title: Altered interoceptive awareness in anorexia nervosa: Effects of meal anticipation, consumption and bodily arousal.
abstract: OBJECTIVE
  Impaired interoceptive awareness (IA), the subjective perception of internal body sensations, has been proposed as a vulnerability or maintaining factor in anorexia nervosa (AN). We examined whether IA of heartbeat and breathing sensations was impaired in AN across a range of arousal levels, and whether it was influenced by meal anticipation and consumption.
  
  
  METHODS
  IA was assessed using randomized, double-blinded, bolus intravenous infusions of isoproterenol, a peripheral beta-adrenergic sympathetic agonist, and saline. Fifteen women with AN and 15 age-, and sex- matched healthy comparisons (HC) were evaluated before and after consumption of a 1,000 Calorie meal. During each infusion participants rated their moment-to-moment intensity of heartbeat and breathing sensations with a dial. To measure IA we evaluated interoceptive detection thresholds, retrospective ratings of palpitation and dyspnea intensity, and interoceptive accuracy via correlations between subjective dial ratings and observed heart rate responses.
  
  
  RESULTS
  Contrary to prediction the AN group was more likely to report detection of interoceptive sensations across all conditions, an effect driven by false discriminations at low arousal levels. Concordant with prediction, meal anticipation was associated with intensified interoceptive sensations, particularly dyspnea. There were no differences in interoceptive accuracy.
  
  
  CONCLUSIONS
  This represents the first demonstration of interoceptive prediction errors in AN. Although IA is unimpaired at high arousal levels in AN, prediction signals are abnormal at low arousal levels, especially during meal anticipation. Altered interoceptive prediction signaling during meal anticipation could contribute to phenotypes of high anxiety in AN or alternatively, might be explained by enhanced meal associated anxiety.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Sahib S
authors.initials: SS
authors.lastname: Khalsa
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Department of Psychology, University of California at Los Angeles, Los Angeles, California.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
authors.affiliation: Neuroscience Program, University of California at Los Angeles, Los Angeles, California.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Vangala
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Strober
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Jamie D
authors.initials: JD
authors.lastname: Feusner
mesh_terms: D000856:Anorexia Nervosa / Q000503:physiopathology*; D001143:Arousal; D001364:Awareness; D005260:Female; D006801:Humans; D010465:Perception; D012189:Retrospective Studies; D055815:Young Adult
keywords: anorexia nervosa; anxiety; arousal; autonomic; eating; heartbeat; interoception; interoceptive awareness; isoproterenol; respiration