Interoceptive processes in anorexia nervosa in the time course of cognitive-behavioural therapy

Abstract

Background: Reduced interceptive processes (especially interoceptive accuracy (IAc) and interoceptive sensibility (IS)) are associated with problems in recognition and processing of emotions as well as difficulties in perceiving hunger and satiety. These are central components in the onset and maintenance of eating disorders, especially anorexia nervosa (AN). Previous studies found a reduced IAc in AN. Whereas first studies suggest an improvement of IS in the time course of therapy in patients with AN, there is still a lack of research regarding the investigation of IAc. Methods: 15 patients with AN (age: 27.40 [SD 7.85], BMI: 15.72 [SD 1.27]) from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls (age: 27.93 [SD 7.56], BMI: 21.02 [SD 1.84]), recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task and completed standard psychological assessments (Beck Depression Inventory-II and Eating Disorder Inventory 2 (subscale: interoceptive awareness)). Results: Patients with AN showed a significantly decreased weight, higher levels of depression and both reduced IS and IAc compared to healthy controls. Following therapy, patients recovered in terms of weight and depression symptomatology. A descriptive trend for recovering from IS and IAc was observed. Conclusions: Our findings suggest that deficits in interoceptive processes are present in recovered patients and could be a major factor for the high relapse rate. For the improvement of IAc a training of this variable (e.g. using biofeedback) is required.