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      Gastrointestinal Interoception in Eating Disorders: Charting a New Path

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          Abstract

          Purpose of Review

          Abnormal interoception has been consistently observed across eating disorders despite limited inclusion in diagnostic conceptualization. Using the alimentary tract as well as recent developments in interoceptive neuroscience and predictive processing as a guide, the current review summarizes evidence of gastrointestinal interoceptive dysfunction in eating disorders.

          Recent Findings

          Eating is a complex process that begins well before and ends well after food consumption. Abnormal prediction and prediction-error signals may occur at any stage, resulting in aberrant gastrointestinal interoception and dysregulated gut sensations in eating disorders. Several interoceptive technologies have recently become available that can be paired with computational modeling and clinical interventions to yield new insights into eating disorder pathophysiology.

          Summary

          Illuminating the neurobiology of gastrointestinal interoception in eating disorders requires a new generation of studies combining experimental probes of gut physiology with computational modeling. The application of such techniques within clinical trials frameworks may yield new tools and treatments with transdiagnostic relevance.

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          Most cited references127

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          Once-Weekly Semaglutide in Adults with Overweight or Obesity

          Obesity is a global health challenge with few pharmacologic options. Whether adults with obesity can achieve weight loss with once-weekly semaglutide at a dose of 2.4 mg as an adjunct to lifestyle intervention has not been confirmed.
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            Interoceptive predictions in the brain.

            Intuition suggests that perception follows sensation and therefore bodily feelings originate in the body. However, recent evidence goes against this logic: interoceptive experience may largely reflect limbic predictions about the expected state of the body that are constrained by ascending visceral sensations. In this Opinion article, we introduce the Embodied Predictive Interoception Coding model, which integrates an anatomical model of corticocortical connections with Bayesian active inference principles, to propose that agranular visceromotor cortices contribute to interoception by issuing interoceptive predictions. We then discuss how disruptions in interoceptive predictions could function as a common vulnerability for mental and physical illness.
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              Interoception and Mental Health: A Roadmap

              Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit, a gathering of interoception experts from around the world, with the goal of accelerating progress in understanding the role of interoception in mental health. The discussions at the meeting were organized around four themes: interoceptive assessment, interoceptive integration, interoceptive psychopathology, and the generation of a roadmap that could serve as a guide for future endeavors. This review article presents an overview of the emerging consensus generated by the meeting.
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                Author and article information

                Contributors
                skhalsa@laureateinstitute.org
                Journal
                Curr Psychiatry Rep
                Curr Psychiatry Rep
                Current Psychiatry Reports
                Springer US (New York )
                1523-3812
                1535-1645
                21 January 2022
                21 January 2022
                2022
                : 24
                : 1
                : 47-60
                Affiliations
                [1 ]GRID grid.417423.7, ISNI 0000 0004 0512 8863, Laureate Institute for Brain Research, ; 6655 South Yale Ave, Tulsa, OK 74136 USA
                [2 ]GRID grid.267360.6, ISNI 0000 0001 2160 264X, Oxley College of Health Sciences, University of Tulsa, ; Tulsa, OK USA
                [3 ]GRID grid.59734.3c, ISNI 0000 0001 0670 2351, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, ; New York, NY USA
                [4 ]GRID grid.17635.36, ISNI 0000000419368657, Department of Psychiatry and Behavioral Sciences, , University of Minnesota Medical School, ; Minneapolis, MN USA
                Article
                1318
                10.1007/s11920-022-01318-3
                8898253
                35061138
                68a5200b-e176-4623-ac6c-8b86fad7ff1b
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 12 November 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R01MH127225
                Award ID: K23MH112949
                Award ID: K23MH123910
                Award ID: K23MH118418
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100001380, William K. Warren Foundation;
                Funded by: FundRef http://dx.doi.org/10.13039/100009670, National Alliance for Research on Schizophrenia and Depression;
                Categories
                Eating Disorders (J Steinglass, Section Editor)
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2022

                Clinical Psychology & Psychiatry
                anorexia nervosa,bulimia nervosa,binge-eating disorder,avoidant/restrictive food intake disorder,interoceptive awareness,digestion

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