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      Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry?

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          Abstract

          Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.

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          Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia

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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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              An insular view of anxiety.

              We propose a general hypothesis that integrates affective and cognitive processing with neuroanatomy to explain anxiety pronenes. The premise is that individuals who are prone to anxiety show an altered interoceptive prediction signal, i.e., manifest augmented detection of the difference between the observed and expected body state. As a consequence, the increased prediction signal of a prospective aversive body state triggers an increase in anxious affect, worrisome thoughts and other avoidance behaviors. The anterior insula is proposed to play a key role in this process. Further testing of this model--which should include investigation of genetic and environmental influences--may lead to the development of novel treatments that attenuate this altered interoceptive prediction signal in patients with anxiety disorders.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/99556
                URI : http://frontiersin.org/people/u/321159
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                25 July 2016
                2016
                : 7
                : 121
                Affiliations
                [1] 1Laureate Institute for Brain Research (LIBR) , Tulsa, OK, USA
                [2] 2Oxley College of Health Sciences, University of Tulsa , Tulsa, OK, USA
                [3] 3Department of Psychology, University of Tulsa , Tulsa, OK, USA
                Author notes

                Edited by: Alexandre Heeren, Harvard University, USA

                Reviewed by: Delphine Grynberg, Université de Lille 3, France; Jennie Kuckertz, San Diego State University, USA; University of California San Diego, USA

                *Correspondence: Sahib S. Khalsa, skhalsa@ 123456laureateinstitute.org

                Specialty section: This article was submitted to Psychopathology, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2016.00121
                4958623
                27504098
                dd69b9f1-193a-453e-a234-b71fc3cf3d20
                Copyright © 2016 Khalsa and Lapidus.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 January 2016
                : 21 June 2016
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 269, Pages: 19, Words: 18127
                Funding
                Funded by: Brain and Behavior Research Foundation 10.13039/100000874
                Categories
                Psychiatry
                Review

                Clinical Psychology & Psychiatry
                interoception,heartbeat detection,panic disorder,depression,anorexia nervosa,bulimia nervosa,somatic symptom disorders,exposure therapy

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