Emotional regulation and bodily sensation: interoceptive awareness is intact in borderline personality disorder

Association between individual differences in interoception and cardiac coherence during heart rate variability biofeedback

Heart rate variability biofeedback (HRVBF) is the training to increase vagally-mediated heart rate variability (vmHRV), accompanied by slow-paced breathing and feedback of heart rhythm. It has been reported to be effective for emotion and cognition. In recent years, increased attention has turned toward participant characteristics as factors affecting HRVBF training effects. Focusing on neural basis commonalities between the mechanisms of HRVBF training effects and processing interoception, this study comprehensively measured interoception and examined the relationship between interoception and cardiac coherence reflecting HRVBF effects. Fifty-four healthy young participants were recruited, and subjective interoception was measured using the Japanese version of Multidimensional Assessment of Interoceptive Awareness (MAIA-J) and the Japanese version of the Body Perception Questionnaire-Body Awareness Very Short Form (BPQ-BAVSF-J), objective interoception using heartbeat counting task (HCT), heart rate variability (HRV), visual exteroception, and the coherence score achieved by HRVBF. We conducted a multiple regression analysis with interoception, HRV, and visual exteroception parameters as explanatory variables and the coherence score as the objective variable. Some subjective interoception and HRV parameters were found to be associated with the coherence score. Our results were consistent with previous studies, showing that higher vmHRV was related to high cardiac coherence. Interoception effects on cardiac coherence may be limited because of the low adjusted coefficient of determination and less selected explanatory variables in the multiple regression analysis. Our results may contribute toward predicting HRVBF training effects and the screening of those who are likely to benefit from the training from the perspective of interoception and vmHRV.

Under the surface: Low cardiac vagal tone and poor interoception in young adults with subclinical depressive symptoms

INTRODUCTION

Depressive symptoms are associated with alterations in central and autonomic nervous system activity, including misperception of bodily activity (e.g., low interoception), somatic symptoms and decreased vagally mediated heart rate variability (vmHRV). However, there is a lack of studies that examine both perception of bodily activity and autonomic function in depression. The present study investigated the association between interoception, vmHRV, and subclinical depressive symptoms.

METHOD

Eighty-eight students were enrolled and vmHRV was calculated from a 5-minute resting electrocardiogram. Interoceptive accuracy (heartbeat tracking task; heartbeat discrimination task), interoceptive sensibility (Body Perception Questionnaire), and depressive symptoms (Depression, Anxiety and Stress Scale - 21 Items) were assessed.

RESULTS

Interoceptive accuracy and sensibility positively correlated with vmHRV and negatively correlates with depressive symptoms. Cluster analysis performed on vmHRV, interoceptive accuracy, and sensibility provided two clusters: the first characterized by a pattern of low interoceptive accuracy, sensibility, and decreased resting vmHRV, the second characterized by an opposite pattern. Regression analyses showed that the first cluster was characterized by significantly higher depressive symptoms compared to the second (β = 1.97; pBonferroni = 0.04), even after controlling for sex, BMI, anxiety, and stress levels.

CONCLUSIONS

Subclinical depressive symptoms are associated with a consistent impairment in the perception and interpretation of bodily activity and altered regulatory function of the autonomic nervous system. The present results suggest that the alteration of brain-body communication could be involved in subclinical depressive symptoms. Early identification of such alterations could help with targeted preventive strategies.

Having the Heart to Exercise Control: Cardiac Interoception Influences Self-Paced Exercise Regulation

The aim of this study was to examine the role of cardiac interoception on self-regulated (Experiment 1) and externally prescribed (Experiment 2) exercises. Cardiac interoception was assessed using heartbeat tracking and discrimination tasks in both experiments. Based on heartbeat discrimination performance, participants were partitioned into groups demonstrating GOOD and POOR cardiac interoceptive accuracy. In Experiment 1, 20 participants completed two self-regulated 20-min cycling tasks at two intensities (light rated physical exertion [RPE on Borg Scale = 10] vs. hard-to-very hard, RPE = 16). During self-regulated exercise, the POOR cardiac interoception group showed lower differences in their exercise work rates and physiological responses between light and hard-to-very hard intensity exercises. These differences were partly attributable to a higher work rate over the first 5 min of light intensity exercise and a higher initial rate of work in the first min of hard-to-very hard intensity exercise. In Experiment 2, 15 participants completed an externally prescribed, constant-load cycling task performed at 80% of the peak power output, to task failure. During externally prescribed exercise, GOOD and POOR groups did not differ in their time-to-task failure nor in their physiological and perceptual responses to the exercise. Together these findings demonstrate that individual differences in interoceptive accuracy influence the regulation of self-paced exercise but do not affect externally prescribed exercise tolerance under constant load.

Exploring Individual Differences in Interoception Among Athletes Based on a Three-Dimensional Construct of Interoception

Previous studies demonstrated that sensorimotor training enhances interoceptive abilities. Athletes are highly engaged in performance-driven physical training and often incorporate-to varying degrees-sensorimotor training into their routines. In this study, we investigated the role of individual differences in interoception by comparing professional athletes of different performance levels and both sexes with recreational athletes and controls, applying a three-dimensional model of interoception. Twenty-six elite athletes, 52 recreational athletes, and 50 college students were recruited from national sports teams, local sports training centers, and local universities. We used the Multidimensional Assessment of Interoperative Awareness (MAIA), the Heartbeat Detecting Task (HDT), and a numeric rating scale based on HDT to measure interoceptive sensibility, accuracy, and awareness. At average, athletes showed significantly higher interoceptive sensibility, interoceptive accuracy, and interoceptive awareness than controls. Elite athletes reported significantly higher scores in all measures of interception compared to recreational athletes. Intriguingly, Non-Distracting for interoceptive sensibility was positively correlated with the level of experience in elite athletes. Male athletes had better interoceptive sensibility and interoceptive awareness compared to female athletes in the elite group, while no significant sex differences were detected in the other two groups. These results indicated that level of sport experience and sex are associated with differences in interoceptive accuracy, interoceptive sensibility, and interoceptive awareness. It also suggests that interoceptive ability is possibly an experience-dependent trait for athletic performance, which provides insight for improving sports performance through an approach of enhancing interoceptive ability.

Attention to cardiac sensations enhances the heartbeat-evoked potential during exhalation

Respiration and cardiac activity intricately interact through complex physiological mechanisms. The heartbeat-evoked potential (HEP) is an EEG fluctuation reflecting the cortical processing of cardiac signals. We recently found higher HEP amplitude during exhalation than inhalation during a task involving attention to cardiac sensations. This may have been due to reduced cardiac perception during inhalation and heightened perception during exhalation through attentional mechanisms. To investigate relationships between HEP, attention, and respiration, we introduced an experimental setup that included tasks related to cardiac and respiratory interoceptive and exteroceptive attention. Results revealed HEP amplitude increases during the interoceptive tasks over fronto-central electrodes. When respiratory phases were taken into account, HEP increases were primarily driven by heartbeats recorded during exhalation, specifically during the cardiac interoceptive task, while inhalation had minimal impact. These findings emphasize the role of respiration in cardiac interoceptive attention and could have implications for respiratory interventions to fine-tune cardiac interoception.

Heart activity perception: narrative review on the measures of the cardiac perceptual ability

Measures of cardiac perceptual ability (also called cardiac accuracy) are methods of cardiac interoception, the perception of bodily sensation related to heart activity. This narrative review aims to provide an overview of these methods. We differentiate between three main measurement types: (1) change detection, i.e., when the task is to notice the change in the heart rate; also called: heart rate perception tasks, (2) discrimination tasks, i.e., when the task is to compare the internal sensations with external signal(s); also called: heartbeat detection tasks and (3) tracking tasks, i.e., when the task is to follow and report heartbeats via tapping or counting. We describe some of the new methods under "mixed methods," as they share features with more than one of the large measurement types described above. Specific measures differ in various aspects, such as their focus (heart rhythm vs. single beats), their sensitivity to non-conscious sensations and the calculated indices (e.g., whether significance level by hypothesis test is provided). When a measure of cardiac perceptual ability is chosen, it is advisable to take its characteristics into consideration in light of the planned research.

Interoception and the musical brain: Evidence from cross-sectional and longitudinal behavioral and resting-state fMRI study

Musical training has been linked to enhanced interoceptive abilities and increased resting-state (RS) functional connectivity (FC) within the interoceptive brain network. We aimed to replicate and extend these findings with a unique cross-sectional and longitudinal study design. Professional musicians and matched individuals with no prior musical experience (training group) were recruited. Participants underwent RS fMRI scans and completed heartbeat counting and discrimination tasks outside of the scanner (time point 1). The training group additionally had RS scans and interoception tests repeated after a 6-month-long keyboard course training (time point 2). We found no evidence for increased interoceptive abilities in professional musicians relative to non-musicians, nor did we observe any improvements in interoception over the course of musical training. RS FC analysis revealed increased FC within the sensorimotor network in professional musicians compared to the training group at the first time point with no change in FC over time in the Training group. These findings challenge the view that musical training may improve interoceptive abilities. Yet, the results suggest that musical training is related to increased communication within the sensorimotor RS network, which consists of some hubs important for interoceptive processing (namely pre- and postcentral gyri and supplementary motor area).

Exploration of interoceptive capabilities in avoidant/restrictive food intake disorder and anorexia nervosa

OBJECTIVE

This proof-of-concept study explores the role of aberrant interoception as a possible mechanism underlying restrictive eating symptoms in avoidant/restrictive food intake disorder (ARFID) compared to anorexia nervosa (AN) and healthy comparisons (HC).

METHOD

We report preliminary normative adolescent interoceptive data in HCs (n = 100) compared to adolescents with ARFID (n = 30) and AN (N = 23). Adolescents (12-18) participated in a one-time virtual visit to assess heartrate guessing accuracy (interoceptive accuracy), correlation between confidence in heartrate guess and accuracy (interoceptive awareness), and self-reported interoception (interoceptive sensibility).

RESULTS

HC adolescents had comparable interoceptive outcomes relative to published adult norms, consistent with existing literature. Data suggest that adolescents with ARFID have poor heartbeat guessing accuracy and experience challenges deciphering interoceptive signals, possibly contributing to symptoms. While adolescents with AN have greater heartbeat guessing accuracy, they cite difficulty trusting body cues, perhaps contributing to their lack of confidence in interoceptive cue detection.

CONCLUSIONS

Preliminary results reflect differences in interoception between the three groups.

Social interoception: Perceiving events during cardiac afferent activity makes people more suggestible to other people's influence

Our judgements are often influenced by other people's views and opinions. Interoception also influences decision making, but little is known about its role in social influence and particularly, the extent to which other people may influence our decisions. Across two experiments, using different forms of social influence, participants judged the trustworthiness of faces presented either during the systolic phase of the cardiac cycle, when baroreceptors convey information from the heart to the brain, or during diastolic phase, when baroreceptors are quiescent. We quantified the extent to which participants changed their minds (as an index of social influence) following the social feedback, in order to compare two competing hypotheses. According to the Arousal-Confidence Hypothesis, cardiac signals create a context of heightened bodily arousal that increases confidence in perceptual judgements. People should, therefore, be less subject to social influence during systole. By contrast, according to the Uncertainty-Conformity Hypothesis, cardiac signals increase neural noise and sensory attenuation, such that people should display greater effects of social influence during systole, as they then underweight private interoceptive signals in favour of the external social information. Across two studies that used different kind of social interactions, we found that participants changed their minds more when faces were presented at systole. Our results, therefore, support the Uncertainly-Conformity hypothesis and highlight how cardiac afferent signals contribute to shape our social decision-making in different types of social interactions.

The impact of traumatic childhood experiences on interoception: disregarding one's own body

BACKGROUND

Deficient interoception, the processing and perception of internal bodily signals, has been discussed as a mechanism underlying various mental disorders. First results indicate a mediating role of interoception in the interplay of traumatic childhood experiences and adult mental disorders. Traumatic childhood experiences may hinder the adequate processing, integration, and trust in bodily signals that are important in order to understand and regulate own needs and emotions, thereby increasing the vulnerability for mental disorders. However, an overarching study investigating alterations in different interoceptive measures and trauma-related disorders as well as their mediating role between early trauma and emotion dysregulation is still missing.

METHODS

One hundred thirty-six individuals with varying levels of traumatic childhood experiences who either had a current diagnosis of major depression, posttraumatic stress disorder, or somatic symptom disorder, or no mental disorder, took part in a multidimensional assessment of interoceptive processes, including interoceptive accuracy, sensibility, and awareness. Kruskal-Wallis tests were used to compare groups regarding interoceptive processes and associations with traumatic childhood experiences and emotion dysregulation were analyzed with Spearman correlations. Furthermore, mediation analyses were computed to examine and compare interoceptive processes as potential mediators between traumatic childhood experiences and emotion dysregulation.

RESULTS

Only body dissociation, a measure for interoceptive sensibility, was significantly reduced in individuals with a current mental disorder. Body dissociation was also the only interoceptive measure significantly associated with traumatic childhood experiences and emotion dysregulation and the only significant mediator in the relationship between traumatic childhood experiences and emotion dysregulation across groups.

CONCLUSION

Results suggest body dissociation, but not other interoceptive measures, as an important feature linking traumatic childhood experiences to current emotion dysregulation, an important transdiagnostic feature. As body dissociation refers to a habitual non-attendance or disregard of interoceptive signals, integrative therapeutic interventions could help affected individuals to overcome difficulties in emotion perception and regulation.

TRIAL REGISTRATION

The general study design was preregistered; see the German Clinical Trials Register (DRKS-ID: DRKS00015182). This study's analysis plan was not preregistered.

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.

Actions of a Shaken Heart: Interoception Interacts with Action Processing

In the present study, we investigated the modulatory influence of the unconscious, bodily arousal on motor-related embodied information. Specifically, we examined how the interoceptive prediction error interacts with the event-related potentials linked to action-effect processing. Participants were asked to perform a task with self-initiated or externally-triggered sounds while receiving synchronous or false auditory cardiac feedback. The results found that interaction of interoceptive manipulation and action-effect processing modulates the frontal subcomponent of the P3 response. During the synchronous cardiac feedback, the P3 response to self-initiated tones was enhanced. During the false cardiac feedback, the frontal cortical response was reversed. N1 and P2 components were affected by the interoceptive manipulation, but not by the interaction of interoception and action processing. These findings provide experimental support for the theoretical accounts of the interaction between interoception and action processing within a framework of predictive coding, manifested particularly in the higher stages of action processing.

A single oral dose of citalopram increases interoceptive insight in healthy volunteers

RATIONALE

Interoception is the signalling, perception, and interpretation of internal physiological states. Many mental disorders associated with changes of interoception, including depressive and anxiety disorders, are treated with selective serotonin reuptake inhibitors (SSRIs). However, the causative link between SSRIs and interoception is not yet clear.

OBJECTIVES

To ascertain the causal effect of acute changes of serotonin levels on cardiac interoception.

METHODS

Using a within-participant placebo-controlled design, forty-seven healthy human volunteers (31 female, 16 male) were tested on and off a 20 mg oral dose of the commonly prescribed SSRI, citalopram. Participants made judgements on the synchrony between their heartbeat and auditory tones and then expressed confidence in each judgement. We measured three types of interoceptive cognition.

RESULTS

Citalopram increased cardiac interoceptive insight, measured as correspondence of self-reported confidence to the likelihood that interoceptive judgements were actually correct. This effect was driven by enhanced confidence for correct interoceptive judgements and was independent of measured cardiac and reported subjective effects of the drug.

CONCLUSIONS

An acute change of serotonin levels can increase insight into the reliability of inferences made from cardiac interoceptive sensations.

Ambivalent heroism? - Psychological burden and suicidal ideation among nurses during the Covid-19 pandemic

AIM

During the Covid-19 pandemic, the risk for nurses' mental health has rapidly increased. The two main goals of this study were the examination of (1) the psychological burden and (2) of suicidal ideation and its associated risk factors one year after the Covid-19 pandemic begun.

DESIGN

This was a cross-sectional online survey.

METHODS

N = 1311 nurses (96.9% female) aged 18-63 years (M = 30.96, SD = 8.48) were assessed for various symptoms of psychological burden, suicidal ideation and behaviour and its risk factors.

RESULTS

Almost half of participants (41.5%) reported heightened levels of depressive symptoms, 691 (52.7%) reported a medium to high risk for burnout. One fifth of participants (21.7%) reported suicidal ideation in the past 4 weeks. The direct contact to people with Covid-19 was not related to the extent of the psychological burden. Depression, agitation, perceived burdensomeness and previous suicide attempt were associated with suicidal ideation.

Adolescents with borderline personality disorder show a higher response to stress but a lack of self-perception: Evidence through affective computing

Stress reactivity is a complex phenomenon associated with multiple and multimodal expressions and functions. Herein, we hypothesized that compared with healthy controls (HCs), adolescents with borderline personality disorder (BPD) would exhibit a stronger response to stressors and a deficit in self-perception of stress due to their lack of insight. Twenty adolescents with BPD and 20 matched HCs performed a socially evaluated mental arithmetic test to induce stress. We assessed self- and heteroperception using both human ratings and affective computing-based methods for the automatic extraction of 39 behavioral features (2D + 3D video recording) and 62 physiological features (Nexus-10 recording). Predictions were made using machine learning. In addition, salivary cortisol was measured. Human ratings showed that adolescents with BPD experienced more stress than HCs. Human ratings and automated machine learning indicated opposite results regarding self- and heteroperceived stress in adolescents with BPD compared to HCs. Adolescents with BPD had higher levels of heteroperceived stress than self-perceived stress. Similarly, affective computing achieved better classification for heteroperceived stress. HCs had an opposite profile; they had higher levels of self-perceived stress, and affective computing reached a better classification for self-perceived stress. We conclude that adolescents with BPD are more sensitive to stress and show a lack of self-perception (or insight). In terms of clinical implications, our affective computing measures may help distinguish hetero- vs. self-perceptions of stress in natural settings and may offer external feedback during therapeutic interaction.

The heart rate discrimination task: a psychophysical method to estimate the accuracy and precision of interoceptive beliefs

Interoception - the physiological sense of our inner bodies - has risen to the forefront of psychological and psychiatric research. Much of this research utilizes tasks that attempt to measure the ability to accurately detect cardiac signals. Unfortunately, these approaches are confounded by well-known issues limiting their validity and interpretation. At the core of this controversy is the role of subjective beliefs about the heart rate in confounding measures of interoceptive accuracy. Here, we recast these beliefs as an important part of the causal machinery of interoception, and offer a novel psychophysical "heart rate discrimination" method to estimate their accuracy and precision. By applying this task in 223 healthy participants, we demonstrate that cardiac interoceptive beliefs are more biased, less precise, and are associated with poorer metacognitive insight relative to an exteroceptive control condition. Our task, provided as an open-source python package, offers a robust approach to quantifying cardiac beliefs.

Sex differences in interoceptive accuracy: A meta-analysis

Interoceptive accuracy, the ability to correctly perceive internal signals arising from the body, is thought to be disrupted in numerous mental and physical health conditions. Whilst evidence suggests poorer interoceptive accuracy in females compared to males, raising the possibility that interoceptive differences may relate to sex differences in mental and physical health, results concerning sex differences in interoceptive accuracy are mixed. Given such ambiguity, this meta-analysis aimed to establish the presence or absence of sex differences in interoceptive accuracy across cardiac, respiratory, and gastric domains. A review of 7956 abstracts resulted in 93 eligible studies. Results demonstrated superior accuracy in males across cardiac, but not gastric, tasks, while findings on respiratory tasks were mixed. Effect sizes were consistent across cardiac tasks, but instability and/or moderate heterogeneity was observed across other domains, likely due to the small number of eligible studies. Despite such limitations, results indicate the possibility of sex differences across interoception tasks and domains. Methodological limitations concerning the influence of physiological factors, and directions for future research are discussed.

Taking the pulse of social cognition: Cardiac afferent activity and interoceptive accuracy modulate emotional egocentricity bias

At the heart of social cognition is our ability to distinguish between self and other and correctly attribute mental and affective states to their origin. Emotional egocentricity bias (EEB) reflects the tendency to use one's own emotional state when relating to others. Although interoception underpins our emotional experience, little is known about its role on how we affectively relate to others. Here, we assessed how cardiac interoceptive impact, manipulated by presenting affective stimuli across different phases of the cardiac cycle coupled with trait-like levels of interoceptive accuracy, modulate the EEB. Individuals with higher interoceptive accuracy displayed an increased EEB when the other's emotional state was presented at the point of maximum interoceptive impact (i.e., at systole), whereas the reverse was observed for individuals with lower interoceptive accuracy. These findings show how interoceptive activity provides the physiological context within which we process other's emotional states in parallel to ours.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

The Cognitive, Ecological, and Developmental Origins of Self-Disturbance in Borderline Personality Disorder

Self-disturbance is recognized as a key symptom of Borderline Personality Disorder (BPD). Although it is the source of significant distress and significant costs to society, it is still poorly specified. In addition, current research and models on the etiology of BPD do not provide sufficient evidence or predictions about who is at risk of developing BPD and self-disturbance, and why. The aim of this review is to lay the foundations of a new model inspired by recent developments at the intersection of social cognition, behavioral ecology, and developmental biology. We argue that the sense of agency is an important dimension to consider when characterizing self-disturbances in BPD. Second, we address the poorly characterized relation between self-disturbances and adverse life conditions encountered early in life. We highlight the potential relevance of Life-History Theory-a major framework in evolutionary developmental biology-to make sense of this association. We put forward the idea that the effect of early life adversity on BPD symptomatology depends on the way individuals trade their limited resources between competing biological functions during development.

Altering Dynamics of Autonomic Processing Therapy (ADAPT) trial: a novel, targeted treatment for reducing anxiety in joint hypermobility

Background

Hypermobility is a poorly recognised and understood musculoskeletal disorder thought to affect around 20% of the population. Hypermobility is associated with reduced physiological and psychological functioning and quality of life and is a known risk factor for the development of an anxiety disorder. To date, no evidence-based, targeted treatment for anxiety in the context of hypermobility exists. The present intervention (ADAPT—Altering Dynamics of Autonomic Processing Therapy) is a novel therapy combining bio-behavioural training with cognitive approaches from clinical health psychology targeting the catastrophisation of internal sensations, with aim to improve autonomic trait prediction error.

Method

Eighty individuals with diagnosed hypermobility will be recruited and the efficacy of ADAPT to treat anxiety will be compared to an Emotion-Focused Supportive Therapy (EFST) comparator therapy in a randomised controlled trial. The primary treatment target will be post therapy score on the Beck Anxiety Inventory, and secondary outcomes will also be considered in relation to interoception, depression, alexithymia, social and work adjustment, panic symptoms and dissociation. Due to COVID restrictions, the intervention will be moved to online delivery and qualitative assessment of treatment tolerance to online therapy will also be assessed.

Discussion

Online delivery of an intervention targeting anxiety would improve the quality of life for those experiencing anxiety disorder and help to reduce the £11.7 billion that anxiety disorders cost the UK economy annually.

Trial registration

World Health Organization ISRCTN17018615. Registered on 20th February 2019; trial protocol version 2

Expectation predicts performance in the mental heartbeat tracking task

The mental heartbeat tracking task by Schandry is sensitive to non-interoceptive (top-down) influences, e.g., estimation of heart rate and expectation. The two studies reported here investigated the impact of these factors on the outcome of the task. In Study 1, performance-related expectation was assessed between the training interval and the real trials. Performance was strongly related (β = .595, p < .001) to expectation even after controlling for sex, body fat, resting heart rate and estimation of heart rate. In Study 2, expectation was assessed before and after the training interval for Group 1 and 2, respectively. The strong association (r = 0.78, p < .001) between performance and expectation was replicated for Group 2; however, a moderate association (r = 0.39, p < .01) was also found in Group 1. People with high expectation may be prone to categorize and count vague sensations, such as attention evoked sensations, as heartbeats; this can lead to an inflated Schandry-score.

Body connection mediates the relationship between traumatic childhood experiences and impaired emotion regulation in borderline personality disorder

BACKGROUND

Previous studies revealed an association between traumatic childhood experiences and emotional dysregulation in patients with borderline personality disorder (BPD). However, possible mediating pathways are still not fully understood. The aim of the present study was to investigate the potential mediating role of body connection, describing the awareness of the relationship of bodily and mental states, for the association between a history of traumatic childhood experiences and BPD core symptomatology.

METHODS

One-hundred-twelve adult female individuals with BPD and 96 healthy female controls (HC) were included. Impaired emotion regulation, traumatic childhood experiences, and BPD symptomatology were assessed with self-report questionnaires. The Scale of Body Connection was used to assess two dimensions of body connection, that is body awareness, describing attendance to bodily information in daily life and noticing bodily responses to emotions and/or environment and body dissociation, describing a sense of separation from one's own body, due to avoidance or emotional disconnection. Mann-Whitney U tests were employed to test for group differences (BPD vs. HC) on the two SBC subscales and associations with clinical symptoms were analyzed with Spearman correlations. We performed mediation analyses in the BPD group to test the assumption that body connection could act as a mediator between a history of traumatic childhood experiences and emotion dysregulation.

RESULTS

Individuals with BPD reported significantly lower levels of body awareness and significantly higher levels of body dissociation compared to HC. Body dissociation, traumatic childhood experiences, and emotion dysregulation were significantly positively associated. Further analyses revealed that body dissociation, but not body awareness, significantly and fully mediated the positive relationship between traumatic childhood experiences and impaired emotion regulation in the BPD sample. This mediation survived when trait dissociation, i.e., general dissociative experiences not necessarily related to the body, was statistically controlled for.

CONCLUSION

Certain dimensions of body connection seem to be disturbed in BPD patients, with body dissociation being an important feature linking a history of traumatic childhood experiences to current deficits in emotion regulation.

Female sweet-likers have enhanced cross-modal interoceptive abilities

There are well known phenotypic differences in sweet-liking across individuals, but it remains unknown whether these are related to broader underlying differences in interoceptive abilities (abilities to sense the internal state of the body). Here, healthy women (N = 64) classified as sweet likers (SLs) or sweet dislikers (SDs) completed a bimodal interoception protocol. A heartbeat tracking and a heartbeat discrimination task determined cardiac interoception; both were accompanied by confidence ratings. A water load task, where participants consumed water to satiation and then to maximum fullness was used to assess gastric interoceptive abilities. Motivational state, psychometric characteristics and eating behaviour were also assessed. SLs performed significantly better than SDs on both heartbeat tasks, independently of impulsivity, anxiety, depression, and alexithymia. No differences in metacognitive awareness and subjective interoceptive measures were found. With gastric interoception, SLs were more sensitive to stomach distention, and they ingested less water than SDs to reach satiety when accounting for stomach capacity. SLs also scored higher on mindful and intuitive eating scales and on emotional eating particularly in response to negative stimuli; emotional overeating was fully mediated via interoceptive performance. Overall, our data suggest the SL phenotype may reflect enhanced responsiveness to internal cues more broadly.

Intuitive eating mediates the relationship between interoceptive accuracy and eating disorder risk

Research supports an association between altered interoceptive accuracy, or the ability to accurately monitor sensations from the body, and disordered eating. However, the behavioral mechanism through which interoceptive accuracy may influence eating behaviors is unclear. Intuitive eating, the ability to regulate food intake according to visceral cues of hunger and satiety, is positively related to interoceptive accuracy and negatively related to disordered eating. Therefore, we hypothesized that interoceptive accuracy would be negatively associated with intuitive eating which would, in turn, influence eating disorder risk. A mediation analysis was performed to test this hypothesis in a sample of 41 undergraduate women who completed a heartbeat counting task to assess interoceptive accuracy, followed by self-report measures of intuitive eating ability and eating disorder risk. We found that eating for physical rather than emotional reasons and reliance on hunger and satiety cues, two aspects of intuitive eating, mediated the relationship between interoceptive accuracy and eating disorder risk. Although further research is necessary, it is possible that findings regarding the association between interoceptive accuracy and intuitive eating may inform the development of eating disorder prevention efforts.

Reduced differentiation of emotion-associated bodily sensations in autism

LAY ABSTRACT

More research has been conducted on how autistic people understand and interpret other people's emotions, than on how autistic people experience their own emotions. The experience of emotion is important however, because it can relate to difficulties like anxiety and depression, which are common in autism. In neurotypical adults and children, different emotions have been associated with unique maps of activity patterns in the body. Whether these maps of emotion are comparable in autism is currently unknown. Here, we asked 100 children and adolescents, 45 of whom were autistic, to color in outlines of the body to indicate how they experienced seven emotions. Autistic adults and children sometimes report differences in how they experience their internal bodily states, termed interoception, and so we also investigated how this related to the bodily maps of emotion. In this study, the autistic children and adolescents had comparable interoception to the non-autistic children and adolescents, but there was less variability in their maps of emotion. In other words, they showed more similar patterns of activity across the different emotions. This was not related to interoception, however. This work suggests that there are differences in how autistic people experience emotion that are not explained by differences in interoception. In neurotypical people, less variability in emotional experiences is linked to anxiety and depression, and future work should seek to understand if this is a contributing factor to the increased prevalence of these difficulties in autism.

Cardiac and Proprioceptive Accuracy Are Not Related to Body Awareness, Perceived Body Competence, and Affect

Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs (visceroception) and the motor system (proprioception). Dimensions of interoception include (1) interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, (2) confidence rating with respect to perceived performance in an actual behavioral test, and (3) interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with affect are scarcely studied. In the present study, undergraduate students (N = 105, 53 males, age: 21.0 ± 1.87 years) filled out questionnaires assessing positive and negative affect (Positive and Negative Affect Schedule), interoceptive sensibility (Body Awareness Questionnaire), and body competence (Body Competence Scale of the Body Consciousness Questionnaire). Following this, they completed a behavioral task assessing cardioceptive accuracy (the mental heartbeat tracking task by Schandry) and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles (weight discrimination task) and the angular position of the elbow joint (joint position reproduction task). Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states (PANAS) are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities.

Heart Rate Variability Modulates Interoceptive Accuracy

Our emotional experiences depend on our interoceptive ability to perceive and interpret changes in our autonomous nervous system. An inaccurate perception and interpretation of autonomic changes impairs our ability to understand and regulate our emotional reactions. Impairments in emotion understanding and emotion regulation increase our risk for mental disorders, indicating that interoceptive deficits play an important role in the etiology and pathogenesis of mental disorders. We, thus, need measures to identify those of us whose interoceptive deficits impair their emotion understanding and emotion regulation. Here, we used cardiac measures to investigate how our ability to engage prefrontal and (para-)limbic brain region regions affects our ability to perceive and interpret cardiac changes. We administered a heartbeat detection task to a sample of healthy individuals (n = 113) whose prefrontal-(para-) limbic engagement had been determined on basis of a heart rate variability recording. We found a positive association between heartbeat detection and heart rate variability, implying that individuals with higher heart rate variability were more accurate in heartbeat detection than individuals with lower heart rate variability. These findings suggest that our interoceptive accuracy depends on our prefrontal-(para-)limbic engagement during the perception and interpretation of cardiac changes. Our findings also show that cardiac measures may be useful to investigate the association between interoceptive accuracy and prefrontal-(para-)limbic engagement in a time- and cost-efficient manner.

Interoception, Stress, and Physical Symptoms in Stress-Associated Diseases

Abstract. The brain and peripheral bodily organs continuously exchange information. Exemplary, interoception refers to the processing and perception of ascending information from the body to the brain. Stress responses involve a neurobehavioral cascade, which includes the activation of peripheral organs via neural and endocrine pathways and can thus be seen as an example for descending information on the brain-body axis. Hence, the interaction of interoception and stress represents bi-directional communication on the brain-body axis. The main hypothesis underlying this review is that the dysregulation of brain-body communication represents an important mechanism for the generation of physical symptoms in stress-related disorders. The aims of this review are, therefore, (1) to summarize current knowledge on acute stress effects on different stages of interoceptive signal processing, (2) to discuss possible patterns of abnormal brain-body communication (i.e., alterations in interoception and physiological stress axes activation) in mental disorders and chronic physical conditions, and (3) to consider possible approaches to modify interoception. Due to the regulatory feedback loops underlying brain-body communication, the modification of interoceptive processes (ascending signals) may, in turn, affect physiological stress axes activity (descending signals), and, ultimately, also physical symptoms.

Age-Related Effects on Interoceptive Accuracy, General Interoceptive Sensibility, and Specific Interoceptive Sensibility

Abstract. Background: The current research into interoception distinguishes between interoceptive accuracy (IAcc), the accurate detection of internal sensations (e.g., heartbeats) as measured by performance on objective IAcc tasks, and interoceptive sensibility (IS), the subjective belief concerning one’s own experience of internal sensations as measured either through self-report questionnaires or through one’s confidence in the accuracy during an IAcc task. Aims: As the two measures of IS, however, are usually uncorrelated and show differential relationships to IAcc, we suggest different types of IS, a general IS and a specific IS. Further, based on a growing body of research linking IAcc and IS to physical and mental diseases, the development of interoception across the adult lifespan is of importance. Methods: Using Structural Equation Modeling the present paper investigates the relationships among IAcc assessed by a heartbeat counting task, and the two proposed dimensions of IS in 138 participants ( Mage = 42.67, SDage = 18.77). Furthermore, we examine age-related differences in IAcc, as well as in general and specific IS. Results: In terms of the relationship between the three dimensions, general and specific IS were weakly correlated and exhibited different relationships to IAcc. Further, we found different age effects on the three interoceptive dimensions. Whereas IAcc decreased with age, specific IS tend to increase with age, and general IS remained unaffected by age. Conclusion: The findings provide further empirical support for a dissociation between general and specific IS and raised important questions concerning the relation between interoceptive accuracy and the emergence of physical diseases in older age.

The relationship between heartbeat counting and heartbeat discrimination: A meta-analysis

Interoception concerns the perception of the body's internal state. Despite the importance of this ability for health and aspects of higher-order cognition, its measurement remains problematic. Most studies of interoception employ one of two tasks: the heartbeat counting or heartbeat discrimination task. These tasks are thought to index common abilities, an assertion often used to justify the use of a single measure of cardiac interoception. However, mixed findings regarding the relationship between performance on these tasks raises the question of whether they can be used interchangeably to assess interoceptive accuracy, confidence and awareness ('metacognition'). The present study employed a meta-analytical approach to assess the association between these tasks. Pooled findings from 22 studies revealed a small relationship between accuracy scores on the measures. Additional analyses demonstrated a moderate relationship between confidence ratings but no association between measures of interoceptive awareness. These findings question the interchangeable use of the two tasks.

Dissociation in How Core Autism Features Relate to Interoceptive Dimensions: Evidence from Cardiac Awareness in Children

Interoception in autism is receiving increasing research attention. Previously, differences were identified in autism on both objective and subjective measures of interoception, and an association with anxiety. Yet, it is currently unknown how interoception relates to core autism features. Here, in 49 autistic children, we consider how interoceptive accuracy (measured with heartbeat detection tasks) and sensibility (subjective judgements of awareness) relate to overall severity on the Autism Diagnostic Observation Schedule, and symptom domains of social-affective and repetitive, restricted behaviors. Socio-affective features were related to interoceptive sensibility, while repetitive restricted behaviors were related to interoceptive accuracy. This dissociation suggests disparate interoceptive mechanisms for the formation and/or maintenance of autistic features.

Impact of cardiac interoception cues and confidence on voluntary decisions to make or withhold action in an intentional inhibition task

Interoceptive signals concerning the internal physiological state of the body influence motivational feelings and action decisions. Cardiovascular arousal may facilitate inhibition to mitigate risks of impulsive actions. Baroreceptor discharge at ventricular systole underpins afferent signalling of cardiovascular arousal. In a modified Go/NoGo task, decisions to make or withhold actions on 'Choose' trials were not influenced by cardiac phase, nor individual differences in heart rate variability. However, cardiac interoceptive awareness and insight predicted how frequently participants chose to act, and their speed of action: Participants with better awareness and insight tended to withhold actions and respond slower, while those with poorer awareness and insight tended to execute actions and respond faster. Moreover, self-reported trait urgency correlated negatively with intentional inhibition rates. These findings suggest that lower insight into bodily signals is linked to urges to move the body, putatively by engendering noisier sensory input into motor decision processes eliciting reactive behaviour.

Heart and brain: Cortical representation of cardiac signals is disturbed in borderline personality disorder, but unaffected by oxytocin administration

BACKGROUND

Emotional dysregulation, a core feature of borderline personality disorder (BPD) has recently been linked to deficits in the cortical representation of bodily signals. Oxytocin modulates the salience of external social cues. However, its role in interoception is still not fully understood. The aim of the current study was to replicate reduced heartbeat-evoked potentials (HEPs) as a marker for the cortical representation of cardiac signals in BPD and to explore potential effects of oxytocin on HEP amplitude.

METHODS

Fifty-three medication-free women with a DSM-IV diagnosis of BPD and sixty healthy female controls (HCs) participated in the study. In a randomized, double-blind placebo-controlled trial, participants self-administered either 24 I.U. of oxytocin or placebo and took part in a 5-minute resting-state electrocardiogram (ECG) with parallel electroencephalogram (EEG) measurement. In addition, emotional dysregulation and BPD symptomatology were assessed with self-report questionnaires.

RESULTS

Patients with BPD had significantly lower mean HEP amplitudes than HCs. Furthermore, HEP amplitudes were negatively correlated with emotional dysregulation in the whole sample. However, oxytocin had no significant effect on HEP amplitude.

LIMITATIONS

Only female participants were investigated and no clinicial controls were included.

CONCLUSIONS

This is the first replication from an independent sample showing a reduced cortical representation of cardiac signals in BPD patients. This, together with other body-related symptoms, suggests deficits in the processing of bodily signals, which seem to be associated with emotional dysregulation. Whether oxytocin influences HEP during emotion regulation tasks needs to be investigated in future studies.

Altered interoception in patients with borderline personality disorder: a study using heartbeat-evoked potentials

BACKGROUND

Patients with borderline personality disorder (BPD) experience difficulties in emotional awareness (alexithymia), and often develop dissociative symptoms, which may reflect broader deficits in interoceptive awareness. Whether this is associated with alterations in cortical processing of interoception is currently unknown.

METHODS

We utilized an electrophysiological marker of interoception, i.e. heartbeat-evoked potentials (HEP), and examined its relationship with electrocardiographic correlates of autonomic nervous system (ANS) functioning (heart rate variability), and with self-report measures of alexithymia, dissociation and borderline symptom severity in patients with BPD.

RESULTS

Individuals with BPD had higher HEP amplitudes over frontal electrodes compared to healthy controls. Sympathetic ANS activity was greater in BPD patients than in controls. Across groups, HEP amplitudes were associated with parasympathetic activity over central electrodes and correlated with alexithymia over frontal electrodes.

CONCLUSIONS

These findings support the idea that difficulties in emotional awareness in BPD are reflected in altered frontal electrophysiological markers of interception. Therefore, emotional awareness can be understood as failures of modulation between interoceptive and exteroceptive attention. Future research may aim to investigate whether altered interoception and its electrophysiological correlates are malleable by therapeutic intervention.

My body, your emotions: Viscerosomatic modulation of facial expression discrimination

Interoception reflects the ability to observe one's innermost bodily states. Here, we assessed whether interoceptive accuracy (IA) is related to the empathic ability to discriminate others' emotions. Participants (N = 111) completed a heartbeat tracking task, as well as an emotional go/no-go task with fearful and disgusted faces. Empathic facial mimicry during the go/no-go task was measured using electromyography (EMG) of the Corrugator Supercilii muscle. Higher IA was associated with higher perceptual sensitivity for emotional faces but was unrelated to response bias. Individuals higher in IA had stronger coupling between facial EMG and task performance. IA and facial EMG were associated with Go but not with NoGo trials, consistent with a specific modulation of perceptual sensitivity. These results suggest that tuning into one's own viscerosomatic signals relates to empathic mimicry and perception of others' emotional states.

Autism and psychosis as diametrical disorders of embodiment

Humans have evolved an elaborate system of self-consciousness, self-identity, self-agency, and self-embodiment that is grounded in specific neurological structures including an expanded insula. Instantiation of the bodily self has been most-extensively studied via the 'rubber hand illusion', whereby parallel stimulation of a hidden true hand, and a viewed false hand, leads to the felt belief that the false hand is one's own. Autism and schizophrenia have both long been regarded as conditions centrally involving altered development of the self, but they have yet to be compared directly with regard to the self and embodiment. Here, we synthesize the embodied cognition literature for these and related conditions, and describe evidence that these two sets of disorders exhibit opposite susceptibilities from typical individuals to the rubber hand illusion: reduced on the autism spectrum and increased in schizophrenia and other psychotic-affective conditions. Moreover, the opposite illusion effects are mediated by a consilient set of associated phenomena, including empathy, interoception, anorexia risk and phenotypes, and patterns of genetic correlation. Taken together, these findings: (i) support the diametric model of autism and psychotic-affective disorders, (ii) implicate the adaptive human system of self-embodiment, and its neural bases, in neurodevelopmental disorders, and suggest new therapies and (iii) experimentally ground Bayesian predictive coding models with regard to autism compared with psychosis. Lay summary: Humans have evolved a highly developed sense of self and perception of one's own body. The 'rubber hand illusion' can be used to test individual variation in sense of self, relative to connection with others. We show that this illusion is reduced in autism spectrum disorders, and increased in psychotic and mood disorders. These findings have important implications for understanding and treatment of mental disorders.

Altered interoceptive processing in smokers: Evidence from the heartbeat tracking task

Neuroimaging evidence suggests that interoceptive processing might be altered in nicotine addiction, however this has not yet been confirmed with behavioural measures. Therefore, we investigated the perception of internal bodily states in smokers (n = 49) and people who had never smoked (n = 51), by measuring interoceptive accuracy (IAcc) and interoceptive sensibility (IS). IAcc was measured with a heartbeat tracking task and a heartbeat discrimination task. Performance on the heartbeat tracking task may be influenced by one's ability to estimate an elapsed time interval so this was controlled by also administering a time-estimation (TE) task. IS was measured using two sub-scales from the Multidimensional Assessment of Interoceptive Awareness (MAIA). All smokers completed the Revised Fagerström Test for Nicotine Dependence (FTND-R) to measure addiction severity. Non-smokers performed significantly better than smokers on the heartbeat tracking task. There were no significant group differences observed for the remaining variables. Furthermore, none of the variables predicted addiction severity. This is the first demonstration of behavioural differences in interoception between smokers and non-smokers.

Dimensions of interoception predict premonitory urges and tic severity in Tourette syndrome

Interoceptive processes in Tourette syndrome may foster the premonitory urges that commonly precede tics. Twenty-one adults with TS and 22 controls completed heartbeat tracking and discrimination tasks. Three dimensions of interoception were examined: objective accuracy, metacognitive awareness, and subjective (self-report) sensibility. Trait interoceptive prediction error was calculated as the discrepancy between accuracy and sensibility. Participants with TS had numerically lower interoceptive accuracy on the heartbeat tracking task, and increased self-reported interoceptive sensibility. While these group differences were not significant, the discrepancy between lower interoceptive accuracy and heightened sensibility, i.e. the trait interoceptive prediction error, was significantly greater in TS compared to controls. This suggests a heightened higher-order sensitivity to bodily sensations in TS, relative to a noisier perceptual representation of afferent bodily signals. Moreover, interoceptive sensibility predicted the severity of premonitory sensations and tics. This suggests interventions that work to align dimensions of interoceptive experience in TS hold therapeutic potential.

Computerized Exposure Therapy for Spider Phobia: Effects of Cardiac Timing and Interoceptive Ability on Subjective and Behavioral Outcomes

OBJECTIVE

Spider phobia is a common form of anxiety disorder for which exposure therapy is an effective first-line treatment. Motivated by the observed modulation of threat processing by afferent cardiac signals, we tested the hypothesis that interoceptive information concerning cardiovascular arousal can influence the outcomes of computerized exposure therapy for spider phobia.

METHOD

Fifty-three normal healthy participants with high spider phobia scores underwent one of the following three modified computerized exposure protocols, defined by the timing of exposure to brief spider stimuli within the cardiac cycle: systole (during afferent baroreceptor firing); diastole (during baroreceptor-quiescent interbeat interval); random (noncontingent on cardiac cycle). Outcomes were judged on phobic and anxiety measures and physiological data (skin conductance). Individuals were also rated on interoceptive accuracy.

RESULTS

MANCOVA analysis showed that timing group affected the outcome measures (F(10,80) = 2.405, p = .015) and there was a group interaction with interoception ability (F(15,110) = 1.808, p = .045). Subjective symptom reduction was greatest in the systolic group relative to the other two groups (diastolic (t = 3.115, ptukey = .009); random (t = 2.438, ptukey = .048)), with greatest reductions in those participants with lower interoceptive accuracy. Behavioral aversion reduced more in cardiac-contingent groups than the noncontingent (random) group (diastolic (t = 3.295, ptukey = .005); systolic (t = 2.602, ptukey = .032)). Physiological (skin conductance response) responses remained strongest for spider stimuli presented at cardiac systole.

CONCLUSIONS

Interoceptive information influences exposure benefit. The reduction in the subjective expression of fear/phobia is facilitated by "bottom-up" afferent signals, whereas improvement in the behavioral expression is further dependent on "top-down" representation of self-related physiology (heart rhythm). Individual interoceptive differences moderate these effects, suggesting means to personalize therapy.

Pain Perception and Body Awareness Among Individuals With Borderline Personality Disorder

Studies indicate that individuals with borderline personality disorder (BPD) often demonstrate attenuated pain perception, termed hypoalgesia. This study examines the hypothesis that body awareness moderates the association between BPD and pain perception. Participants consisted of 46 women diagnosed with BPD and 47 healthy controls. Sensory testing included the measurement of heat-pain thresholds, ratings of suprathreshold stimuli, measurement of temperature evoking moderate pain, and temporal summation of noxious mechanical stimuli. Body awareness was assessed by a self-report questionnaire. As hypothesized, among subjects with low levels of body awareness, those with BPD demonstrated hypoalgesia as manifested in their lower suprathreshold pain ratings and moderate pain evoked by higher temperature, in comparison with the controls. Among those with high levels of body awareness, BPD subjects demonstrated increased reactivity to pain as manifested in their higher pain ratings and moderate pain evoked by lower temperature, in comparison with the controls.

Disconnected - Impaired Interoceptive Accuracy and Its Association With Self-Perception and Cardiac Vagal Tone in Patients With Dissociative Disorder

Patients suffering from dissociative disorders are characterized by an avoidance of aversive stimuli. This includes the avoidance of emotions and, in particular, bodily perceptions. In the present pilot study, we explored the potential interoceptive accuracy deficit of patients suffering from dissociative disorders in a heartbeat detection task. Moreover, we investigated the impact of facial mirror-confrontation on interoceptive accuracy and the potential association between cardiac vagal tone derived from heart rate variability and interoceptive accuracy. Eighteen patients suffering from dissociative disorders and 18 healthy controls were assessed with the Mental Tracking Paradigm by Schandry for heartbeat detection at baseline and after confrontations exposing them to their own faces in a mirror (2 min each, accompanied by a negative or positive cognition). During the experiment, cardiac vagal tone was assessed. We used Pearson correlations to calculate potential associations between cardiac vagal tone and interoceptive accuracy. Patients performed significantly worse than the healthy controls in the heartbeat detection task at baseline. They displayed no significant increase in interoceptive accuracy following facial mirror-confrontation. In the patient group, higher cardiac vagal tone was associated with a more precise heartbeat detection performance. Dissociative disorder patients showed a considerable deficit in interoceptive accuracy. Our results fit with the assumption that highly dissociative patients tend to tune out the perceiving of bodily signals. To the extent that bodily signal perception may play a causal role in these disorders, therapeutic approaches enhancing interoceptive accuracy and cardiac vagal tone may be considered important and practicable steps to improve the therapy outcome of this patient group.

Impact of intranasal oxytocin on interoceptive accuracy in alcohol users: an attentional mechanism?

Interoception, i.e. the perception and appraisal of internal bodily signals, is related to the phenomenon of craving, and is reportedly disrupted in alcohol use disorders. The hormone oxytocin influences afferent transmission of bodily signals and, through its potential modulation of craving, is proposed as a possible treatment for alcohol use disorders. However, oxytocin's impact on interoception in alcohol users remains unknown. Healthy alcohol users (n = 32) attended two laboratory sessions to perform tests of interoceptive ability (heartbeat tracking: attending to internal signals and, heartbeat discrimination: integrating internal and external signals) after intranasal administration of oxytocin or placebo. Effects of interoceptive accuracy, oxytocin administration and alcohol intake, were tested using mixed-effects models. On the tracking task, oxytocin reduced interoceptive accuracy, but did not interact with alcohol consumption. On the discrimination task, we found an interaction between oxytocin administration and alcohol intake: Oxytocin, compared with placebo, increased interoceptive accuracy in heavy drinkers, but not in light social drinkers. Our study does not suggest a pure interoceptive impairment in alcohol users but instead potentially highlights reduced flexibility of internal and external attentional resource allocation. Importantly, this impairment seems to be mitigated by oxytocin. This attentional hypothesis needs to be explicitly tested in future research.

Interoception and Its Interaction with Self, Other, and Emotion Processing: Implications for the Understanding of Psychosocial Deficits in Borderline Personality Disorder

PURPOSE OF REVIEW

We review evidence for the potential importance of interoception, i.e., the processing of signals arising from inside the body, for deficient psychosocial functioning in borderline personality disorder (BPD).

RECENT FINDINGS

Evidence suggests that variability in interoception interacts with higher-order psychological functions such as self, other, and emotion processing. These domains are characteristically impaired in BPD, suggesting a likely causal role of disturbed interoception in the etiology of the disorder. The inability to identify and describe one's own emotional states represents a proxy of impaired interoception which might further mediate between the perception of inner physiological conditions and psychosocial functioning in BPD. There is preliminary evidence explaining how early life stress might adversely affect central interoceptive representation and psychosocial functioning in BPD. Based on these findings and the specific pattern of disturbances in BPD, we propose the crucial role of interoception in an integrated biobehavioral model for BPD.