Anorexia nervosa as a disorder of the subcortical-cortical interoceptive-self

Author: Lorenzo Lucherini Angeletti1, Matteo Innocenti2, Federica Felciai2, Emanuele Ruggeri2, Emanuele Cassioli2, Eleonora Rossi2, Francesco Rotella3, Giovanni Castellini2, Giovanni Stanghellini4, Valdo Ricca2, Georg Northoff5,6,7,8
1 Department of Health Sciences, Psychiatry Unit, University of Florence, Largo G. Alessandro Brambilla 3, 50134, Florence, Italy.
2 Department of Health Sciences, Psychiatry Unit, University of Florence, Largo G. Alessandro Brambilla 3, 50134, Florence, Italy.
3 AOU Careggi Hospital, Psychiatry Unit, Florence, Italy.
4 Department of Health Sciences, Psychology Unit, University of Florence, Florence, Italy.
5 Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, China.
6 Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China.
7 The Royal's Institute of Mental Health Research & University of Ottawa, Ottawa, ON, Canada.
8 Centre for Neural Dynamics, Faculty of Medicine, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.
Conference/Journal: Eat Weight Disord
Date published: 2022 Nov 10
Other: Special Notes: doi: 10.1007/s40519-022-01510-7. , Word Count: 204

Anorexia nervosa (AN) is characterized by a diminished capacity in perceiving the physiological correlates of interoceptive sensations, namely bodily self-consciousness. Given the neural division of self-processing into interoceptive-, exteroceptive- and mental-self, we hypothesize neural deficits in the interoceptive-processing regions in AN.

To prove this, we reviewed resting state (rs), task and rest-task studies in AN literature.

Neuronal data demonstrate the following in AN: (i) decreased rs-functional connectivity (rsFC) of subcortical-cortical midline structures (SCMS); (ii) reduced rsFC between medial (default-mode network/DMN and salience network/SN) and lateral (executive-control network/ECN) cortical regions; (iii) decreased rsFC in mainly the regions of the interoceptive-self; (iv) altered activity with overall increased activity in response to sensory/body image stimuli, especially in the regions of the interoceptive-self; (v) lack of a clear task-related distinction between own's and others' body image.

These data may indicate that rs-hypoconnectivity between SCMS, as neural correlate of a reduced intero-exteroceptive integration resulting in self-objectification, might be linked to overall increased activity in interoceptive regions during sensory/body image stimuli in AN, engendering an "anxious bodily self."

Level of evidence:
I: Systematic review.

Keywords: Anorexia nervosa; Interoception; Resting-state functional connectivity; Self-objectification; Task-induced activity; fMRI.

PMID: 36355249 DOI: 10.1007/s40519-022-01510-7