Can you feel the body that you see? On the relationship between interoceptive accuracy and body image

From early relational experiences to non-suicidal self-injury in anorexia and bulimia nervosa: a structural equation model unraveling the role of impairments in interoception

PURPOSE

Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) frequently exhibit Non-Suicidal Self-Injury (NSSI), yet their co-occurrence is still unclear. To address this issue, the aim of this study was to elucidate the role of impairments in interoception in explaining the NSSI phenomenon in AN and BN, providing an explanatory model that considers distal (insecure attachment/IA and traumatic childhood experiences/TCEs) and proximal (dissociation and emotional dysregulation) risk factors for NSSI.

METHOD

130 patients with AN and BN were enrolled and administered self-report questionnaires to assess the intensity of NSSI behaviors, interoceptive deficits, IA, TCEs, emotional dysregulation and dissociative symptoms.

RESULTS

Results from structural equation modeling revealed that impairments in interoception acted as crucial mediators between early negative relational experiences and factors that contribute to NSSI in AN and BN, particularly emotional dysregulation and dissociation. Precisely, both aspects of IA (anxiety and avoidance) and various forms of TCEs significantly exacerbated interoceptive deficits, which in turn are associated to the emergence of NSSI behaviors through the increase in levels of dissociation and emotional dysregulation.

CONCLUSIONS

The proposed model provided a novel explanation of the occurrence of NSSIs in patients with AN and BN by accounting for the significance of interoception.

LEVEL OF EVIDENCE

Level V-Cross-sectional observational study.

Incels, autism, and hopelessness: affective incorporation of online interaction as a challenge for phenomenological psychopathology

Recent research has drawn attention to the prevalence of self-reported autism within online communities of involuntary celibates (incels). These studies suggest that some individuals with autism may be particularly vulnerable to the impact of incel forums and the hopelessness they generate. However, a more precise description of the experiential connection between inceldom, self-reported autism, and hopelessness has remained unarticulated. Therefore, this article combines empirical studies on the incel community with phenomenological and embodiment approaches to autism, hopelessness, and online affectivity. We analyze three interrelated aspects of online interactions in incel communities - worldview, bodily self-relation, and mutual dismissals - and examine how these elements contribute to the consolidation of the loss of significant life possibilities. By investigating the potential negative influence of specific online environments on affective dispositions, our approach contributes to the debate on current challenges to "situate" phenomenological psychopathology.

Spontaneous eye blinking during an auditory, an interoceptive and a visual task: The role of the sensory modality and the attentional focus

Previous evidence suggested that spontaneous eye blinking changes as a function of the attentional focus. In particular, eye blink rate (EBR) tends to increase when attention is directed to internal versus environmental processing. Most studies on this issue compared eye blinking during visual and mental imagery tasks, and interpreted the increase in EBR as a mechanism to focus cognitive resources on internal processing by disengaging attention from interfering information. However, since eye blinking also depends on the sensory modality of the task, the findings might be influenced by a modality-specific effect. In the present Registered Report we aim at investigating whether the environmental versus internal attentional focus can affect spontaneous blinking behaviour in non-visual tasks as well, in conditions where visual stimuli are not relevant. In a within-subject design, healthy participants performed an interoceptive task (i.e., heartbeat counting) and an auditory task in which pre-recorded heartbeats were presented aurally; during both tasks irrelevant visual stimuli were also presented. In a further control condition with the same auditory and visual stimuli, the participants were required to focus their attention on visual stimuli. Participants' EBR was recorded during each task by means of an eye-tracking system. We found that, although the interoceptive task was more difficult than the auditory and visual tasks, participants' EBR decreased by a comparable level in all tasks with respect to a rest condition, with no differences between internal versus environmental conditions. The present findings do not support the idea that EBR is modulated by an internal versus external focus of attention, at least in presence of controlled visual stimulation.

Abnormal sense of agency in eating disorders

The feeling of controlling one's own actions and, through them, impacting the external environment (i.e. Sense of Agency-SoA) can be relevant in the eating disorders (EDs) symptomatology. Yet, it has been poorly investigated. This study aims to implicitly assess SoA exploiting the Sensory Attenuation paradigm in two groups of EDs patients (Anorexia Nervosa Restrictive and Anorexia Nervosa Binge-Purging or Bulimia Nervosa) compared to a control group. We find that controls perceive self-generated stimuli as less intense than other-generated ones showing the classic pattern of sensory attenuation. By contrast, EDs patients show the opposite pattern, with self-generated perceived as more intense than other-generated stimuli. This result indicates an alteration of the implicit component of the feeling of control in EDs patients, thus suggesting a potential implication of these results for the clinical practice and the treatment of EDs symptomatology.

Investigation of body awareness and body image perception in patients with type 2 diabetes mellitus

OBJECTIVES

The purpose of the study is to investigate body awareness and body image perception of patients with type 2 diabetes mellitus (T2DM) and to explore the association between clinical parameters and body awareness.

METHODS

A total of 92 participants with T2DM (38 women and 54 men) aged 36-76 years were recruited. Biochemical measurements, including fasting blood glucose, postprandial blood glucose and hemoglobin A1c (HbA1c), were obtained from the patients' blood sample records. The Body Awareness Questionnaire (BAQ), Body Cathexis Scale (BCS) and Awareness Body Chart (ABC) were filled in by all subjects.

RESULTS

Most participants had an above-average BAQ (81.5%) and BCS (87%) score. There was a significant correlation between body mass index and ABC pain subscale. HbA1c was significantly associated with the duration of diabetes and sleep-wake cycle, process domains and total BAQ score. The body awareness score for the lower leg and foot regions (ABC parts) was negatively correlated with fasting blood glucose and HbA1c levels, while body awareness in the foot region was negatively correlated with the duration of diabetes. There was no association between BCS and any clinical parameters.

CONCLUSION

This study showed that body awareness is associated with diabetes-related clinical parameters, such as fasting blood glucose and HbA1c levels, and duration of diabetes in patients with T2DM. Following diabetes progression and an increase in blood glucose levels, body awareness tended to decrease, particularly in the lower leg and foot regions. These findings highlighted the importance of evaluating body awareness in patients with T2DM.

Efficacy of interoceptive and embodied rehabilitative training protocol in patients with mild multiple sclerosis: A randomized controlled trial

Introduction

The aim of this randomized controlled trial was to evaluate the effect of an embodied rehabilitative protocol, in improving interoceptive awareness respect balance and motor performance in patients with mild multiple sclerosis (pwMS).

Methods

In this study patients with relapsing-remitting multiple sclerosis were enrolled. The rehabilitative treatment group (TG) participated in an embodied physiotherapy program consisting of 8 one-hour sessions in groups of 4 patients at a time, 1 per week and 2 one-hour sessions of neuro-cognitive exercise in single session during the rehabilitation program. All pwMS underwent a clinical assessment to measure the interoception sense for the Multidimensional Assessment of Interoceptive Awareness scale, balance for the Tinetti Mobility test and stabilometry, quality of life for the Short Form Health Survey-12 and body image perception for Trunk Appearance Perception Scale and Body Image Scale. All previous scales and tests were performed at baseline (T0), at the end of treatment (T1) and after 2 months of follow up (T2).

Results

Sixty patients were enrolled and randomized into two groups: TG (n = 30), aged 43.0 ± 10.2 years, and a control/waiting list (WLG) group (n = 30), aged 40.7 ± 10.4 years. Statistically significant improvements in interoceptive awareness, body image perception, balance and quality of life were reported in TG versus WLG (p < 0.05).

Discussion

This study suggests that enhancing interoceptive awareness could improve postural balance. Future studies with a larger sample of patients will be needed to better quantify the effects of an embodied rehabilitation.

[To experience one's physicality through the "bizarre" experience of touching oneself]

The touch of oneself is essential in the construction of a conscious self. It contributes to the feeling of ownership of the body. Feeling touched and touching reveals the subject in a being-self inscribed in its environment. This sensory experience can be disturbing for the subject. A study conducted with adolescent girls with obesity has shown that this haptic experience, during a postural session, can generate a feeling of strangeness. This singular discovery of oneself reveals the opening towards new exploratory fields of the body self-consciousness, during our care.

Manipulating the sensation of feeling fat: The role of alexithymia, interoceptive sensibility and perfectionism

OBJECTIVE

Feeling fat reflects difficulties in processing emotions and is an important aspect of body image and eating disorders. The current study aimed to develop a novel social comparison manipulation to induce feeling fat and to explore personality traits that may increase an individual's vulnerability.

METHODS

At time 1254 healthy females (24.14 years, BMI = 23.77) completed the feeling fat subscale of the Body Attitudes Questionnaire, as well as self-report measures of alexithymia, interoceptive sensibility, physical appearance comparison and perfectionism online.

RESULTS

Greater tendency to feel fat was significantly associated with difficulty identifying and describing feelings (alexithymia), poorer interoceptive sensibility, higher socially-prescribed perfectionism, and greater engagement in physical appearance comparisons. At time 2, a subset of 107 participants (22.39 years, BMI = 23.85) were randomly assigned to a condition: negative social comparison, positive social comparison, negative general, or neutral (as a control). Participants in the negative social comparison condition reported significantly greater increases in feeling fat compared to the control condition, but only when they were also high in alexithymia or socially-prescribed perfectionism.

DISCUSSION

Current findings provide new insights into the potential mechanisms underpinning feeling fat and highlight how a novel social comparison manipulation can be used to induce the sensation of feeling fat.

Physical activity and interoceptive processing: Theoretical considerations for future research

Interoception, defined as the sense of the internal bodily state, plays a critical role in physical, cognitive, emotional and social well-being. Regarding physical well-being, contemporary models of exercise regulation incorporate interoceptive processes in the regulation of physical exertion. Top-down processes continuously monitor the physiological condition of the body to ensure allostasis is maintained, however, flagged perturbations also appear to influence these higher order processes in return. More specifically, enhancing one's physiological arousal by means of physical activity is a viable way of manipulating the afferent input entering the interoceptive system, appearing to optimise the integration of early sensory stimulation with later affective responses. Despite this, the relationship between physical activity and top-down regulation is underrepresented in interoceptive research. We here address this gap by integrating findings from different disciplines to support the overlapping mechanisms, with the hope of stimulating further research in this field. Developing our understanding of how interoceptive processes are shaped by physical activity could hold significant clinical implications considering the impact of interoceptive deficits to mental health and well-being.

Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study

BACKGROUND

The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder.

OBJECTIVE

We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores.

METHODS

We conducted a case-control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge - assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test.

RESULTS

The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered.

CONCLUSION

We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image.

LEVEL OF EVIDENCE

Level II: controlled trial without randomization.

The ageing body: contributing attitudinal factors towards perceptual body size estimates in younger and middle-aged women

Over-estimation of body size, a core feature of eating disorders (EDs), has been well-documented both in young healthy and ED individuals. Yet, evidence that altered body perception might also affect older women is limited. Here, we examined whether attitudinal components of body image (i.e. the feelings an individual has about their body size and shape) might affect perceived actual and ideal body shape self-estimates in midlife, similarly to younger women. Thirty-two younger (mean age, 24.22 years) and 33 middle-aged (mean age, 53.79 years) women took part to a computerized body perception assessment of perceived, actual and ideal aspects of body image. Body mass index (BMI), societal and interpersonal aspects of appearance ideals, measured by means of Sociocultural Attitudes towards Appearance Questionnaire (SATAQ-4), and assessment of body uneasiness and concerns for specific body parts, measured by Body Uneasiness Test (BUT-A/B) scales, were also investigated. Younger and middle-aged women with larger BMI showed greater discrepancy in perceptual distortions from their perceived actual body size. However, middle-aged women with greater body part concerns overestimated their perceived body size, as opposed to younger women who were almost accurate. Unlike middle-aged women, younger women with higher body part concerns desired slimmer ideal body image than their perceived actual. Results suggest that distortions in the perceived actual and ideal body size self-estimates of younger and middle-aged women are best explained by a combination of BMI, body part concerns and the particular age group to which a participant belonged. In the future, a personalized approach for the assessment of women's perceptions and concerns of specific body areas during lifespan should be adopted.

The role of affective touch in whole-body embodiment remains equivocal

Previous studies have highlighted that affective touch delivered at slow velocities (1-10 cm/s) enhances body-part embodiment during multisensory illusions, yet its role towards whole-body embodiment is less established. Across two experiments, we investigated the role of affective touch towards subjective embodiment of a whole mannequin body within the full body illusion, amongst healthy females. Participants perceived affective touch to be more pleasant than non-affective touch, but this did not enhance subjective embodiment within the illusion and no interaction between synchrony (Experiment 1), or congruency (Experiment 2), and the velocity of touch was observed. Finally, the perceived pleasantness of touch was not modulated by subthreshold eating disorder psychopathology, as measured by means of a self-report questionnaire. Therefore, the present findings suggest that enhancement of embodiment due to affective touch may be body-part specific, and not generalise to greater ownership towards a whole body.

How ageing shapes body and space representations: A comparison study between healthy young and older adults

To efficiently interact with the external world, the brain needs to represent the size of the involved body parts - body representations (BR) - and the space around the body in which the interactions with the environment take place - peripersonal space representation (PPS). BR and PPS are both highly flexible, being updated by the continuous flow of sensorimotor signals between the brain and the body, as observed for example after tool-use or immobilization. The progressive decline of sensorimotor abilities typically described in ageing could thus influence BR and PPS representations in the older adults. To explore this hypothesis, we compared BR and PPS in healthy young and older participants. By focusing on the upper limb, we adapted tasks previously used to evaluate BR and PPS plasticity, i.e., the body-landmarks localization task and audio-tactile interaction task, together with a new task targeting explicit BR (avatar adjustment task, AAT). Results show significantly higher distortions in the older rather than young participants in the perceived metric characteristic of the upper limbs. We found significant modifications in the implicit BR of the global shape (length and width) of both upper limbs, together with an underestimation in the arm length. Similar effects were also observed in the AAT task. Finally, both young and older adults showed equivalent multisensory facilitation in the space close to the hand, suggesting an intact PPS representation. Together, these findings demonstrated significant alterations of implicit and explicit BR in the older participants, probably associated with a less efficient contribution of bodily information typically subjected to age-related decline, whereas the comparable PPS representation in both groups could be supported by preserved multisensory abilities in older participants. These results provide novel empirical insight on how multiple representations of the body in space, subserving actions and perception, are shaped by the normal course of life.

Étude qualitative de l’expérience psychocorporelle des autotouchers faciaux spontanés chez des infirmiers portés volontaires en renfort covid

Introduction&#160;: The COVID-19 pandemic has warranted the implementation of barrier actions and the wearing of personal protective equipment (PPE). These behavioral adaptations counteract spontaneous self-touching reflex gestures. I propose to explore the mind-body experience generated by these gesture changes in this health context.Method&#160;: I conducted a qualitative study with nine nurses who volunteered as reinforcements. The semistructured interviews I carried out were analyzed using the interpretative phenomenological analysis approach.Results&#160;: The perception of the risk of self-inoculation is not related to the level of virus exposure. Facial PPE is perceived both as reassuring and difficult to put up with. The experience of self-touches is influenced by the level of attention the subject pays to his or her face and by the medical background related to this. Three kinds of mind-body adaptations are used to control self-touching&#160;: control by avoidance, control by keeping one&#8217;s hands busy, and compensatory bodily strategies. The representations of the bodily self are modified in terms of gestures and of the feeling of humanness. This generates a form of bodily abandonment and a lived experience of soiled bodies.Conclusion&#160;: The results highlight the cognitive load involved in refraining from self-touching and with the wearing of facial PPE. They emphasize the importance of questioning the implications of these sensorimotor modifications. Supporting health professionals in assessing the mind-body repercussions in a pandemic situation appears key.

Implicit mechanisms of body image alterations: The covert attention exposure effect

Visual exposure to extreme-sized bodies elicits explicit self-body image variations. Several features of such modulation remain to be clarified. In this study we explored whether this effect: (i) acts on implicit mechanisms in modifying one's body-size perception, (ii) is body-exposure-specific also at the implicit level, and (iii) is modulated by interoceptive sensibility. We assigned a covert attention task to 100 women, exposing them to extreme-sized bodies (thin and fat) or extreme-sized objects (thin and fat bottles). Before and after the attentional exposure, we tested the association between the "self/others" and "thin/fat" concepts using an Implicit Association Test. We also collected a measure of interoceptive sensibility by means of a self-report questionnaire. Results showed that participants exposed to fat bodies implicitly presented a stronger association between the "self" and "thin" concepts. This association was significantly weaker in the group exposed to thin bodies. This effect was absent after exposure to thin and fat bottles. Notably, participants with a higher tolerance of negative bodily interoceptive signals were less susceptible to the malleability of body image exerted by the exposure attentional task. Our findings shed new light on the relationship between the perception of internal (e.g., visceral) and external (e.g., visual) signals in the representation of our body.

An Active Inference Approach to Interoceptive Psychopathology

Interoception refers to the process by which the nervous system senses and integrates signals originating from within the body, providing a momentary mapping of the body's internal landscape and its relationship to the outside world. Active inference is based on the premise that afferent sensory input to the brain is constantly shaped and modified by prior expectations. In this review we propose that interoceptive psychopathology results from two primary interoceptive dysfunctions: First, individuals have abnormally strong expectations of the situations that elicit bodily change (i.e., hyperprecise priors), and second, they have great difficulty adjusting these expectations when the environment changes (i.e., context rigidity). Here we discuss how these dysfunctions potentially manifest in mental illness and how interventions aimed at altering interoceptive processing can help the brain create a more realistic model of its internal state.

Body Awareness and its Relation to Quality of Life in Individuals with Idiopathic Scoliosis

An individual's body awareness depends on the integration of bodily signals from both inside and outside the body. The etiology of idiopathic scoliosis includes a variety of somatosensorial and biomechanical alterations that may affect an individual's body awareness. In this study, we investigated body awareness and its relation to quality of life among individuals with idiopathic scoliosis. We studied 96 participants with scoliosis and 71 healthy control participants. We evaluated both participant groups' body awareness using the Awareness-Body-Chart, and we assessed the quality of life of those with scoliosis using the Scoliosis Research Society-22 (SRS-22) questionnaire. The overall body awareness score and the body awareness values for the face, cervical/lumbar region, back, shoulder, upper arm, lower arm/elbow, hand, genital area, thigh/hip, lower leg, and foot were all found to be significantly lower among the participants with scoliosis than among healthy participants. Among participants with scoliosis, the body awareness value for the back region was positively correlated with pain, body image, mental health, and overall quality of life scores on the SRS-22, whereas the pain score on the Awareness-Body-Chart was negatively correlated with the function/activity, pain, mental health, and overall scores for the SRS-22. This study showed that participants with idiopathic scoliosis have poorer body awareness than control participants without scoliosis, and body awareness among participants with scoliosis was correlated with their self-reports of pain, body image, function, and mental health. These findings highlight the particular importance of body awareness to quality of life for individuals with scoliosis.

Improving interoceptive ability through the practice of power posing: A pilot study

Interoception refers to the detection and perception of signals from the inner body. Deficits in this domain have been linked to psychopathologies, prompting the search for strategies to improve this ability. Preliminary studies have shown that interoception could be enhanced through the manipulation of subjective feelings of power. We tested the effects of adopting powerful postures on different facets of interoception. Firstly, we measured the impact of a single power posing session on interoceptive ability in 41 healthy females. Then, the same participants were randomly assigned to two conditions (daily power posing practice vs. no practice). After one week the conditions alternated. Interoceptive accuracy, measured by the heartbeat tracking task, interoceptive sensibility, measured by the Body Perception Questionnaire (BPQ) and confidence ratings, as well as subjective feelings of power were assessed at baseline, after a single power posing session and after one week of training. A single power posing session significantly increased individuals' interoceptive accuracy. Also, power posing reduced individuals' scores on the BPQ after one week of daily practice and increased subjective feelings of power after one session and one week of daily practice. These findings suggest that adopting powerful postures has the potential to increase interoceptive accuracy, as well as subjective feelings of power, and to reduce interoceptive sensibility, measured by questionnaire.

Adaptation and validation of body maps for musculoskeletal pain location in patients with severe obesity

Background

Although a variety of instruments implement body maps for the precise identification of pain symptoms, no instrument has been validated for use in people with obesity. This study reports the adaptation and validation of body maps for musculoskeletal pain location in people with obesity.

Methods

Nine key anatomical regions were highlighted based on the original images of the Nordic Musculoskeletal Questionnaire body maps. Adult silhouettes were generated from photographs of men and women with obesity. The body dimensions were adjusted to take into account the different body fat distribution patterns of people with obesity. The validity of the images was assessed by 12 experts. Subsequently, a data collection stage was performed with 58 patients with severe obesity from both sexes. The reproducibility of the images was tested by comparison with the original images.

Results

The results of the validation pilot study indicated that the adapted images facilitated the location of musculoskeletal pain in men and women with obesity. The reproducibility of the original and adapted versions of the body maps indicated good agreement for pain over the last 12 months and 7 days (80% vs. 79.7%). Pain scores in the last 12 months indicated good and high sensitivity and specificity for all body areas (60.9% vs. 89.1%). Considering pain in the last 7 days, high sensitivity and specificity for all areas of the body (85.1% vs. 70.1%).

Conclusions

The body maps developed in this study are reliable and valid to identify the location of pain in people with obesity.