Cardiac interoception in Anorexia Nervosa: A resting-state heartbeat-evoked potential study

ObjectiveA deficit in interoception - the ability to perceive, interpret and integrate afferent signals about the physiological state of the body - has been shown in Anorexia Nervosa (AN), and linked to altered hunger sensations, body dysmorphia, and abnormal emotional awareness.The present high-density electroencephalography (hdEEG) study aims to assess cardiac interoception in AN and to investigate its neural correlates, using an objective neurophysiological measure.ObjectiveA deficit in interoception - the ability to perceive, interpret and integrate afferent signals about the physiological state of the body - has been shown in Anorexia Nervosa (AN), and linked to altered hunger sensations, body dysmorphia, and abnormal emotional awareness.The present high-density electroencephalography (hdEEG) study aims to assess cardiac interoception in AN and to investigate its neural correlates, using an objective neurophysiological measure.MethodHeartbeat-evoked potentials (HEPs) were computed from 5 min of resting-state EEG and electrocardiogram (ECG) data and compared between individuals with AN (N = 22) and healthy controls (HC) (N = 19) with waveform, topographic, and source imaging analyses.ResultsDifferences in the cortical representation of heartbeats were present between AN and HC at a time window of 332-348 ms after the ECG R-peak. Source imaging analyses revealed a right-sided hypoactivation in AN of brain regions linked to interoceptive processing, such as the anterior cingulate and orbitofrontal areas.ConclusionsTo the best of our knowledge, this is the first study using hdEEG to localise the underlying sources of HEPs in AN. Results point to altered interoceptive processing during resting-state in AN. As our participants had a short duration of illness, this might not be the consequence of prolonged starvation. Interventions targeted at interoception could provide an additional tool to facilitate recovery. An interoceptive deficit might play a role in the pathogenesis and maintenance of Anorexia Nervosa (AN), but research on neural correlates is lacking.Individuals with AN show altered cortical representation of cardiac signals, as measured with Heartbeat-evoked potentials (HEPs).Hypoactivation in a right-sided interoceptive network underlies differences in cardiac signal processing observed at the scalp.