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Objectives: Alexithymia is characterized by a difficulty in identifying and describing one's emotions. Recent research has associated differential effects of the alexithymia facets to hypothalamic pituitary adrenal (HPA) axis markers during stress. This study aimed to analyze how the facets of alexithymia interact with autonomic reactivity as well as self- and observer-rated anxiety during a social stress task. Methods: With the use of a public-speaking paradigm, skin conductance levels (SCLs) and heart rate (HR) during the defined periods of baseline, preparation, stress, and recovery were assessed in 60 volunteers (42 females, mean age 22.8) categorized as having either high (HDA) or low (LDA) degrees of alexithymia. Results: We found smaller SCLs during preparation and speech in the HDA group. Regression analyses indicated that only the alexithymia facet "difficulty in describing feelings" (DDF) was associated with smaller electrodermal responses. In the HDA group, self- and observer-rated anxiety was higher in the HDA than in the LDA group, which was attributable to higher scores in the subscales "difficulty in identifying feelings" (DIF) and "externally oriented thinking" (EOT). Conclusions: Our data support and specify the decoupling hypothesis of alexithymia by showing that the facets of alexithymia are differentially related to autonomic reactivity as well as self- and observer-rated anxiety during social stress.
Somatoform disorders are characterized by the presence of multiple somatic symptoms. Patients often experience different pain syndromes, and recent research suggests that sympathovagal balance is disturbed in somatoform patients, which could be related to alteration in pain sensitivity. This study analyzed how proposed sympathovagal imbalance interacts with objective pain assessment and the imagination of pain in somatoform disorders. Twenty-one patients (4 men) with diagnosed multisomatoform disorder were included in the study and matched to healthy control subjects. Autonomic measures and heart rate variability were assessed during baseline; pain perception was assessed by means of a pressure algometer and pain imagination. We found evidence for a sympathovagal imbalance in somatoform disorders characterized by low parasympathetic activation and high sympathetic activation during all conditions. Additionally, somatoform patients had reduced pain tolerance. Vagal withdrawal during pain assessment was more pronounced for healthy control subjects and correlated positively with assessed pain tolerance. During imagination somatoform, patients reported higher pain unpleasantness and higher pain intensity as compared to control subjects. We conclude that our data demonstrate an imbalance in sympathovagal activation and a hyposensitivity to pain tolerance stimuli in somatoform disorders. Parasympathetic reactivity might form crucial information when judging pain-associated affective-motivational components. Our results might be attributable to a deficient detection of visceral signals and might be a pathogenetic mechanism for the development of emotional difficulties and increased everyday vulnerability in somatoform patients.
Objectives: Somatoform disorders are characterized by the presence of multiple somatic symptoms. While the accuracy of perceiving bodily signal (interoceptive awareness) is only sparely investigated in somatoform disorders, recent research has associated autonomic imbalance with cognitive and emotional difficulties in stress-related diseases. This study aimed to investigate how sympathovagal reactivity interacts with performance in recognizing emotions in faces (facial recognition task).
Methods: Using a facial recognition and appraisal task, skin conductance levels (SCLs), heart rate (HR) and heart rate variability (HRV) were assessed in 26 somatoform patients and compared to healthy controls. Interoceptive awareness was assessed by a heartbeat detection task.
Results: We found evidence for a sympathovagal imbalance in somatoform disorders characterized by low parasympathetic reactivity during emotional tasks and increased sympathetic activation during baseline. Somatoform patients exhibited a reduced recognition performance for neutral and sad emotional expressions only. Possible confounding variables such as alexithymia, anxiety or depression were taken into account. Interoceptive awareness was reduced in somatoform patients.
Conclusions: Our data demonstrate an imbalance in sympathovagal activation in somatoform disorders associated with decreased parasympathetic activation. This might account for difficulties in processing of sad and neutral facial expressions in somatoform patients which might be a pathogenic mechanism for increased everyday vulnerability.
Interoceptive awareness (IA) is associated with emotional experience, the processing of emotional stimuli, and activation of brain structures that monitor the internal visceral and emotional state of the organism. Alexithymia is characterized by difficulties in identifying and describing one's emotions and externally oriented thinking (EOT) and reflects impairments in emotional awareness and the regulation of emotions. This study examined the relationship between alexithymia and IA in a healthy population of N = 155 persons. A well-validated heartbeat perception task to measure interoceptive awareness, the Toronto Alexithymia Scale (TAS-20) and a depression questionnaire (BDI-2) were administered to 88 women and 67 men. IA was inversely associated with all features of alexithymia in the whole sample. When considering sex differences, IA turned out to be a relevant negative predictor for the EOT subscale only in men. This large sample investigation in a nonclinical population indicates that IA represents a relevant negative predictor for alexithymia.
While food deprivation has known effects on sympathovagal balance, little is known about hunger's influence on the perception of pain. Since autonomic activities influence many cognitive and emotional processes, this suggests that food deprivation should interact with the perception of pain. This study analyzed the possible effects of short-term food deprivation on pain sensitivity in healthy female participants. This study was comprised of 32 healthy female participants who underwent a 48-hr inpatient hospital investigation. Prior to testing, heart rate and heart rate variability were assessed. After a standardized breakfast, day 1 measurements were taken. Food intake was then not allowed again until the following evening for 22 participants (experimental group), while 12 participants were served standard meals (control group). Pain threshold and tolerance were assessed at 10:00 a. m. on both days using a pressure algometer. Additionally pain experience was examined. Food deprivation significantly reduced pain thresholds and tolerance scores in the experimental group. Additionally, the sympathovagal balance changed, characterized by a decrease in parasympathetic activation. Higher vagal withdrawal after food deprivation was associated with higher pain sensitivity in the experimental group. Furthermore, perceived unpleasantness and pain intensity increased for threshold and tolerance stimuli in the experimental group. We conclude that short-term food deprivation sensitized pain perception in healthy females. An imbalance in sympathovagal activation evoked by food deprivation accounted for this effect. Our results might be a pathogenic mechanism for the development of emotional difficulties associated with disturbed eating behavior.
The perception of internal bodily signals (interoception) plays a relevant role for emotion processing and feelings. This study investigated changes of interoceptive awareness and cardiac autonomic activity induced by short-term food deprivation and its relationship to hunger and affective experience. 20 healthy women were exposed to 24 h of food deprivation in a controlled setting. Interoceptive awareness was assessed by using a heartbeat tracking task. Felt hunger, cardiac autonomic activity, mood and subjective appraisal of interoceptive sensations were assessed before and after fasting. Results show that short-term fasting intensifies interoceptive awareness, not restricted to food cues, via changes of autonomic cardiac and/or cardiodynamic activity. The increase of interoceptive awareness was positively related to felt hunger. Additionally, the results demonstrate the role of cardiac vagal activity as a potential index of emotion related self-regulation, for hunger, mood and the affective appraisal of interoceptive signals during acute fasting.
Attenuated modulation of brain activity accompanies emotion regulation deficits in alexithymia
(2012)
The personality trait alexithymia has been associated with deficits in emotion regulation; nevertheless, experimental investigations on this research question are sparse. We investigated reappraisal as one emotion regulation strategy in 44 healthy participants with high (HDA) versus low (LDA) degrees of alexithymia. High density EEG and spatiotemporal current density reconstruction were used to characterize the time course of emotion regulation and to identify brain regions involved. Main results were that reappraisal was accompanied by reduced arousal and significant amplitude reduction of P3 and slow wave in the LDA group only. In contrast to the LDA group, reappraisal was not associated with an increase of activation in fusiform gyrus and inferior temporal gyrus in the HDA group. We demonstrate profound deficits in emotion regulation, which might contribute to everyday problems of social functioning in alexithymia.
The individual sensitivity for ones internal bodily signals ("interoceptive awareness'') has been shown to be of relevance for a broad range of cognitive and affective functions. Interoceptive awareness has been primarily assessed via measuring the sensitivity for ones cardiac signals ("cardiac awareness'') which can be non-invasively measured by heartbeat perception tasks. It is an open question whether cardiac awareness is related to the sensitivity for other bodily, visceral functions. This study investigated the relationship between cardiac awareness and the sensitivity for gastric functions in healthy female persons by using non-invasive methods. Heartbeat perception as a measure for cardiac awareness was assessed by a heartbeat tracking task and gastric sensitivity was assessed by a water load test. Gastric myoelectrical activity was measured by electrogastrography (EGG) and subjective feelings of fullness, valence, arousal and nausea were assessed. The results show that cardiac awareness was inversely correlated with ingested water volume and with normogastric activity after water load. However, persons with good and poor cardiac awareness did not differ in their subjective ratings of fullness, nausea and affective feelings after drinking. This suggests that good heartbeat perceivers ingested less water because they subjectively felt more intense signals of fullness during this lower amount of water intake compared to poor heartbeat perceivers who ingested more water until feeling the same signs of fullness. These findings demonstrate that cardiac awareness is related to greater sensitivity for gastric functions, suggesting that there is a general sensitivity for interoceptive processes across the gastric and cardiac modality.
Individual differences in interoceptive sensitivity are associated with differences in reported intensity of emotional experience, vulnerability to anxiety and mood disorder and capacity for emotional self-regulation. Enhanced sensitivity to autonomic state is often accompanied by increased autonomic reactivity. Here we tested the hypothesis that healthy people classified as more interoceptively sensitive, by their performance of a heartbeat monitoring task, will demonstrate enhanced perception of pain. We further explored whether this effect is associated with a greater physiological reactivity to the pain stimuli. Using an algometer, cutaneous pressure pain was applied to the thenar eminence in 60 healthy participants. Heart rate variability and respiratory activity were recorded concurrently. We observed significant relationships between heightened interoceptive sensitivity and both enhanced sensitivity and decreased tolerance to pain. These effects were accompanied by a more pronounced parasympathetic decrease and a change in sympathovagal balance during pain assessment in the high, compared to the low, interoceptively sensitive group. Our study provides novel evidence that interoceptive sensitivity is associated with the experience and tolerability of pain in conjunction with reactive changes in autonomic balance.
Background: Empirical evidence suggests substantial deficits regarding emotion recognition in bulimia nervosa (BN). The aim of the current study was to investigate electrophysiologic evidence for deficits in emotional face processing in patients with BN. Methods: Event-related potentials were recorded from 13 women with BN and 13 matched healthy controls while viewing neutral, happy, fearful, and angry facial expressions. Participants' recognition performance for emotional faces was tested in a subsequent categorization task. In addition, the degree of alexithymia, depression, and anxiety were assessed via questionnaires. Results: Categorization of emotional faces was hampered in BN (p = .01). Amplitudes of event-related potentials differed during emotional face processing: face-specific N170 amplitudes were less pronounced for angry faces in patients with BN (mean [M] [standard deviation {SD}] = 1.46 [0.56] mu V versus M [SD] = -1.23 [0.61] mu V, p = .02). In contrast, P3 amplitudes were more pronounced in patients with BN as compared with controls (M [SD] = 2.64 [0.46] mu V versus M [SD] = 1.25 [0.39] mu V, p = .04), independent of emotional expression. Conclusions: The study provides novel electrophysiologic data showing that emotional faces are processed differently in patients with BN as compared with healthy controls. We suggest that deficits in early automatic emotion classification in BN are followed by an increased allocation of attentional resources to compensate for those deficits. These findings might contribute to a better understanding of the impaired social functioning in BN.