Abstract
Anorexia Nervosa (AN) is widely considered to be a bodily disorder accompanied by unrealistic perceptions about one’s own body. Some researchers thus have wondered whether deficits in interoception, a conscious or non-conscious sense of one’s own body, could be a primary cause of AN. In this paper, we make the case that rather than interoception being a primary cause, deficits in interoception may occur as by-products of emotions that arise upstream in the pathogenesis of AN and interact with feelings of a loss of self-control. We consider interoception, emotion, and self-control as a dynamical triad involved in the explanation of AN, with emotions as the central aspect of their interactions. We begin with a critical analysis of recent empirical literature on AN and differentiate three types of interoceptive processes. We then consider the role of self-control in AN. We go on to evaluate recent empirical and philosophical work on the role of emotions in AN and assess their importance in both interoception and self-control dynamics. We develop a testable integrative model that we believe best captures how self-control, emotional and interoceptive processes causally interact in the pathogenesis of AN. In this model, AN behaviors are not caused by interoceptive abnormalities, but rather interact with changes in emotional regulation and feelings of loss of self-control, subsequently leading to interoceptive deficits downstream. To capture a later stage in the pathogenesis of AN, we show how AN behaviors are maintained as a result of feedback among components in the model. We briefly explain future plans to further complement the model using a semi-structured interview to probe patient perspectives in AN. To develop a more valid understanding of AN, this model will have to be integrated into pluralistic approaches that include patient perspectives.
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Notes
As one reviewer noted, it is a difficult matter to determine what “normal” gastric interoception is and to distinguish it from “abnormal” gastric interoception. In the Brown et al. 2022 study, inclusion criteria for the control group consisted of a BMI of 18.5–25, regularly eating breakfast, no ED behaviors or ED diagnosis, no current or past DSM-5 disorders, and no diagnosed gastrointestinal disorders or asthma. Still, it is possible, given how much is still unknown about gastric interoception, that these criteria were insufficient for ensuring that the control group had “normal” gastric interoception processes compared to the AN group. We want to thank this reviewer for drawing our attention to the limitations of this study–limitations that likely plague interoception studies given the current lack of conceptual clarity and understanding of the phenomena associated with it.
More about the reward model and habit model can be found in (Evans 2022).
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Arnaud, S., Sullivan, J., MacKinnon, A. et al. Teasing Apart the Roles of Interoception, Emotion, and Self-Control in Anorexia Nervosa. Rev.Phil.Psych. (2023). https://doi.org/10.1007/s13164-023-00706-9
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DOI: https://doi.org/10.1007/s13164-023-00706-9