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Olfactory performance of patients with anorexia nervosa and healthy subjects in hunger and satiety
(2008)
The aim of this study was to compare the olfactory performance of anorectic patients and healthy controls with regard to the state of satiety. Using the Sniffin" Sticks, sensitivity to a nonfood odor (n-butanol) and to a food- related odor (isoamyl acetate) was assessed in 12 anorectic females and compared with 24 healthy controls. Threshold tests were performed in a hungry as well as in a satiated state, odor discrimination and odor identification only when satiated. Pleasantness of the odors was recorded. In terms of the non-food odor n-butanol, the olfactory sensitivity of anorectic patients and controls did not differ. Patients with anorexia nervosa had a significantly lower detection threshold for the food-related odor, but only in the hungry condition. Anorectic patients showed significant deficits in odor discrimination and identification, and under-evaluated the pleasantness of isoamyl acetate. Our results suggest an impaired projection from secondary to tertiary olfactory structures in anorexia nervosa, based upon the dichotomy of performance between detection threshold and odor discrimination/dentification. The reduced pleasantness of isoamyl acetate indicates a decreased olfactory responsiveness to food stimuli in anorexia nervosa.
Internal signals like one's heartbeats are centrally processed via specific pathways and both their neural representations as well as their conscious perception (interoception) provide key information for many cognitive processes. Recent empirical findings propose that neural processes in the insular cortex, which are related to bodily signals, might constitute a neurophysiological mechanism for the encoding of duration. Nevertheless, the exact nature of such a proposed relationship remains unclear. We aimed to address this question by searching for the effects of cardiac rhythm on time perception by the use of a duration reproduction paradigm. Time intervals used were of 0.5, 2, 3, 7, 10, 14, 25, and 40s length. In a framework of synchronization hypothesis, measures of phase locking between the cardiac cycle and start/stop signals of the reproduction task were calculated to quantify this relationship. The main result is that marginally significant synchronization indices (Sls) between the heart cycle and the time reproduction responses for the time intervals of 2, 3, 10, 14, and 25s length were obtained, while results were not significant for durations of 0.5, 7, and 40s length. On the single participant level, several subjects exhibited some synchrony between the heart cycle and the time reproduction responses, most pronounced for the time interval of 25s (8 out of 23 participants for 20% quantile). Better time reproduction accuracy was not related with larger degree of phase locking, but with greater vagal control of the heart. A higher interoceptive sensitivity (IS) was associated with a higher synchronization index (SI) for the 2s time interval only. We conclude that information obtained from the cardiac cycle is relevant for the encoding and reproduction of time in the time span of 2-25s. Sympathovagal tone as well as interoceptive processes mediate the accuracy of time estimation.
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.
BACKGROUND: Feedback from the body is assumed to be altered in depression. Nevertheless, empirical studies investigating this assumed relationship remain sparse. This study aimed to examine interrelations between the ability to perceive heartbeats accurately (interoceptive awareness), depressive symptoms, and anxiety in healthy participants. METHODS: A well-validated heartbeat perception task to measure interoceptive awareness together with two questionnaires indexing anxiety and depression were administered to 119 participants. RESULTS: As main results we observed a negative correlation between heartbeat perception and depression. Only when focussing on high anxiety levels this negative correlation coefficient between depression and interoception remained significant. CONCLUSIONS: Our results highlight the possible relationship between depressive symptoms and interoceptive awareness and may have further implications for theoretical models of anxiety disorders and their treatment. Further research is required to examine the potential consequences of altering interoceptive awareness in healthy subjects in relation to depression and anxiety.
Abstract Alexithymia is characterized by a difficulty in identifying and describing one"s emotions. This study addressed the question of whether alexithymic tendencies are related to limited affective reactivity to briefly presented emotional stimuli. Skin conductance responses were assessed and backward masking was used to minimize elaborated processing of emotional pictures. Results indicated that alexithymic tendencies are associated with smaller electrodermal responses to briefly presented negative pictures. These effects were driven by difficulties in identifying and communicating emotions whereas externally orientated thinking was unrelated to affective reactivity. We conclude that there is an early processing deficit in response to negative stimuli in participants with high scores in alexithymia. Differences in the early emotional reactivity to arousing material could contribute to difficulties in emotional processes related to alexithymia.
The ability to perceive interoceptive signals plays a central role in many theories of emotions. The present study was designed to investigate the relationship between interoceptive awareness and the conscious processing and memory of emotional information. Heart-rate changes were recorded during baseline and affective picture presentation in two groups of participants, differing in cardiac awareness. After a 60-minute break, a recognition task was conducted. Statistical analyses revealed significantly stronger heart-rate deceleration to pleasant and unpleasant stimuli in participants with high interoceptive awareness. In the subsequent picture recognition task, participants with high interoceptive awareness demonstrated a superior recall of pleasant and unpleasant pictures, while no differences were found between interoceptive awareness groups for pictures of neutral content. Our results demonstrate a strong relationship between the perception of cardiac signals and both the processing as well as the recognition of emotional stimuli. High interoceptive awareness was related to increased physiological responses to emotional stimuli and is therefore an important mediating variable when investigating cardiovascular reactivity both in healthy subjects as well as in clinical populations.
The perception of time is a fundamental part of human experience. Recent research suggests that the experience of time emerges from emotional and interoceptive (bodily) states as processed in the insular cortex. Whether there is an interaction between the conscious awareness of interoceptive states and time distortions induced by emotions has rarely been investigated so far. We aimed to address this question by the use of a retrospective time estimation task comparing two groups of participants. One group had a focus on interoceptive states and one had a focus on exteroceptive information while watching film clips depicting fear, amusement and neutral content. Main results were that attention to interoceptive processes significantly affected subjective time experience. Fear was accompanied with subjective time dilation that was more pronounced in the group with interoceptive focus, while amusement led to a quicker passage of time which was also increased by interoceptive focus. We conclude that retrospective temporal distortions are directly influenced by attention to bodily responses. These effects might crucially interact with arousal levels. Sympathetic nervous system activation affecting memory build-up might be the decisive factor influencing retrospective time judgments. Our data substantially extend former research findings underscoring the relevance of interoception for the effects of emotional states on subjective time experience.
OBJECTIVE: Interoceptive awareness is known to be impaired in eating disorders. To date, it has remained unclear whether this variable is related to the construct of interoceptive sensitivity. Interoceptive sensitivity is considered to be an essential variable in emotional processes. The objective of the study was to elucidate this potential relationship and to clarify whether general interoceptive sensitivity is reduced in anorexia nervosa. METHODS: Using a heartbeat perception task, interoceptive sensitivity was assessed in 28 female patients with anorexia nervosa and 28 matched healthy controls. Questionnaires assessing interoceptive awareness (EDI) and several other variables were also administered. RESULTS: Patients with anorexia nervosa displayed significantly decreased interoceptive sensitivity. They also had more difficulties in interoceptive awareness. CONCLUSIONS: In addition to a decreased ability to recognize certain visceral sensations related to hunger, there is a generally reduced capacity to accurately perceive bodily signals in anorexia nervosa. This highlights the potential importance of interoceptive sensitivity in the pathogenesis of eating disorders.
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.
OBJECTIVES: To elucidate the potential relationship between classification of emotional faces and impaired central processing in eating disorders and to investigate the potential mediatory role of alexithymia and depression in this relationship. METHODS: Visual-evoked potentials (VEPs) to emotional faces and classification performance were assessed in 12 anorexic females and matched healthy controls. RESULTS: Patients with anorexia nervosa showed no modulation of emotional face processing and displayed significantly increased N200 amplitudes in response to all emotional categories and decreased VEPs in response to unpleasant emotional faces in the P300 time range as compared with healthy controls. They also made more mistakes in emotional face recognition, in particular, for neutral, sad, and disgusted content. CONCLUSIONS: There are marked differences in evoked potentials and emotion recognition performances of patients with anorexia nervosa and controls in facial processing. Differences in brain dynamics might contribute to difficulties in the correct recognition of facially expressed emotions, deficits in social functioning, and in turn the maintenance of eating disorders.
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.
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.
Alexithymia describes difficulties to identify and describe one's emotions. Previous research focused on difficulties associated with the later processing stages of appraisal in alexithymia. We tested whether early processing deficits are apparent in alexithymic persons and whether these abnormalities contribute to later processing difficulties. 20 participants were selected and identified as either having high (HDA) or low (LDA) degrees of alexithymia. IAPS pictures were presented while EEG was recorded. For HDA subjects processing of emotional pictures was accompanied by reduced P1 amplitudes most pronounced for pleasant and neutral pictures. In response to unpleasant pictures the P3 amplitudes were reduced. These amplitude modulations were predicted only by one alexithymia facet. P1 amplitudes systematically covaried with P3 amplitudes supporting the assumption that deficits in early emotional processing contribute to later processing deficits.
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.
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.
During visual fixation, the eye generates microsaccades and slower components of fixational eye movements that are part of the visual processing strategy in humans. Here, we show that ongoing heartbeat is coupled to temporal rate variations in the generation of microsaccades. Using coregistration of eye recording and ECG in humans, we tested the hypothesis that microsaccade onsets are coupled to the relative phase of the R-R intervals in heartbeats. We observed significantly more microsaccades during the early phase after the R peak in the ECG. This form of coupling between heartbeat and eye movements was substantiated by the additional finding of a coupling between heart phase and motion activity in slow fixational eye movements; i.e., retinal image slip caused by physiological drift. Our findings therefore demonstrate a coupling of the oculomotor system and ongoing heartbeat, which provides further evidence for bodily influences on visuomotor functioning.
On the relationship between interoceptive awareness and the attentional processing of visual stimuli
(2009)
Mental processes related to visceral activity have gained growing interest during the last few years. The following study is the first to investigate possible interactions between interoceptive awareness and measures of attentional performance. We tested the hypothesis whether interoceptive awareness is positively related to indices of selective and divided attentional performances. Using a heartbeat perception task, 29 healthy female participants were separated into two groups scoring either high or low in an interoceptive awareness task. Attentional performance was assessed by several tests including the 'd2 test of attention' and subtests from the 'TAP: Test Battery for Attentional Performance'. We observed a significantly better performance in selective and divided attention for participants with high interoceptive awareness. Our data suggests that interoceptive awareness is related to a better performance especially in tasks assessing selective and divided attention. We conclude 1) that perception of bodily states might be a crucial determinant for the processing of external, visual stimuli, 2) that the ability to perceive internal signals might be an indicator of self-focused attention, and 3) that bodily signals may use, at least in part, similar processing resources as signals from the attention system.
Electrophysiological evidence for an attentional bias in processing body stimuli in bulimia nervosa
(2015)
Empirical evidence suggests abnormalities in the processing of body stimuli in bulimia nervosa (BN). This study investigated central markers of processing body stimuli by means of event-related potentials in BN. EEG was recorded from 20 women with BN and 20 matched healthy controls while watching and evaluating underweight, normal and overweight female body pictures. Bulimics evaluated underweight bodies as less unpleasant and overweight bodies as bigger and more arousing. A higher P2 to overweight stimuli occurred in BN only. In contrast to controls, no N2 increase to underweight bodies was observed in BN. P3 was modulated by stimulus category only in healthy controls; late slow waves to underweight bodies were more pronounced in both groups. P2 amplitudes to overweight stimuli were correlated with drive for thinness and body dissatisfaction. We present novel support for altered perceptual and cognitive-affective processing of body images in BN on the subjective and electrophysiological level. (C) 2015 Elsevier B.V. All rights reserved.
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.