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Altered interoceptive activation before, during, and after aversive breathing load in women remitted from anorexia nervosa

Published online by Cambridge University Press:  17 July 2017

L. A. Berner ,
A. N. Simmons ,
C. E. Wierenga ,
A. Bischoff-Grethe ,
M. P. Paulus ,
U. F. Bailer ,
A. V. Ely  and
W. H. Kaye
L. A. Berner
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA
A. N. Simmons
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
C. E. Wierenga
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
A. Bischoff-Grethe
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA
M. P. Paulus
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
U. F. Bailer
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
A. V. Ely
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA
W. H. Kaye*
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA
*
*Address for correspondence: W. H. Kaye, M.D., UCSD Department of Psychiatry, UCSD Eating Disorder Research and Treatment Program , Chancellor Park, 4510 Executive Dr., Suite 315, San Diego, CA 92121-3021, USA. (Email: [email protected])
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Abstract

Background

The neural mechanisms of anorexia nervosa (AN), a severe and chronic psychiatric illness, are still poorly understood. Altered body state processing, or interoception, has been documented in AN, and disturbances in aversive interoception may contribute to distorted body perception, extreme dietary restriction, and anxiety. As prior data implicate a potential mismatch between interoceptive expectation and experience in AN, we examined whether AN is associated with altered brain activation before, during, and after an unpleasant interoceptive state change.

Methods

Adult women remitted from AN (RAN; n = 17) and healthy control women (CW; n = 25) underwent functional magnetic resonance imaging during an inspiratory breathing load paradigm.

Results

During stimulus anticipation, the RAN group, relative to CW, showed reduced activation in right mid-insula. In contrast, during the aversive breathing load, the RAN group showed increased activation compared with CW in striatum and cingulate and prefrontal cortices (PFC). The RAN group also showed increased activation in PFC, bilateral insula, striatum, and amygdala after stimulus offset. Time course analyses indicated that RAN responses in interoceptive processing regions during breathing load increased more steeply than those of CW. Exploratory analyses revealed that hyperactivation after breathing load was associated with markers of past AN severity.

Conclusions

Anticipatory deactivation with a subsequent exaggerated brain response during and after an aversive body state may contribute to difficulty predicting and adapting to internal state fluctuation. Because eating changes our interoceptive state, restriction may be one method of avoiding aversive, unpredictable internal change in AN.

Keywords

Anorexia nervosaaversivebreathing loadfunctional magnetic resonance imaging (fMRI)interoception
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 1 , January 2018 , pp. 142 - 154
Copyright
Copyright © Cambridge University Press 2017 

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