGROUND

Multiple sclerosis (MS) is a demyelinating autoimmune condition, in which body image may be altered due to a range of biopsychosocial factors. The aim of this review was to examine whether there is a relationship between body image and psychological outcomes in MS, in order to guide clinical intervention development.

METHODS

PsycINFO, Medline, CINAHL and Scopus databases were searched systematically in November 2023 for eligible studies, using terms relating to MS and body image. Quantitative studies, published in English, that examined the relationship between body image and psychological outcomes in adults with MS were included. The QualSyst tool was used to assess risk of bias across studies. Screening and quality appraisal was verified by the third author. A narrative synthesis was used to report patterns in findings.

RESULTS

Thirteen studies (ten cross-sectional and three intervention studies) met inclusion criteria and were included in the final review. The sample size across all included studies totalled 1533. The results suggested that positive body image was associated with improved mood, lower anxiety, increased self-esteem, and better quality of life. However, the causal nature of these relationships was unclear.

CONCLUSION

The findings offer preliminary evidence to suggest that a more negative body image is associated with higher levels of psychological distress in MS, indicating that body image may be a target for intervention. Further research is necessary to provide a greater understanding of this association, and to inform future clinical practice.

Linking the inner and outer mental representations of the body to social cognition skills: A systematic review and meta-analysis

An interesting interpretation of embodiment highlights the critical role of mental body representations (BR), including motor, somatosensory, and interoceptive formats, for social cognition. However, the nature of this relationship is still debated at the empirical level, with various studies arriving at different conclusions. Here, we present a systematic review and meta-analysis aimed to summarize data from 3466 participants in 21 studies to provide a more comprehensive understanding of the relationship between inner and outer BR and social cognition. We focused on two core social cognition aspects: empathy and Theory of Mind (ToM). Concerning the inner BR, our meta-analytic findings reveal a significant correlation between specific interoceptive dimensions (i.e., interoceptive sensibility and accuracy) and social cognition, which was stronger for empathy than ToM. Conversely, although further research is needed, functional BR that mainly involve the outer body processing (i.e., nonaction-oriented BR) may show positive links with ToM. These findings point to specific interactions between BR and social cognition skills, supporting multi-faceted and embodied social cognition models. However, we also identified critical knowledge gaps and highlighted the need for further investigation to deepen our theoretical understanding of these relationships and their implications for clinical practice.

Psychotic-like anomalous self-experiences in feeding and eating disorders: Their role in eating psychopathology through the mediation of body uneasiness and embodiment and identity disorders

BACKGROUND

Psychotic-like anomalous self-experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED.

METHODS

Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic-like anomalous self-experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE-Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology.

RESULTS

Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE-Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image.

DISCUSSION

Anomalous interoceptive processes may represent the first step of a maladaptive process-impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early-shared vulnerability of severe disorders characterized by embodiment alterations.

A network analysis of body image concern, interoceptive sensibility, self-consciousness, and self-objectification

OBJECTIVE

Disrupted interoception has been found in individuals with body image concerns and related psychiatric conditions (i.e., eating disorders, body dysmorphic disorder). However, few studies have explored the role of interoception in the relationship between body image concern and self-objectification (SO). As components of the bodily self, interoception and body image may also contribute to the fostering of self-consciousness.

METHODS

The current study estimated the network model of body image concern, adaptive and maladaptive interoceptive sensibility (IS), self-consciousness, and SO, with data from 743 neurotypical adults. The centrality of nodes and the robustness of the network were verified.

RESULTS

Our network showed that interoception correlated with certain characteristics of body image concern (BIC) with varying strength and different directions. The most central node described beliefs of BIC, namely, negative evaluation toward appearance. Self-objectification and maladaptive IS presented the highest bridge centrality. Interoception also linked BICs with SO and self-consciousness.

CONCLUSION

Findings suggested that SO, adaptive and maladaptive interoception might be the targets of intervention for individuals with BIC, specifically for those with high levels of appearance-related negative self-evaluations.

Extreme weight conditions impact on the relationship between risky decision-making and interoception

Anorexia nervosa (AN) and obesity (OB) lie on the two ends of the broad spectrum of extreme weight conditions (EWC). Both disorders entail the constant risk to one's body integrity. Importantly, risk-taking is supported by internal signals, the perception of which is typically distorted in EWC. In this study, we sought to characterize in EWC: (i) risky decision-making by contrasting situations in which people process bodies or neutral objects and (ii) the relationship between interoceptive ability and risky decision-making. In a between-subject design, participants with AN restricting type, participants with class 2 OB, and two groups of matched healthy controls (HC) (total N = 160) were administered either the Balloon Analogue Risk Task (BART) or a modified version of it by using a body-related stimulus as a cue in the place of the balloon. Moreover, we collected a measure of interoceptive sensibility and a measure of interoceptive accuracy. Results showed that, when analysing the global population as a continuum based on the BMI, the risk propensity decreased as a function of increased BMI, only for the task involving a body-related stimulus. Moreover, while HC risk propensity toward a body-related stimulus correlated with interoceptive sensibility, such correlation was absent in participants with AN. Individuals with OB, on the opposite pole, showed mixed interaction between interoception and risky decision-making in both tasks. These findings add one more tile to understanding these complex pathologies in the EWC spectrum, opening up future differential rehabilitation scenarios.

Development and Psychometric Validation of the Body Trust Scale

Interoception (e.g., abilities to recognize/attend to internal sensations) is robustly associated with psychopathology. One form of interoception, body trust, is relevant for the development of disordered eating and suicidal thoughts/behaviors. However, measures of body trust are narrow, despite research suggesting body trust is multifaceted. The aim of this study was to develop a comprehensive measure of body trust: The Body Trust Scale (BTS). 479 U.S. adults completed self-report surveys containing the BTS and psychopathology measures. Exploratory and confirmatory factor analyses revealed a three-factor structure: Comfort with One's Body, Physical Attractiveness, and Comfort with Internal Sensations. Factors showed strong construct, convergent, and divergent validity, as well as moderate predictive validity for suicidal thoughts/non-suicidal self-injury. Furthermore, factors showed strong internal consistency, test-retest reliability, and were invariant across the gender binary. The BTS can be used in research and clinical settings to understand how specific facets of body trust relate to psychopathology.

Effects of Breast Surgery on Interoceptive Awareness in Females

Background

The driving force for many seeking plastic surgery is comfort in one's body. Along with comfort come satisfaction, improved self-awareness, and potential change in interoceptive awareness-a term defined as the conscious perception of one's body. Although conscious perception of bodily signals is influenced by many factors, sense of self and body image play significant roles. Studies show diminished interoceptive awareness in those with negative body image, but no research has assessed the impact of change in body image on interoceptive awareness.

Objectives

The purpose of this study is to investigate how interoceptive awareness changes following elective breast surgery.

Methods

The Multidimensional Assessment of Interoceptive Awareness Version 2 (MAIA-2) was administered to females undergoing breast surgery. A baseline survey was administered preoperatively, with follow-up surveys at 1 week, 1 month, and 3 months postoperatively.

Results

Data were collected from 39 females and analyzed using paired t-tests to compare MAIA-2 overall and subscores over time. Significance was seen at 1 week for subcategories of "not distracting" and "trust," at 1 month for "trust," and 3 months for "not worrying," "emotional awareness," "self-regulation," and "trust." Overall survey averages were significantly increased at all postoperative intervals.

Conclusions

From this study, it can be concluded that breast surgery positively impacts interoceptive awareness. These findings are clinically relevant as they offer providers' insight into the psychological effects of breast procedures. A comprehensive understanding of procedure outcomes enables providers to educate patients on both anticipated physical results and changes in sense of self.

Level of Evidence 2

Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories

OBJECTIVE

This review investigated the extant literature regarding the relationship between eating disorder diagnoses and sensory processing as measured by validated and reliable self-report inventories. Increasing evidence highlights the role of sensory processing in cognitive functions. Sensory processing is implicated in mental-ill health, including eating disorders (ED) and body image disturbances. However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored.

METHOD

We included studies involving participants aged 15 years or older with an eating disorder diagnosis confirmed by semi-structured or structured interviews. We further limited inclusion to articles using validated and reliable self-report instruments to measure sensory processing. Our meta-analysis focused on studies using the interoceptive awareness subscale from the second version of the Eating Disorder Inventory. We used the Critical Appraisal checklist for quasi-experimental studies to assess the quality of included articles.

RESULTS

There were 19 studies that met our inclusion criteria. Most studies showed moderate-to-high quality. Anorexia nervosa (AN) and bulimia nervosa (BN) were associated with heightened exteroception. Moreover, people with AN reported a heightened sense of taste compared to those with BN. Our meta-analysis comprising 10 studies, 19 samples, and 6382 participants revealed that AN (binge-purge subtype) and BN were associated with increased interoceptive difficulties compared to AN (restrictive subtype) or binge-eating disorder.

DISCUSSION

Overall, this review emphasizes the need for a deeper investigation into sensory processing, spanning both exteroception and interoception, in relation to ED. This may prove important for individualizing person-centered care.

PUBLIC SIGNIFICANCE

How people process internal, for example, hunger, and external, for example, taste and sensations is known to influence cognition and mental-ill health, including ED and body image disturbances. However, the ways in which sensory processing may contribute to ED are incompletely understood. We found that individuals with AN or BN experienced heightened exteroception, while people with an eating disorder characterized by purging reported increased interoceptive difficulties. These patterns could inform the development of more personalized treatments.

Exploring the role of disgust in hands and feet laterality judgement tasks

The hand laterality task (HLT) and the foot laterality task (FLT) are used to explore motor imagery, the ability to imagine an action without executing it. With our limbs, we interact with our body, with others, and with the environment. These contacts might cause negative feelings, such as disgust. Disgust is elicited by different drivers. For instance, body products and body envelope violations provoke disgust to avoid contaminations and to avoid damaging our bodies. However, not much is known about how disgust changes our motor imagery processes. In this study, we examined whether there is any difference in the ability to imagine hands and feet when these are emotionally charged with reminders of disgust. Thirty-six participants completed an online version of a classic (neutral) HLT and FLT and two emotionally charged (disgust) versions. Our findings show that when body parts are modified so that they elicit emotional processing, disgust is salient overall, rather than being salient specifically for actions. This is true for both our hands and our feet.

Maternal interoceptive focus is associated with greater reported engagement in mother-infant stroking and rocking

Parental caregiving during infancy is primarily aimed at the regulation of infants' physiological and emotional states. Recent models of embodied cognition propose that interoception, i.e., the perception of internal bodily states, may influence the quality and quantity of parent-infant caregiving. Yet, empirical investigations into this relationship remain scarce. Across two online studies of mothers with 6- to 18-month-old infants during Covid-19 lockdowns, we examined whether mothers' self-reported engagement in stroking and rocking their infant was related to self-reported interoceptive abilities. Additional measures included retrospective accounts of pregnancy and postnatal body satisfaction, and mothers' reports of their infant's understanding of vocabulary relating to body parts. In Study 1 (N = 151) and Study 2 (N = 111), mothers reported their engagement in caregiving behaviours and their tendency to focus on and regulate bodily states. In a subsample from Study 2 (N = 49), we also obtained an objective measure of cardiac interoceptive accuracy using an online heartbeat counting task. Across both studies, the tendency to focus on and regulate interoceptive states was associated with greater mother-infant stroking and rocking. Conversely, we found no evidence for a relationship between objective interoceptive accuracy and caregiving. The findings suggest that interoception may play a role in parental engagement in stroking and rocking, however, in-person dyadic studies are warranted to further investigate this relationship.

Probing corporeal awareness in women through virtual reality induction of embreathment illusion

We capitalized on the respiratory bodily illusion that we discovered in a previous study and called 'Embreathment' where we showed that breathing modulates corporeal awareness in men. Despite the relevance of the issue, no such studies are available in women. To bridge this gap, we tested whether the synchronization of avatar-participant respiration patterns influenced females' bodily awareness. We collected cardiac and respiratory interoceptive measures, administered body (dis)satisfaction questionnaires, and tracked participants' menstrual cycles via a mobile app. Our approach allowed us to characterize the 'Embreathment' illusion in women, and explore the relationships between menstrual cycle, interoception and body image. We found that breathing was as crucial as visual appearance in eliciting feelings of ownership and held greater significance than any other cue with respect to body agency in both women and men. Moreover, a positive correlation between menstrual cycle days and body image concerns, and a negative correlation between interoceptive sensibility and body dissatisfaction were found, confirming that women's body dissatisfaction arises during the last days of menstrual cycle and is associated with interoception. These findings have potential implications for corporeal awareness alterations in clinical conditions like eating disorders and schizophrenia.

Disturbed interoception in body dysmorphic disorder: A framework for future research

Body dysmorphic disorder is a severe psychiatric condition characterised by a preoccupation with a perceived appearance flaw or flaws that are typically not observable to others. Although significant advances in understanding the disorder have been made in the past decade, current explanations focus on cognitive, behavioural and visual perceptual disturbances that contribute to the disorder. Such a focus does not consider how perception of the internal body or interoception may be involved, despite (1) clinical observations of disturbed perception of the body in body dysmorphic disorder and (2) disturbed interoception being increasingly recognised as a transdiagnostic factor underlying a wide range of psychopathologies. In this paper, we use an existing model of hierarchical brain function and neural (predictive) processing to propose that body dysmorphic disorder involves defective interoception, with perceived appearance flaws being the result of 'interoceptive prediction errors' that cause body parts to be experienced as 'not just right'. We aim to provide a framework for interoceptive research into body dysmorphic disorder, and outline areas for future research.

Is Interoception Deficit Linking Alexithymia and Eating Spectrum Symptoms? Study on a Non-Clinical Sample of Young Adults

We investigated if interoceptive deficits could be the link between alexithymic traits and eating spectrum manifestations in a non-clinical sample. One-hundred sixty-one young adults (mean age: 23.2 ± 2.4 years) were evaluated with the Toronto Alexithymia Scale-20 (TAS-20), the Interoceptive Accuracy Scale (IAS), the Interoceptive Confusion Questionnaire (ICQ), and the Eating Attitudes Test-26 (EAT-26). Questionnaires were administered with an online procedure (Microsoft Form, Office 365 A1, Pisa, Italy) (Study Protocol #0012005/2023). We compared ICQ, IAS, and TAS-20 scores in subjects who met the threshold for a potential eating spectrum disorder according to EAT-26 scores ≥ 20 (n = 27) vs. subjects who scored <20 (n = 134), with an ANCOVA corrected for 'age' and 'gender'. Subjects with EAT-26 ≥ 20, scored significantly higher at ICQ (54.4 ± 13.2 vs. 50.2 ± 6.8; p = 0.011), TAS-20 'Total Score' (60.8 ± 11.9 vs. 58.1 ± 9.2; p = 0.006), and TAS-20 'Identifying Feelings' (21.5 ± 7.6 vs. 17.3 ± 5.8; p = 0.0001). A binary logistic regression analysis, with EAT-26 scores < 20 vs. ≥20 as the dependent variable, and ICQ, IAS, TAS-20 total scores and dimensions, age, and gender (categorical) as covariates, showed that the only variable predicting eating spectrum symptomatology was 'ICQ Total Score' (OR = 1.075, 95% CI: 1.016-1.139; p = 0.013). Interoceptive confusion was the dimension linking the occurrence of alexithymic traits and eating spectrum manifestations.

A new conceptual model for anorexia nervosa: A role for connective tissue?

The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra-articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN. Therefore, a better understanding is needed to elucidate: (1) the relationship between abnormal connective tissue and AN, (2) the impact of starvation toward the development of abnormal connective tissue and how this manifests clinically, (3) the etiology of autonomic nervous system changes contributing to the dysautonomia in AN, and (4) how the sensory signals sent from potentially abnormal connective tissue to the central nervous system impact interoception in AN. A conceptual model incorporating abnormal connective tissue is provided. PUBLIC SIGNIFICANCE: The etiology of AN remains poorly understood and current theories fail to account for the direct impact of starvation on the health of the organs and tissues of the body. There is significant clinical overlap between AN and hereditary connective tissue disorders. This paper attempts to provide a new conceptual model for AN in which abnormal connective tissue contributes to the underlying pathogenesis.

A conceptual framework on body representations and their relevance for mental disorders

Many mental disorders are accompanied by distortions in the way the own body is perceived and represented (e.g., eating disorders, body dysmorphic disorder including muscle dysmorphia, or body integrity dysphoria). We are interested in the way these distortions develop and aim at better understanding their role in mental health across the lifespan. For this purpose, we first propose a conceptual framework of body representation that defines this construct and integrates different perspectives (e.g., cognitive neuroscience, clinical psychology) on body representations. The framework consists of a structural and a process model of body representation emphasizing different goals: the structural model aims to support researchers from different disciplines to structure results from studies and help collectively accumulate knowledge about body representations and their role in mental disorders. The process model is reflecting the dynamics during the information processing of body-related stimuli. It aims to serve as a motor for (experimental) study development on how distorted body representations emerge and might be changed. Second, we use this framework to review the normative development of body representations as well as the development of mental disorders that relate to body representations with the aim to further clarify the potential transdiagnostic role of body representations.

Beyond Gender: Interoceptive Sensibility as a Key Predictor of Body Image Disturbances

Body image disturbance (BID) involves negative attitudes towards shape and weight and is associated with lower levels of interoceptive sensibility (IS) (the subjective perceptions of internal bodily states). This association is considered a risk factor for developing eating disorders (EDs) and is linked to altered sensorimotor representations of the body (i.e., body schema). BIDs manifest across genders and are currently understudied in men. This study investigated gender-related differences in BID and its relationship to the body schema and IS. Data were collected from 86 men and 86 women. BID was assessed using questionnaires measuring self-objectification, state, and trait body dissatisfaction. IS was measured via the MAIA-2. The body schema was indexed via an embodied mental rotation task. Results showed that women reported higher BID than men across all scales. Gender differences in sub-components of interoceptive sensibility were found. Overall, both gender and interoceptive sensibility predicted BID. However, interoceptive sensibility exhibited its own unique association with BID beyond the influence of gender. BID, IS and gender were not significant predictors of performance in the body schema task. Therefore, while gender predicts differences in BID and interoceptive sensibility, there was no evidence of gender-related differences in body schema.

Incels, autism, and hopelessness: affective incorporation of online interaction as a challenge for phenomenological psychopathology

Recent research has drawn attention to the prevalence of self-reported autism within online communities of involuntary celibates (incels). These studies suggest that some individuals with autism may be particularly vulnerable to the impact of incel forums and the hopelessness they generate. However, a more precise description of the experiential connection between inceldom, self-reported autism, and hopelessness has remained unarticulated. Therefore, this article combines empirical studies on the incel community with phenomenological and embodiment approaches to autism, hopelessness, and online affectivity. We analyze three interrelated aspects of online interactions in incel communities - worldview, bodily self-relation, and mutual dismissals - and examine how these elements contribute to the consolidation of the loss of significant life possibilities. By investigating the potential negative influence of specific online environments on affective dispositions, our approach contributes to the debate on current challenges to "situate" phenomenological psychopathology.

Intolerable feelings of uncertainty within the body: Associations between interoceptive awareness, intolerance of uncertainty, and body dissatisfaction

BACKGROUND

Adolescence is a period marked by important physical and social changes, which often leads to an increase of body dissatisfaction. Recent studies have shown an association between interoception and body dissatisfaction in female adolescents. One variable that may contribute to the association between interoceptive awareness and body dissatisfaction is intolerance of uncertainty (IU). This study aims to investigate multiple facets of interoceptive awareness, IU, and their relations with body dissatisfaction in adolescent girls.

METHODS

In a cross-sectional study, a convenience sample of 307 adolescent girls (mean age = 17.73; SD = 1.02) was recruited in the Netherlands in 2022. Three questionnaires were completed measuring interoceptive awareness, IU, and body dissatisfaction. A moderation analyses using a multiple hierarchical regression was used to investigate associations between variables.

RESULTS

Correlation analyses indicated that several facets of lower interoceptive awareness (Not distracting, Not worrying and Trusting) were related to higher levels of body dissatisfaction. IU only marginally moderated the relationship between several domains of interoceptive awareness (Notice, Attention regulation and Emotional awareness) and body dissatisfaction.

DISCUSSION

Findings suggest that experiencing bodily signals as ambiguous and uncertain may result in more complex body image issues. Within certain domains of interoceptive awareness, IU may affect the process of appraising bodily signals. Furthermore, adolescent girls who do not feel safe in their body and who find it difficult to distract their thoughts when experiencing pain or discomfort in their body may be particularly at risk for developing more complex body image disturbances and may benefit from interventions improving both interoceptive awareness and IU. Moreover, future research should focus on interoceptive awareness and IU as potential underlying mechanisms for body image issues.

Body image disturbance, interoceptive sensibility and the body schema across female adulthood: a pre-registered study

Introduction

Body image disturbance (BID) typically involves explicit negative attitudes toward one's shape and weight and is associated with altered interoceptive sensibility (the subjective perception of internal bodily states). This association is a known risk factor for the development and maintenance of eating disorders. However, while research has centred on younger women with eating disorders, diverse facets of BID appear in women without eating disorders across adulthood. Research shows that in the general population, young women (ages 18-25) with high BID exhibit disturbances in the body schema: an implicit sensorimotor representation of the body in space which includes mental simulation of a movement such as motor imagery. Given that body image is subject to age-related influences, it is important to investigate how age-related variation in BID can influence the body schema beyond young adulthood alone. Here, we examine the relationship between BID, interoceptive sensibility and the body schema across female adulthood.

Methods

Cross-sectional data was collected online from 1,214 women across four age groups: Young adults (18-24), Adults (25-39), Middle-aged adults (40-59), and Older aged adults (60-75). BID was indexed by questionnaires measuring body objectification, state, and trait body dissatisfaction. Interoceptive sensibility (IS) was measured using the MAIA-2 questionnaire. The body schema was evaluated through the Own Body Transformation task: a mental rotation task which assesses the capacity to make an embodied mental transformation.

Results

Analyses revealed that while body objectification and trait body dissatisfaction decreased from young to older adulthood, state body dissatisfaction showed a marked increase. A negative relationship between IS and BID across all age groups was also evidenced. Finally, age, BID and orientation of the presented body were significant predictors of the time taken to make an embodied transformation.

Discussion

These findings highlight the consistent relationship of BID and IS across age groups beyond young adulthood and demonstrate the varying importance of different aspects of BID as individuals age. We also evidence for the first time that disruptions in body image have the potential to impact implicit sensorimotor representations of the body even in women without eating disorders across female adulthood.

Linguistic embodiment in typical and atypical anorexia nervosa: Evidence from an image-word matching task

OBJECTIVE

The integration of sensory, motor, and cognitive systems is embodied cognition, according to which mind and body are not separate and distinct, and our body (and our brain, as part of the body) contributes to determining our mental and cognitive processes. In spite of limited data available, Anorexia nervosa (AN) appears as a condition in which embodied cognition is altered, in particular, if we consider bodily sensations and visuospatial information processing. We aimed to evaluate the ability to correctly identify body parts and actions in both full (AN) and atypical AN (AAN), looking at the role of the underweight status.

METHOD

A group of 143 females (AN = 45, AAN = 43, unaffected women = 55) was enrolled. All participants performed a linguistic embodied task to evaluate the association between a picture-showing a bodily action-and a written verb. Additionally, a subsample of 24 AN participants performed a retest after stable weight recovery.

RESULTS

Both AN and AAN demonstrated an abnormal ability to evaluate the picture-written verb associations, especially if the involved bodily effectors were the same in both stimuli (i.e., pictorial and verbal) and needed a longer response time.

CONCLUSIONS

Specific embodied cognition linked to body schema seems to be impaired in persons with AN. The longitudinal analysis showed a difference between AN and AAN only in the underweight condition, suggesting the presence of an abnormal linguistic embodiment. More attention should be devoted to embodiment during AN treatment to improve bodily cognition, which might, in turn, diminish body misperception.

Interoceptive and Affective Alterations in Body Integrity Dysphoria: An Online Self-Reporting Study

INTRODUCTION

Body integrity dysphoria (BID) is a rare condition in which individuals experience a long-lasting desire to achieve a specific physical disability. In this study, we tested the hypothesis of interoceptive and affective abnormalities in BID, in line with the evidence of structural and functional alteration of the interoceptive-affective neural system in these individuals.

METHOD

Our study involved 68 participants with BID (mean age: 35.6, SD: 16.4). Among these participants, 47 expressed a desire for amputation, 14 desired paralysis, 3 sought sensory deprivation, and 3 desired a combination of these forms. For comparisons, we recruited a control group of 79 participants (mean age: 35.2, SD: 15.8). We administered assessment measures to investigate alexithymia level (TAS-20), disgust sensitivity (DS-R), interoceptive awareness (MAIA-2), and (affective and cognitive) empathy (QCAE). We also administered the Short Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) to identify psychiatric comorbidities. Subgroups with low O-LIFE scores (BID = 31; controls = 43) and subgroups with high O-LIFE scores (BID = 37; controls = 36) were derived through a median-split procedure.

RESULTS

Within the BID low O-LIFE group, we found reduced interoceptive sensibility, reduced disgust sensitivity, and increased difficulty in identifying feelings, which refers to a dimension of the alexithymia trait. Within the BID high O-LIFE group, we observed a reduced disgust sensitivity and interoceptive sensibility, accompanied by a diminished score in cognitive empathy.

CONCLUSION

Our study suggests that BID can be associated with altered interoceptive and affective processing.

Dysfunctional decision-making in binge-eating disorder: A meta-analysis and systematic review

Binge-Eating Disorder (BED) involves anticipatory craving and urges, subjective loss-of-control during binge-eating episodes, and post-feeding psychological distress and guilt. Evidence indicates neurocognitive dysfunctions contribute to BED onset, maintenance, and treatment response. However, an integrated understanding of how cognitive processes underpin BED symptomology is lacking. We utilised a multi-stage decision-making model defining ten cognitive processes underpinning Preference Formation, Choice Implementation, Feedback Processing, and Flexibility/Shifting, to comprehensively review research published since 2013. We used preregistered PICOS criteria to assess 1966 articles identified from PubMed, PsycInfo, and Scopus database searches. This yielded 50 studies reporting behavioural cognitive tasks outcomes, comparing individuals with BED to controls with normal and higher weight. Meta-analyses revealed a unique profile of cognitive dysfunctions that spanned all decision-making stages. Significant deficits were evident in Uncertainty Evaluation, Attentional Inhibition, Choice Consistency, and Cognitive Flexibility/Set-shifting. We propose a novel model of dysfunctional decision-making processes in BED and describe their role in binge-eating behaviour. We further highlight the potential for cognitive interventions to target these processes and address the significant treatment gap in BED.

Connectome-based prediction of eating disorder-associated symptomatology

BACKGROUND

Despite increasing knowledge on the neuroimaging patterns of eating disorder (ED) symptoms in non-clinical populations, studies using whole-brain machine learning to identify connectome-based neuromarkers of ED symptomatology are absent. This study examined the association of connectivity within and between large-scale functional networks with specific symptomatic behaviors and cognitions using connectome-based predictive modeling (CPM).

METHODS

CPM with ten-fold cross-validation was carried out to probe functional networks that were predictive of ED-associated symptomatology, including body image concerns, binge eating, and compensatory behaviors, within the discovery sample of 660 participants. The predictive ability of the identified networks was validated using an independent sample of 821 participants.

RESULTS

The connectivity predictive of body image concerns was identified within and between networks implicated in cognitive control (frontoparietal and medial frontal), reward sensitivity (subcortical), and visual perception (visual). Crucially, the set of connections in the positive network related to body image concerns identified in one sample was generalized to predict body image concerns in an independent sample, suggesting the replicability of this effect.

CONCLUSIONS

These findings point to the feasibility of using the functional connectome to predict ED symptomatology in the general population and provide the first evidence that functional interplay among distributed networks predicts body shape/weight concerns.

Abnormal sense of agency in eating disorders

The feeling of controlling one's own actions and, through them, impacting the external environment (i.e. Sense of Agency-SoA) can be relevant in the eating disorders (EDs) symptomatology. Yet, it has been poorly investigated. This study aims to implicitly assess SoA exploiting the Sensory Attenuation paradigm in two groups of EDs patients (Anorexia Nervosa Restrictive and Anorexia Nervosa Binge-Purging or Bulimia Nervosa) compared to a control group. We find that controls perceive self-generated stimuli as less intense than other-generated ones showing the classic pattern of sensory attenuation. By contrast, EDs patients show the opposite pattern, with self-generated perceived as more intense than other-generated stimuli. This result indicates an alteration of the implicit component of the feeling of control in EDs patients, thus suggesting a potential implication of these results for the clinical practice and the treatment of EDs symptomatology.

The impact of interoceptive accuracy and stimulation type on the out-of-body experience

People tend to perceive a virtual body standing in front of them as their own if it is either stroked or moving synchronously with their own real body-the out-of-body experience (OBE). We combined synchrony manipulation with two other factors of theoretical interest: the kind of stimulation, visuotactile stimuli or visuomotor correlations, being synchronised and the interoceptive accuracy (IA) of participants, assessed by means of the heartbeat counting task. Results showed that explicit measures of embodiment were systematically affected by synchrony, and this synchrony effect was more pronounced for visuomotor than for visuotactile conditions. The walking drift was affected by IA: In visuotactile conditions, the synchrony effect was pronounced in individuals with low IA, presumably reflecting a stronger impact of the visual information. In visuomotor conditions, however, the synchrony effect was stronger in individuals with high IA, presumably reflecting a stronger impact of re-afferent information generated by the participants' own movements.

Central Autonomic Network Alterations in Anorexia Nervosa Following Peripheral Adrenergic Stimulation

BACKGROUND

Anorexia nervosa (AN) is characterized by low body weight, disturbed eating, body image disturbance, anxiety, and interoceptive dysfunction. However, the neural processes underlying these dysfunctions in AN are unclear. This investigation combined an interoceptive pharmacological probe, the peripheral β-adrenergic agonist isoproterenol, with resting-state functional magnetic resonance imaging to examine whether individuals with AN relative to healthy comparison participants show dysregulated neural coupling in central autonomic network brain regions.

METHODS

Resting-state functional magnetic resonance imaging was performed in 23 weight-restored female participants with AN and 23 age- and body mass index-matched healthy comparison participants before and after receiving isoproterenol infusions. Whole-brain functional connectivity (FC) changes were examined using central autonomic network seeds in the amygdala, anterior insular cortex, posterior cingulate cortex, and ventromedial prefrontal cortex after performing physiological noise correction procedures.

RESULTS

Relative to healthy comparison participants, adrenergic stimulation caused widespread FC reductions in the AN group between central autonomic network regions and motor, premotor, frontal, parietal, and visual brain regions. Across both groups, these FC changes were inversely associated with trait anxiety (State-Trait Anxiety Inventory-Trait), trait depression (9-item Patient Health Questionnaire), and negative body image perception (Body Shape Questionnaire) measures, but not with changes in resting heart rate. These results were not accounted for by baseline group FC differences.

CONCLUSIONS

Weight-restored females with AN show a widespread state-dependent disruption of signaling between central autonomic, frontoparietal, and sensorimotor brain networks that facilitate interoceptive representation and visceromotor regulation. Additionally, trait associations between central autonomic network regions and these other brain networks suggest that dysfunctional processing of interoceptive signaling may contribute to affective and body image disturbance in AN.

Association of Hypnotizability, Interoception, and Emotion

The present scoping review reports the reciprocal relations between hypnotizability, interoception, and emotion. Brain morpho-functional differences may account for the lower interoceptive accuracy, higher interoceptive sensitivity, and different emotional strategies observed in highly hypnotizable participants with respect to medium-to-low hypnotizables. Since interoception is relevant to both physical and mental health and hypnotizability can predict both interoceptive abilities and the efficacy of interoception-based mental training, this allows for the development of new forms of treatment and rehabilitation.

Feeling difficult to identify: Alexithymia is inversely associated with positive body image in adults from the United Kingdom

BACKGROUND

Research has increasingly examined the ways in which internal bodily experiences influence body image, including the relationship between alexithymia - the reduced ability to identify and describe one's own emotional feelings and bodily sensations - and negative body image. However, relationships between facets of alexithymia and positive body image remain unexplored.

METHODS

To bridge this gap in the literature, we assessed relationships between facets of alexithymia and multiple, core indices of positive body image in an online sample of adults from the United Kingdom. A total of 395 participants (226 women, 169 men) aged 18 to 84 years completed measures of alexithymia, body appreciation, functionality appreciation, body image flexibility, body acceptance by others, and positive rational acceptance.

RESULTS

Once the effects of age had been accounted for, alexithymia was significantly and negatively associated with all five body image constructs in hierarchical multiple regressions. In the final models, the alexithymia facet of Difficulties Identifying Feeling emerged as a significant and negative predictor of all indices of positive body image.

LIMITATIONS

The use of cross-sectional data limits the causal conclusions that can be drawn.

CONCLUSIONS

These findings extend previous work by demonstrating the unique relationship between alexithymia and positive body image, providing important implications for body image research and practice.

Body image, interoceptive awareness, depression and eating disorder symptoms: Within-group variability among sexual minority women

This study investigates within-group differences in body image concerns among sexual minority women and their related association with eating disorders and depression. Cross-sectional data were collected in 2017 and analysed in 2020 from 201 sexual minority women in the United States. Latent profile analyses and post hoc comparison analyses were conducted to investigate within-group variability in body image concerns and to understand their impact on depressive and eating disorder symptoms. Results suggested that a 5-class solution best fit the data, with five distinct profiles emerging in patterns of interoceptive awareness, sociocultural attitudes toward appearance, body shame, body surveillance and appearance anxiety. Significant differences in mean scores of depressive and eating disorder symptomatology emerged among the profiles; groups that reported low interoceptive awareness and high body image concerns experienced greater levels of eating disorder and depressive symptoms, compared to groups with average or higher levels of interoceptive awareness and average or lower body image concerns. Results underscore the significant within-group variability that exists for sexual minority women with regard to the prevalence of body image concerns, depressive symptoms and eating disorder symptoms. Efforts that aim to increase interoceptive awareness (for example, mindfulness) alongside strategies aimed at addressing negative body image concerns may be particularly effective avenues for future depression and eating disorder prevention in this diverse group. Our reporting adheres to the STROBE research reporting checklist.

Mapping the mental space of emotional concepts through kinematic measures of decision uncertainty

Emotional concepts and their mental representations have been extensively studied. Yet, some ecologically relevant aspects, such as how they are processed in ambiguous contexts (e.g., in relation to other emotional stimuli that share similar characteristics), are incompletely known. We employed a similarity judgement of emotional concepts and manipulated the contextual congruency of the responses along the two main affective dimensions of hedonic valence and physiological activation, respectively. Behavioural and kinematics (mouse-tracking) measures were combined to gather a novel 'similarity index' between emotional concepts, to derive topographical maps of their mental representations. Self-report (interoceptive sensibility, positive-negative affectivity, depression) and physiological measures (heart rate variability, HRV) have been collected to explore their possible association with emotional conceptual representation. Results indicate that emotional concepts typically associated with low arousal profit by contextual congruency, with faster responses and reduced uncertainty when contextual ambiguity decreases. The emotional maps recreate two almost orthogonal axes of valence and arousal, and the similarity measure captures the smooth boundaries between emotions. The emotional map of a subgroup of individuals with low positive affectivity reveals a narrower conceptual distribution, with variations in positive emotions and in individuals with reduced arousal (such as those with reduced HRV). Our work introduces a novel methodology to study emotional conceptual representations, bringing the behavioural dynamics of decision-making processes and choice uncertainty into the affective domain. This article is part of the theme issue 'Concepts in interaction: social engagement and inner experiences'.

Self-Consciousness and Self-Awareness: Associations between Stable and Transitory Levels of Evidence

The theory of objective self-awareness predicts the assessment of stable or dispositional self-consciousness and transitory or situational self-awareness. The aim of the present research was to investigate potential associations between patterns of experiential self-description to scores on self-report measures of dispositional self-consciousness. A total of 64 Brazilian volunteers (Mage = 29.7, SD = 8.79, 64.1% female) responded to the Revised Self-Consciousness Scale, the Philadelphia Mindfulness Scale, and the Rumination-Reflection Questionnaire before participating in an experience sampling protocol. The protocol consisted of random daily requests for up to four self-description experiences across seven consecutive days. Participants recorded audio messages on their mobile phones in reply to each request describing their current experience. Reports were analyzed through a reflexive thematic analysis that produced twenty sub-themes accounting for descriptive markers of experience. Based on those descriptive markers, the qualitative data were then transformed into quantitative data for the situational self-awareness indexes. Evidence of association between self-consciousness and self-awareness was stronger for the awareness subscale in a positive correlation with affective situational self-awareness and in a negative correlation with mental representational transitory self-awareness. Although relational evidence has been provided, the data reinforced the theoretical distinction between self-consciousness and self-awareness.

The influence of high worry on static and dynamic insular functional connectivity

Worry is a form of repetitive negative thought. High worry-proneness is one risk factor leading to anxiety disorder. Several types of research indicated that anxiety disorder was highly associated with disrupted interoception. The insula is consistently considered to play a key role in interoception. However, the relationship between worry and the interoception network is poorly investigated in worry-prone individuals. Thus, it is essential to identify the neural characteristic of high worry-proneness subjects. A total of 32 high worry-proneness (HWP) subjects and 25 low worry-proneness (LWP) subjects were recruited and underwent magnetic resonance imaging scanning. Six subregions of insula were chosen as regions of interest. Then, seed-based static and dynamic functional connectivity were calculated. Increased static functional connectivity was observed between the ventral anterior insula and inferior parietal lobule in HWP compared to LWP. Decreased static functional connectivity was found between the left ventral anterior insula and the pregenual anterior cingulate cortex. Decreased dynamic functional connectivity was also shown between the right posterior insula and the inferior parietal lobule in HWP. Moreover, a post-hoc test exploring the effect of changed function within the insular region confirmed that a significant positive relationship between static functional connectivity (ventral anterior insula-inferior parietal lobule) and dynamic functional connectivity (posterior insula-inferior parietal lobule) in LWP but not in HWP. Our results might suggest that deficient insular function may be an essential factor related to high worry in healthy subjects.

Longitudinal relationships between specific domains of interoception and muscle dysmorphia symptoms

Muscle dysmorphia (MD) is a subtype of body dysmorphic disorder (BDD); few risk factors for MD symptom development have been identified. One potential risk factor may be decreased interoceptive sensibility (impaired ability to recognize bodily sensations), which is present across a range of mental disorders. Notably, impaired interoceptive awareness is elevated in populations at-risk for MD. Furthermore, interoception is associated with MD symptoms, and theoretically, interoceptive dysfunction may facilitate engagement in MD symptoms. However, longitudinal research on interoception and MD is scarce, and specific MD symptoms implicated in these relationships are unknown. This study examined longitudinal relationships between specific domains of interoceptive sensibility and MD symptoms. Participants were 255 (26.7% Male; 72.1% Female; 1.2% Non-binary) undergraduates who completed two self-report surveys separated by four weeks. A path model was specified in which seven forms of interoception predicted five MD symptoms. Results suggested that interoceptive sensibility characterized by difficulties attending to bodily sensations and viewing these sensations as distracting predicted MD symptoms like muscle checking, positive attitudes towards using muscle-building substances, and compulsive exercise. Specific forms of impaired interoceptive sensibility may represent a risk factor for MD symptoms. If clinicians can increase the interoceptive abilities of their clients at risk for MD, this may prevent the development of MD symptoms.

Efficacy of interoceptive and embodied rehabilitative training protocol in patients with mild multiple sclerosis: A randomized controlled trial

Introduction

The aim of this randomized controlled trial was to evaluate the effect of an embodied rehabilitative protocol, in improving interoceptive awareness respect balance and motor performance in patients with mild multiple sclerosis (pwMS).

Methods

In this study patients with relapsing-remitting multiple sclerosis were enrolled. The rehabilitative treatment group (TG) participated in an embodied physiotherapy program consisting of 8 one-hour sessions in groups of 4 patients at a time, 1 per week and 2 one-hour sessions of neuro-cognitive exercise in single session during the rehabilitation program. All pwMS underwent a clinical assessment to measure the interoception sense for the Multidimensional Assessment of Interoceptive Awareness scale, balance for the Tinetti Mobility test and stabilometry, quality of life for the Short Form Health Survey-12 and body image perception for Trunk Appearance Perception Scale and Body Image Scale. All previous scales and tests were performed at baseline (T0), at the end of treatment (T1) and after 2 months of follow up (T2).

Results

Sixty patients were enrolled and randomized into two groups: TG (n = 30), aged 43.0 ± 10.2 years, and a control/waiting list (WLG) group (n = 30), aged 40.7 ± 10.4 years. Statistically significant improvements in interoceptive awareness, body image perception, balance and quality of life were reported in TG versus WLG (p < 0.05).

Discussion

This study suggests that enhancing interoceptive awareness could improve postural balance. Future studies with a larger sample of patients will be needed to better quantify the effects of an embodied rehabilitation.

The neural correlates of socio-cognitive factors and eating disorders in young people: A systematic review

BACKGROUND

Although the primary aetiology of Eating Disorders (ED) remains unknown, research suggests a complex interplay of biological, psychological, and cultural/environmental factors. This paper aims to systematically review the literature on neuroimaging studies that measure socio-cognitive factors, in the context of body dissatisfaction and EDs in young people. Specifically, our aim was to identify patterns in the findings linked to social media-type behaviours.

METHODS

The review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. 799 papers were identified in the database search and 38 studies were selected based on exclusion and inclusion criteria. Selected studies were assessed using the National Institute of Health study quality assessment tool.

RESULTS

Findings point to state-related impairments in inhibitory control and salient emotional processing. Anorexia Nervosa(AN) showed impaired set-shifting abilities, working memory and decision making, while altered activation in attention networks and associated difficulties with conflict resolution were seen for Bulimia Nervosa(BN) and Other Specified Feeding and Eating Disorders(OSFED). AN and BN also demonstrated altered sensitivity to food-related stimuli in striatal regions, suggesting aberrant top-down emotional-cognitive control. ED participants also show deficits in body representation, impaired control over social behaviours and altered integration of visual and body perception.

DISCUSSION

These findings support the notion that socio-cognitive dysfunctions in ED are underpinned by a distributed network of structural and functional brain changes which influence the way young people with ED interact with and respond to social media, and ultimately places at them at increased risk for body image disturbances. This Review was registered with the PROSPERO International Register of Systematic Reviews, Registration number CRD42021270696.

Time evaluation and its accuracy in eating disorders: differences in relation to interoceptive awareness

PURPOSE

Time evaluation has been poorly studied in eating disorder (ED) patients despite its relationship with body awareness, which is a core psychopathological feature in EDs and is influenced by impulsivity, interoception, and working memory. This study aims to evaluate time estimation and its accuracy across the ED spectrum in connection with specific and general psychopathology.

METHODS

A group of 215 women was enrolled in a computerized task involving the estimation of 1-min intervals. Impulsivity and body awareness constructs (self-monitoring, depersonalization, interoceptive deficit) were evaluated and examined for significant correlations with time estimation and the accuracy of the measure.

RESULTS

Patients with EDs showed an impaired ability to estimate time, with an accuracy that positively correlated with compulsive self-monitoring (p = 0.03). Differences between diagnostic subgroups showed an overestimation of time in anorexia nervosa patients and an underestimation of time in binge eating disorder patients, whose time estimation was also less accurate.

CONCLUSION

The relationship between time estimation and compulsive self- monitoring might corroborate the presence of an imbalanced integration of information in patients with EDs that was not present in the community women included in the study. Time perception should be further evaluated in the ED field, and longitudinal changes due to psychopathological recovery or BMI changes should be examined.

LEVEL OF EVIDENCE

Level III: Evidence obtained from a well-designed cohort or case-control analytic study.

Physical activity improves body image of sedentary adults. Exploring the roles of interoception and affective response

To reduce the number of sedentary people, an improved understanding of effects of exercise in this specific group is needed. The present project investigates the impact of regular aerobic exercise uptake on body image, and how this effect is associated with differences in interoceptive abilities and affective response to exercise. Participants were 29 sedentary adults who underwent a 12-week aerobic physical activity intervention comprised of 30–36 sessions. Body image was improved with large effect sizes. Correlations were observed between affective response to physical activity and body image improvement, but not with interoceptive abilities. Explorative mediation models suggest a neglectable role of a priori interoceptive abilities. Instead, body image improvement was achieved when positive valence was assigned to interoceptive cues experienced during exercise.

Interoceptive sensibility and body satisfaction in pregnant and non-pregnant women with and without children

Pregnancy is a time of great physical and psychological change. As well as prominent changes in the external appearance of the body, such as the baby bump, there are also substantial changes taking place within the body. Our awareness of, and attention towards, internal bodily signals (interoception) is thought to have a direct impact on how we feel about our bodies. Therefore, understanding how our experience of these interoceptive signals might change during pregnancy may have important implications for maternal wellbeing. This study examined body satisfaction and interoceptive sensibility (subjective experience of interoception) in pregnant and non-pregnant women with and without children. Feelings towards pregnancy-specific changes in body satisfaction and interoceptive sensibility were also examined in women in their first pregnancy (primigravida) and subsequent pregnancies (multigravida). It was found that pregnancy did not directly impact levels of body satisfaction, instead pregnant and non-pregnant women with children reported less satisfaction with their bodies compared to those without children. Primigravida women were more satisfied with the appearance of pregnancy specific bodily changes compared to multigravida women. Interestingly, these differences in body satisfaction in those with children (pregnant and non-pregnant) were mediated by the extent to which women trusted their bodies (measure of interoceptive sensibility). All other pregnancy related changes in interoceptive sensibility and body satisfaction were either non-significant or had small effect sizes. These results may suggest body trust as an important factor to support during the transition to parenthood in order to improve body satisfaction in mothers.

Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program

Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.

Vicarious ratings of self vs. other-directed social touch in women with and recovered from Anorexia Nervosa

Anorexia Nervosa (AN) is an eating pathology characterized by restricted eating, body image distortions and impaired socio-cognitive abilities. Altered responses to affective touch—a pleasant interoceptive stimulus hypothesised to involve activation of the C-Tactile (CT) system, may contribute to the aetiology and maintenance of this disorder. Here, we investigated whether third-party social touch vicarious ratings of different body sites at CT-optimal vs. non-CT optimal velocities differed in women with and recovered from AN (RAN) and healthy controls (HCs). Thirty-five HCs, 27 AN and 29 RAN provided pleasantness ratings for two different tasks designed to probe expectations of how touch is perceived by self (self-directed touch) vs. others (other-directed touch). Findings revealed that both clinical groups, compared to HCs, did not differ in their pleasantness ratings to touch for another but when evaluating touch for self, both clinical groups rated CT-optimal touch as less pleasant than HCs. These findings suggest that AN and RAN women demonstrate an atypical vicarious pleasantness response to affective touch involving self, but not others. Novel therapeutic approaches that help anorexics to better interpret or improve tolerance of affective tactile experiences involving the self may be an important addition to current standard treatments.

Creating Inclusive Classrooms for Highly Dysregulated Students: What Can We Learn from Existing Literature?

The ability to self-regulate is a key focus for educators, especially for neurodivergent students, such as those with ADHD, fetal alcohol syndrome, mental health difficulties, autism, and/or anxiety. Students not being able to self-regulate frequently results in their behaviours being labelled as “naughty” or “challenging” by teachers. Continued dysregulation can lead to periods of suspension and exclusion, impacting both attendance rates for students and their broader families. Previous research has shown that the impacts of poor self-regulation can be wide-ranging, spanning both social and academic outcomes. The broad negative impact of poor self-regulation means that it is important to support families and classroom teachers to effectively improve children’s self-regulation. However, to support families and educators, there is a need to develop and deploy a theoretical framework to suggest why self-regulation may be under-developed and, conversely, how self-regulation may be effectively developed across a wide range of contexts. This paper considers current literature exploring the links between individual experiences of emotions and connections with core abilities of interoception, self-regulation, emotional intelligence, and metacognition. It outlines a hypothesised model of how these abilities intertwine and how supporting core building blocks within educational settings can enable supportive and inclusive educational contexts, providing positive experiences for students and teachers alike.

Mirror, mirror, on the wall: During pandemics, how can self-perception research in people with eating disorders happen at all?

BACKGROUND

'Classic' embodiment illusions (e.g., the feeling of owning another person's hand) involves a three-way interaction between visual, proprioceptive, and tactile stimuli. These illusions have been studied in eating disorder (ED) populations given the potential implications for better understanding and improving body image concerns. Recently, several studies have employed 'tactile-reduced' methods mainly relying on the integration of visual and proprioceptive information to induce embodiment illusions in non-ED populations. To date, there has been no substantial review of these tactile-reduced approaches to consider their potential research and clinical utility in ED populations.

METHOD

This review sought to examine and integrate studies across three areas. Firstly, those that employed tactile-reduced embodiment techniques in non-ED populations. Secondly, those that used classic embodiment techniques to compare whether ED and non-ED populations differ in their susceptibility to embodiment. Thirdly, studies that investigated whether experiencing classic or tactile-reduced embodiment techniques can improve image-related concerns.

RESULTS

For the first aim five studies were identified, all of which found that tactile-reduced methods consistently induced embodiment illusions in non-ED individuals. For the second aim, seven studies comparing ED and non-ED samples were found. ED patients were more susceptible to embodiment than non-ED samples in four studies, less susceptible in one study, and equally susceptible in two studies. Finally, for aim three, amongst the seven studies that used classic or tactile-reduced embodiment methods in ED populations, six reported improvements in self-perception (i.e., reduced body size overestimation, decreased body dissatisfaction and fear of gaining weight).

CONCLUSIONS

Along with the classic approach, tactile-reduced embodiment approaches have implications for ED research and clinical practice, particularly for situations when face-to-face contact with people are restricted. Suggestions are provided for future researchers who wish to ensure best practice for planning embodiment research involving classic and tactile-reduced approaches.

Association between high levels of body-esteem and increased degree of midcingulate cortex global connectivity: A resting-state fMRI study

Multiple neuroimaging studies have examined the neural underpinnings of body image disturbances in patients with eating disorders. However, key brain regions related to body image, such as body-esteem (BE), among healthy individuals are understudied. Given the extremely crucial role of BE in eating behaviors and physical and mental health, the current study conducted data-driven analysis and characterized the neurobiological correlates of BE with the network properties of the resting brain using the voxel-wise degree centrality (DC) measures of resting-state functional magnetic resonance imaging (rs-fMRI) data and seed-based resting-state functional connectivity (RSFC). A total of 694 healthy young adults (females = 474, mean age = 18.38 years, range = 17-22) underwent rs-fMRI, and completed the Body-Esteem Scale for Adolescents and Adults, the Eating Disorder Diagnosis Scale, and the Restraint Scale. After correcting for differences in age, gender, body mass index, and head motion, whole-brain correlation analyses revealed that a high level of BE was associated with increased DC within the right midcingulate cortex (MCC) and subsequent high levels of MCC-based RSFC strengths. Furthermore, MCC connectivity patterns related to BE were inversely associated with disordered eating behaviors. These findings suggest that adaptive cognitive and emotional regulation (i.e., self-evaluation and emotion based on body image) may explain the potential relationship between MCC connectivity patterns and BE to a certain extent. As such, future studies should investigate these interesting possibilities.

Permutation Entropy as a Universal Disorder Criterion: How Disorders at Different Scale Levels Are Manifestations of the Same Underlying Principle

What do bacteria, cells, organs, people, and social communities have in common? At first sight, perhaps not much. They involve totally different agents and scale levels of observation. On second thought, however, perhaps they share everything. A growing body of literature suggests that living systems at different scale levels of observation follow the same architectural principles and process information in similar ways. Moreover, such systems appear to respond in similar ways to rising levels of stress, especially when stress levels approach near-lethal levels. To explain such communalities, we argue that all organisms (including humans) can be modeled as hierarchical Bayesian controls systems that are governed by the same biophysical principles. Such systems show generic changes when taxed beyond their ability to correct for environmental disturbances. Without exception, stressed organisms show rising levels of 'disorder' (randomness, unpredictability) in internal message passing and overt behavior. We argue that such changes can be explained by a collapse of allostatic (high-level integrative) control, which normally synchronizes activity of the various components of a living system to produce order. The selective overload and cascading failure of highly connected (hub) nodes flattens hierarchical control, producing maladaptive behavior. Thus, we present a theory according to which organic concepts such as stress, a loss of control, disorder, disease, and death can be operationalized in biophysical terms that apply to all scale levels of organization. Given the presumed universality of this mechanism, 'losing control' appears to involve the same process anywhere, whether involving bacteria succumbing to an antibiotic agent, people suffering from physical or mental disorders, or social systems slipping into warfare. On a practical note, measures of disorder may serve as early warning signs of system failure even when catastrophic failure is still some distance away.

Affective touch topography and body image

Recent evidence suggests that altered responses to affective touch—a pleasant interoceptive stimulus associated with activation of the C-Tactile (CT) system—may contribute to the aetiology and maintenance of mental conditions characterised by body image disturbances (e.g., Anorexia Nervosa). Here, we investigated whether tactile pleasantness and intensity differ across body sites, and if individual differences in dysmorphic appearance concerns and body and emotional awareness might be associated with touch perceptions across body sites. To this end, we measured perceived pleasantness and intensity of gentle, dynamic stroking touches applied to the palm, forearm, face, abdomen and back of 30 female participants (mean age: 25.87±1.17yrs) using CT-optimal (3 cm/s) and non-CT optimal (0.3 and 30 cm/s) stroking touch. As expected, participants rated CT-targeted touch as more pleasant compared to the two non-CT optimal stroking touch at all body sites. Regardless of stroking velocity, touch applied to the abdomen elicited the lowest pleasantness ratings. Lower levels of emotional awareness, greater levels of interoceptive sensibility and of dysmorphic concerns were associated with lower preference for CT-optimal stroking touch applied to the forearm and the back. These findings begin to elucidate the link between CT sensitivity, dysmorphic appearance concerns and body and emotional awareness, which may have implications for future research looking to inform early interventions. Addressing impaired processing of affective interoceptive stimuli, such as CT-targeted touch, may be the key to current treatment approaches available for those populations at risk of disorders characterised by body image disturbance.