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Stevenson RJ, Serebro J, Mruk A, Martin-Rivera D, Wyver S, Francis HM. Caregivers' Attention Toward, and Response to, Their Child's Interoceptive Hunger and Thirst Cues. Dev Psychobiol 2024; 66:e22531. [PMID: 39039660 DOI: 10.1002/dev.22531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024]
Abstract
People can use their internal state to determine if they are hungry or thirsty. Although the meaning of some interoceptive cues may be innate (e.g., pain), it is possible that others-including those for hunger and thirst-are acquired. There has been little exploration of this idea in humans. Consequently, we conducted a survey among child caregivers to determine if the basic conditions necessary for interoceptive learning were present. Two-hundred and thirty-five caregivers of children aged 1-12 years were asked if they had recently noticed stomach rumbling, hunger-related irritability, and a dry mouth in their child. They were also asked how they would respond. The impact of several moderating variables, especially caregiver beliefs about the causes of hunger, fullness, and thirst, was also explored. Fifteen percent of caregivers had recently noticed stomach rumbling in their child, 28% hunger-related irritability, and 14% a dry mouth. Forty-four percent of caregivers had noticed at least one of these three cues. Noticing hunger cues was significantly moderated by caregiver beliefs about their cause, by child age, and in one case by temporal context (around vs. outside mealtimes). Key caregiver responses were providing the need (e.g., offer food) and/or asking the child if they had a need (e.g., hungry?). Each type of response could potentially support a different form of interoceptive learning. In conclusion, we suggest the necessary conditions for children to learn interoceptive hunger and thirst cues, are present in many caregiver-offspring dyads.
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Affiliation(s)
- Richard J Stevenson
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Serebro
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Alexandra Mruk
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | | | - Shirley Wyver
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Heather M Francis
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
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Cobbaert L, Hay P, Mitchell PB, Roza SJ, Perkes I. Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories. Int J Eat Disord 2024; 57:1465-1488. [PMID: 38511825 DOI: 10.1002/eat.24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This review investigated the extant literature regarding the relationship between eating disorder diagnoses and sensory processing as measured by validated and reliable self-report inventories. Increasing evidence highlights the role of sensory processing in cognitive functions. Sensory processing is implicated in mental-ill health, including eating disorders (ED) and body image disturbances. However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored. METHOD We included studies involving participants aged 15 years or older with an eating disorder diagnosis confirmed by semi-structured or structured interviews. We further limited inclusion to articles using validated and reliable self-report instruments to measure sensory processing. Our meta-analysis focused on studies using the interoceptive awareness subscale from the second version of the Eating Disorder Inventory. We used the Critical Appraisal checklist for quasi-experimental studies to assess the quality of included articles. RESULTS There were 19 studies that met our inclusion criteria. Most studies showed moderate-to-high quality. Anorexia nervosa (AN) and bulimia nervosa (BN) were associated with heightened exteroception. Moreover, people with AN reported a heightened sense of taste compared to those with BN. Our meta-analysis comprising 10 studies, 19 samples, and 6382 participants revealed that AN (binge-purge subtype) and BN were associated with increased interoceptive difficulties compared to AN (restrictive subtype) or binge-eating disorder. DISCUSSION Overall, this review emphasizes the need for a deeper investigation into sensory processing, spanning both exteroception and interoception, in relation to ED. This may prove important for individualizing person-centered care. PUBLIC SIGNIFICANCE How people process internal, for example, hunger, and external, for example, taste and sensations is known to influence cognition and mental-ill health, including ED and body image disturbances. However, the ways in which sensory processing may contribute to ED are incompletely understood. We found that individuals with AN or BN experienced heightened exteroception, while people with an eating disorder characterized by purging reported increased interoceptive difficulties. These patterns could inform the development of more personalized treatments.
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Affiliation(s)
- Laurence Cobbaert
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Mental Health Services, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sabine J Roza
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Iain Perkes
- Faculty of Medicine and Health, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Stevenson RJ, Martin-Rivera D, Dixon G, Francis HM. Parent-offspring similarity in hunger and thirst sensations. Appetite 2024; 195:107208. [PMID: 38218415 DOI: 10.1016/j.appet.2024.107208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
The internal (i.e., interoceptive) sensations that characterise hunger vary between people, and this may also be the case for thirst, although it has not been so well explored. There are probably both heritable and learning-based causes for this interoceptive variability. Consequently, it would seem plausible that parents and their offspring would have more similar patterns of hunger and thirst than pairs of strangers. We tested this idea, in addition to exploring its potential moderating variables, by studying the similarity of self-reported hunger and thirst sensations in 170 students and their primary caregivers from childhood. Both students and caregivers completed the same online-survey, covering hunger and thirst sensations, beliefs about the causes of hunger and thirst, the Three Factor Eating Questionnaire (revised) and demographic data. We find evidence of robust student-caregiver similarity in interoceptive hunger and thirst sensations (medium effect sizes), with these being moderated by caregiver beliefs about the homeostatic nature of each state (medium effect sizes). This suggests a potential role for caregivers in the development of their offspring's interoceptive cues for hunger and for thirst. In addition, thirst, like hunger, appears to be multidimensional, and varies between people. The implications of these findings are discussed.
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Affiliation(s)
| | | | - Gabriela Dixon
- School of Psychology, Macquarie University, Sydney, Australia
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McNaughton BA, Burrows K, Choquette E, Poplin T, Kuplicki R, Paulus MP, Ironside M, Stewart JL. Impaired eating behaviors but intact metabolic hormone levels in individuals with major depressive disorder and generalized anxiety disorder. J Psychiatr Res 2023; 168:193-203. [PMID: 37918032 PMCID: PMC10842703 DOI: 10.1016/j.jpsychires.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) and generalized anxiety disorder (GAD) contribute significantly to global health burdens. Identifying disease markers for these comorbid disorders can increase understanding of pathogenesis and improve screening and intervention strategies. This study examined the association of physical health factors with MDD and MDD + GAD, across sexes. METHODS Two samples of participants from the Tulsa-1000 study (exploratory cohort: N = 136; confirmatory cohort: N = 185) completed body composition measurements, eating behavior (Three Factor Eating Questionnaire [TFEQ], Eating Disorder Diagnostic Scale [EDDS]), exercise questionnaires, and a blood draw. Metabolic hormone concentrations (leptin, insulin, and adiponectin) were analyzed from blood samples. Within each cohort, a two-way analysis of variance compared three groups (MDD, MDD + GAD, and healthy controls [HC]), sex, and their interaction on dependent variables. Hedges g was calculated to reflect effect size magnitude. RESULTS Medium-to-large group main effects across cohorts indicated that compared to HC: (1) MDD (g = 1.71/0.57) and MDD + GAD (g = 0.93/0.69) reported higher TFEQ Disinhibition scores; (2) MDD endorsed higher TFEQ Hunger scores (g = 0.66/0.48); and (3) MDD (g = 1.60/1.30) and MDD + GAD (g = 0.92/1.72) reported greater EDDS scores. Large sex main effects across cohorts indicated that females exhibited higher levels than males for percent body fat (g = 1.07/1.17), leptin (g = 1.27/1.12), and adiponectin (g=0.82/0.88). LIMITATIONS The power to detect group*sex interactions was limited due to a greater number of females (than males) in the study, and over half of clinical participants were taking medications. CONCLUSIONS Individuals with MDD and MDD + GAD demonstrate difficulties in regulating eating behaviors, potentially contributing to functional impairment and increased disease burden.
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Affiliation(s)
| | | | | | - Tate Poplin
- Laureate Institute of Brain Research, Tulsa, OK, USA
| | | | - Martin P Paulus
- Laureate Institute of Brain Research, Tulsa, OK, USA; The University of Tulsa, Tulsa, OK, USA
| | - Maria Ironside
- Laureate Institute of Brain Research, Tulsa, OK, USA; The University of Tulsa, Tulsa, OK, USA
| | - Jennifer L Stewart
- Laureate Institute of Brain Research, Tulsa, OK, USA; The University of Tulsa, Tulsa, OK, USA.
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Stevenson RJ. The psychological basis of hunger and its dysfunctions. Nutr Rev 2023:nuad092. [PMID: 37495211 DOI: 10.1093/nutrit/nuad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
This article describes a new and emerging psychological perspective on hunger, together with the implications of that perspective, which is based upon learning and memory. Hunger is a psychological state characterized by a desire to eat. Historically, conceptions of hunger have largely been expressed in terms of physiology (eg, biological process X causes hunger). However, physiology neither offers a psychological account of hunger nor explains why memory impairment can eliminate hunger. Two forms of hunger are identified - specific and general. Specific hunger is for particular palatable foods. It involves recollecting episodic memories of eating that food, when an associated cue is encountered (eg, an advert). General hunger is a desire to eat triggered by temporal (eg, it is lunchtime) or interoceptive (eg, tummy rumble) cues. It involves semantic memory retrieval, which then augments the expected - remembered - pleasure for any food. Both hungers are supported by the medial temporal lobe memory system. Damage to this system can occur from eating a Western-style diet and, longer-term, from obesity and its consequences. Medial temporal lobe memory damage may cause deficits in specific hunger, but most especially in general hunger, resulting in little motivation to eat foods that the individual considers to be of low-to-moderate palatability, such as fruit and vegetables. The implications of this account for teaching people hunger, for how hunger is affected by diet, for public education, and pharmaceutical intervention, are discussed. Psychological concepts of hunger are widely used in nutritional practice. This article provides a new and emerging perspective on the psychological basis of hunger and its implications.
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