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Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: Evidence of interoceptive dysregulation
Author(s) -
Strigo Irina A.,
Matthews Scott C.,
Simmons Alan N.,
Oberndorfer Tyson,
Klabunde Megan,
Reinhardt Lindsay E.,
Kaye Walter H.
Publication year - 2013
Publication title -
international journal of eating disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 138
eISSN - 1098-108X
pISSN - 0276-3478
DOI - 10.1002/eat.22045
Subject(s) - insula , interoception , anticipation (artificial intelligence) , psychology , functional magnetic resonance imaging , anorexia nervosa , anterior cingulate cortex , neuroscience , dorsolateral prefrontal cortex , neural correlates of consciousness , audiology , prefrontal cortex , eating disorders , cognition , clinical psychology , medicine , artificial intelligence , computer science , perception
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. Method: 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. Discussion: 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. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)