title: Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: evidence of interoceptive dysregulation.
abstract: OBJECTIVE
  Recent evidence raises the possibility that symptoms of anorexia nervosa (AN) could be related to impaired interoception. Pain is an interoceptive process with well-characterized neuroanatomical pathways that may overlap to a large degree with neural systems that may be dysregulated in individuals with AN, such as the insula.
  
  
  METHODS
  Functional magnetic resonance imaging (fMRI) was used to assess neural substrates of pain anticipation and processing in 10 healthy control women (CW) and 12 individuals recovered from AN (REC AN) in order to avoid the confounding effects of malnutrition. Painful heat stimuli were applied while different colors signaled the intensity of the upcoming stimuli.
  
  
  RESULTS
  REC AN compared with CW showed greater activation within right anterior insula (rAI), dorsolateral prefrontal cortex (dlPFC) and cingulate during pain anticipation, and greater activation within dlPFC and decreased activation within posterior insula during painful stimulation. Greater anticipatory rAI activation correlated positively with alexithymic feelings in REC AN participants.
  
  
  CONCLUSIONS
  REC AN showed a mismatch between anticipation and objective responses, suggesting altered integration and, possibly, disconnection between reported and actual interoceptive state. Alexithymia assessment provided additional evidence of an altered ability to accurately perceive bodily signals in women recovered from AN.
authors: Department of Psychiatry, University of California San Diego, 3350 La Jolla Village Dr., Building 13, MC 9151-B, La Jolla, CA 92161, USA. istrigo@ucsd.edu
authors: Irina A
authors: IA
authors: Strigo
authors: Scott C
authors: SC
authors: Matthews
authors: Alan N
authors: AN
authors: Simmons
authors: Tyson
authors: T
authors: Oberndorfer
authors: Megan
authors: M
authors: Klabunde
authors: Lindsay E
authors: LE
authors: Reinhardt
authors: Walter H
authors: WH
authors: Kaye
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000503:physiopathology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000503:physiopathology*; D058748:Pain Perception / Q000502:physiology*; D011795:Surveys and Questionnaires