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Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: Evidence of interoceptive dysregulation

Authors

  • Irina A. Strigo PhD,

    Corresponding author
    1. Research Service, VA San Diego Healthcare System, San Diego, California
    2. VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California
    3. BioCircuits Institute (BCI), La Jolla, California
    • Department of Psychiatry, University of California San Diego, 3350 La Jolla Village Dr., Building 13, MC 9151-B, La Jolla, CA 92161
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  • Scott C. Matthews MD,

    1. Department of Psychiatry, University of California, San Diego, La Jolla, California
    2. Research Service, VA San Diego Healthcare System, San Diego, California
    3. VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California
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  • Alan N. Simmons PhD,

    1. Research Service, VA San Diego Healthcare System, San Diego, California
    2. VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California
    3. Psychiatry Service, VA San Diego Healthcare System, San Diego, California
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  • Tyson Oberndorfer MSc,

    1. Department of Psychiatry, University of California, San Diego, La Jolla, California
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  • Megan Klabunde PhD,

    1. Department of Child and Adolescent Psychiatry, Stanford University, Stanford, California
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  • Lindsay E. Reinhardt BSc,

    1. Research Service, VA San Diego Healthcare System, San Diego, California
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  • Walter H. Kaye MD

    1. Department of Psychiatry, University of California, San Diego, La Jolla, California
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Abstract

Objective:

Recent evidence raises the possibility that symptoms of anorexia nervosa (AN) could be related to impaired interoception. Pain is an interoceptive process with well-characterized neuroanatomical pathways that may overlap to a large degree with neural systems that may be dysregulated in individuals with AN, such as the insula.

Method:

Functional magnetic resonance imaging (fMRI) was used to assess neural substrates of pain anticipation and processing in 10 healthy control women (CW) and 12 individuals recovered from AN (REC AN) in order to avoid the confounding effects of malnutrition. Painful heat stimuli were applied while different colors signaled the intensity of the upcoming stimuli.

Results:

REC AN compared with CW showed greater activation within right anterior insula (rAI), dorsolateral prefrontal cortex (dlPFC) and cingulate during pain anticipation, and greater activation within dlPFC and decreased activation within posterior insula during painful stimulation. Greater anticipatory rAI activation correlated positively with alexithymic feelings in REC AN participants.

Discussion:

REC AN showed a mismatch between anticipation and objective responses, suggesting altered integration and, possibly, disconnection between reported and actual interoceptive state. Alexithymia assessment provided additional evidence of an altered ability to accurately perceive bodily signals in women recovered from AN. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)

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