Updating Prospective Self-Efficacy Beliefs About Cardiac Interoception in Anorexia Nervosa: An Experimental and Computational Study.

Patients with anorexia nervosa (AN) typically hold altered beliefs about their body that they struggle to update, including global, prospective beliefs about their ability to know and regulate their body and particularly their interoceptive states. While clinical questionnaire studies have provided ample evidence on the role of such beliefs in the onset, maintenance, and treatment of AN, psychophysical studies have typically focused on perceptual and 'local' beliefs. Across two experiments, we examined how women at the acute AN (N = 86) and post-acute AN state (N = 87), compared to matched healthy controls (N = 180) formed and updated their self-efficacy beliefs retrospectively (Experiment 1) and prospectively (Experiment 2) about their heartbeat counting abilities in an adapted heartbeat counting task. As preregistered, while AN patients did not differ from controls in interoceptive accuracy per se, they hold and maintain 'pessimistic' interoceptive, metacognitive self-efficacy beliefs after performance. Modelling using a simplified computational Bayesian learning framework showed that neither local evidence from performance, nor retrospective beliefs following that performance (that themselves were suboptimally updated) seem to be sufficient to counter and update pessimistic, self-efficacy beliefs in AN. AN patients showed lower learning rates than controls, revealing a tendency to base their posterior beliefs more on prior beliefs rather than prediction errors in both retrospective and prospective belief updating. Further explorations showed that while these differences in both explicit beliefs, and the latent mechanisms of belief updating, were not explained by general cognitive flexibility differences, they were explained by negative mood comorbidity, even after the acute stage of illness.

Hypermobile spectrum disorders symptoms in patients with functional neurological disorders and autism spectrum disorders: A preliminary study.

Autism spectrum disorders (ASDs) and functional neurological disorders (FNDs) share some clinical characteristics such as alexithymia, sensory sensitivity and interoceptive issues. Recent evidence shows that both the disorders present symptoms compatible with a diagnosis of hypermobile Ehlers-Danlos Syndrome and hypermobile spectrum disorders (hEDS/HSD), a heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Here we compared the prevalence of hEDS/HSD-related symptoms in a group of patients with FNDs, of people with ASDs without intellectual disabilities, and a non-clinical comparison group (NC). Twenty patients with FNDs, 27 individuals with ASDs without intellectual disabilities and 26 NC were recruited and completed the Self-reported screening questionnaire for the assessment of hEDS/HSD-related symptoms (SQ-CH). We found that 55% of the patients with FNDs, 44.4% of the individuals with ASDs and 30.8% of NC scored above the cut-off at the SQ-CH; SQ-CH scores of both FNDs and ASDs group were significantly higher than the NC group's ones. In conclusion, both ASDs and FNDs individuals present hEDS/HSD-related symptoms in a higher number than the general population. Imputable mechanisms include (i) overwhelming of executive functions with consequent motor competence impairment for ASDs individuals, and (ii) exacerbation of FNDs symptoms by physical injury and chronic pain due to abnormal range of joint mobility. Moreover, we speculated that the amygdala and the anterior cingulate cortex circuitry might be responsible for the imbalances at the proprioceptive, interoceptive, and emotional levels.

The relationship between interoception and agency and its modulation by heartbeats: an exploratory study.

Interoception, the sense of the internal physiological state of the body, theoretically underpins aspects of self-representation. Experimental studies link feelings of body ownership to interoceptive perception, yet few studies have tested for association between the sense of agency and interoceptive processing. Here, we combined an intentional binding paradigm with cardiac measures of interoceptive processing (behavioural performance on a heartbeat discrimination task, and effects of timing within the cardiac cycle) in twenty-six non-clinical participants as an exploratory study. We found performance accuracy on the heartbeat discrimination task correlated positively with the intentional binding effect, an index of sense of agency (ß = 0.832, p = 0.005), even after controlling for effects of age, sex, educational level, heart rate, heart rate variability and time accuracy. The intentional binding effect was enhanced during cardiac systole (compared to diastole) in individuals with greater heartbeat discrimination accuracy (ß = 0.640, p = 0.047). These findings support the proposal that interoception contributes to mechanisms underlying the emergence of sense of agency.

Clinical overlap between functional neurological disorders and autism spectrum disorders: a preliminary study.

Functional neurological disorders (FNDs) and autism spectrum disorders (ASDs) share common features in terms of deficits in emotion regulation and recognition, sensory sensitivity, proprioception and interoception. Nevertheless, few studies have assessed their overlap. We recruited 21 patients with FNDs, 30 individuals with ASDs without intellectual disabilities and 45 neurotypical adults (NA). Participants completed: the Autism Quotient (AQ); the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R); and a questionnaire assessing functional neurological symptoms (FNS). ASDs participants also completed the Sensory Perception Quotient-Short Form (SPQ-SF35), assessing sensory sensitivity. In the FNDs sample, no patient scored above the clinical cut-off at the AQ and the 19% scored above the cut-off at the RAADS-R, a prevalence similar to the one we found in NA (15.6%; both p > 0.05). The 86.7% of participants with ASDs reported at least one FNS, a prevalence significantly higher than the NA one (35.6%, p < 0.001). In the ASDs sample, tactile hypersensitivity was found to be a risk factor for functional weakness (OR = 0.74, p = 0.033) and paraesthesia (OR = 0.753, p = 0.019). In conclusions, FNDs individuals did not present autistic traits more than NA, but ASDs individuals presented a higher number of FNSs than NA; this rate was associated with higher sensory sensitivity, especially in the touch domain.

The Anticipation and Perception of Affective Touch in Women with and Recovered from Anorexia Nervosa.

Disruptions in reward processing and anhedonia have long been observed in Anorexia Nervosa (AN). Interoceptive deficits have also been observed in AN, including reduced tactile pleasure. However, the extent to which this tactile anhedonia is specifically liked to an impairment in a specialised, interoceptive C-tactile system originating at the periphery, or a more top-down mechanism in the processing of tactile pleasantness remains debated. Here, we investigated differences between patients with and recovered from AN (RAN) and healthy controls (HC) in the perception of pleasantness of touch delivered in a CT-optimal versus a CT-non-optimal manner, and in their top-down, anticipatory beliefs about the perceived pleasantness of touch. To this end, we measured the anticipated pleasantness of various materials touching the skin and the perceived pleasantness of light, dynamic touch applied to the forearm of 27 women with AN, 24 women who have recovered and 30 HCs using C Tactile (CT) afferents-optimal (slow) and non-optimal (fast) velocities. Our results showed that both clinical groups anticipated tactile experiences and rated delivered tactile stimuli as less pleasant than HCs, but the latter difference was not related to the CT optimality of the stimulation. Instead, differences in the perception of CT-optimal touch were predicted by differences in top-down beliefs, alexithymia and interoceptive sensibility. Thus, tactile anhedonia in AN might persist as a trait even after otherwise successful recovery of AN and it is not linked to a bottom-up interoceptive deficit in the CT system, but rather to a learned, defective top-down anticipation of tactile pleasantness.

The effect of a single yoga class on interoceptive accuracy in patients affected by anorexia nervosa and in healthy controls: a pilot study.

PURPOSE: To evaluate interoceptive accuracy (Iac) before and after a single yoga class in a population of patients with anorexia nervosa (AN) and in a population of healthy controls (HC). METHODS: Fifteen patients with AN and twenty HC were included in the study. All individuals participated in a single yoga class. Before (T0) and after (T1) the yoga class, they underwent the heartbeat detection task for the evaluation of Iac. At T0, all participants also underwent a psychological assessment, including evaluation of depression, anxiety, body awareness, alexithymia, self-objectification and eating disorders psychopathology. RESULTS: Patients with AN had lower Iac than HC at T0. A significant improvement of Iac at T1 was found in the HC group but not in the group of patients with AN. CONCLUSION: We infer that our findings might be linked to the fact that patients with AN, differently from HC, did not properly attend to their bodies, despite the yoga class. This hypothesis is consistent with previous studies showing that patients with AN have decreased Iac during self-focused behavior because of body-related avoidance. Moreover, we surmise that HC might be keener to improve their perception of internal body signals even after a single yoga class because their emotional awareness system is not impaired. Patients with AN, on the contrary, may have an intrinsic impairment of their emotional awareness, making it harder for them to modulate their Iac. LEVEL OF EVIDENCE: Level III, evidence obtained from well-designed cohort or case-control analytical studies.

Hedonicity in functional motor disorders: a chemosensory study assessing taste.

The aim of this study was to explore hedonicity to basic tastes in patients with functional motor disorders (FMDs) that are often associated with impairment in emotional processing. We recruited 20 FMD patients and 24 healthy subjects, matched for age and sex. Subjects were asked to rate the hedonic sensation (i.e., pleasant, neutral, and unpleasant) on a - 10 to +10 scale to the four basic tastes (sweet, sour, salty, and bitter) at different concentrations, and neutral stimuli (i.e., no taste stimulation) by means of the Taste Strips Test. Anxiety, depression, and alexithymia were assessed. FMD patients rated the highest concentration of sweet taste (6.7 ± 2.6) as significantly more pleasant than controls (4.7 ± 2.5, p = 0.03), and the neutral stimuli significantly more unpleasant (patients: - 0.7 ± 0.4, controls: 0.1 ± 0.4, p = 0.013). Hedonic ratings were not correlated to anxiety, depression, or alexithymia scores. Hedonic response to taste is altered in FMD patients. This preliminary finding might result from abnormal interaction between sensory processing and emotional valence.

A physical therapy programme for functional motor symptoms: A telemedicine pilot study.

INTRODUCTION: for a proportion of patients with functional motor symptoms (FMS), specific physiotherapy has recently emerged as a promising treatment. Aim of the present study was to assess in a sample of patients with FMS the efficacy of a physical therapy-based telemedicine programme on the motor symptoms themselves and on some psychological variables such as anxiety, depression, alexithymia and quality of life. MATERIALS AND METHODS: eighteen patients were recruited. The programme consisted of 24 sessions: three face-to-face sessions (at week 0 (T0), 12 (T1) and 24 (T2)) and 21 tele-sessions. Each session included education, movement retraining exercises and development of a management plan. All patients underwent the following assessment at T0, T1 and T2: Psychogenic movement disorders rating scale (PMDRS), assessment of depression, anxiety, alexithymia and quality of life. Self-assessment of outcome (CGI) was recorded at T1 and T2. RESULTS: On the CGI improvement was reported by 66,7% of patients at T1 and 77,8% at T2. A significant improvement over the three time points was shown for PMDRS and for the following domains of the SF-36: general health, vitality, social functioning and mental health. CONCLUSION: the use of two innovative approaches for FMS (physiotherapy and telemedicine), combined together, might have a valuable role in the treatment of this neuropsychiatric condition.

Limbic neurochemical changes in patients with functional motor symptoms.

OBJECTIVE: To assess by magnetic resonance spectroscopy (MRS) the N-acetylaspartate, myo-inositol, choline, sum of glutamate and glutamine (Glx), and creatine (Cr) content in the anterior cingulate cortex (ACC)/medial prefrontal cortex (mPFC) and in the occipital cortex (OCC) (control region) in patients with functional motor symptoms (FMS) and healthy controls, and to determine whether neurochemical limbic changes as estimated by MRS correlate with FMS-related motor symptom severity, alexithymia, anxiety, depression, and quality of life. METHODS: This case-control study enrolled 10 patients with FMS and 10 healthy controls. Participants underwent MRS and were tested with the Mini-Mental State Examination, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, 20-Item Toronto Alexithymia Scale, and EuroQol 5D. RESULTS: In patients with FMS, MRS showed increased Glx/Cr in the ACC/mPFC but normal content in the control OCC. All the other metabolites tested were normal in both regions. The increased Glx/Cr content in the ACC/mPFC correlated with alexithymia, anxiety, and severity of symptoms. CONCLUSIONS: The abnormal limbic Glx increase could have a crucial pathophysiologic role in FMS, possibly by altering limbic-motor interactions, ultimately leading to abnormal movements.

The neuromodulatory effect of tDCS in patients affected by functional motor symptoms: an exploratory study.

BACKGROUND: Recent studies have shown how emotional and cognitive factors might combine together to determine the onset and maintenance of functional motor symptoms (FMS). Nevertheless, no studies have assessed whether brain circuits involved in regulation and processing of emotions and attention might be influenced by neuromodulation. The purpose of this study was to evaluate the effect of a single anodic tDCS session over the right posterior parietal cortex in subjects with FMS and in healthy individuals. MATERIALS AND METHODS: Nine patients and seven healthy subjects underwent two sessions of tDCS (real and sham), in a randomized order. At the end of each session, all participants underwent the heart beat detection task (interoceptive sensitivity) and the Posner paradigm (spatial attention). RESULTS: After sham stimulation, patients with FMS showed significantly lower interoceptive sensitivity and greater cueing effect for reaction times at the Posner paradigm than healthy controls. There was a significant improvement between the levels of interoceptive sensitivity after real and sham stimulation in the whole group of participants and in the group of patients with FMS. CONCLUSIONS: Our study provides first indications for a neuromodulatory effect of a single anodic tDCS session over the right posterior parietal cortex on interoceptive sensitivity in subjects with FMS.

The truth about cognitive impairment in functional motor symptoms: An experimental deception study with the Guilty Knowledge Task.

BACKGROUND: A century ago, Janet was the first to conceptualize conversion reactions as having a neurocognitive component, as disorders of memory processing that arise in the wake of trauma. The available evidence suggests that this impairment might arise from dysfunction in the fronto-subcortical circuits. Our aim was to examine the cognitive functions regulating deception in patients with functional motor symptoms (FMS), using a computerised task, the Guilty Knowledge Task (GKT). We also tested a group of healthy subjects (HS) as a control group. MATERIALS AND METHODS: Thirteen patients affected by FMS and 14 HS underwent a modified version of the GKT, a computer-controlled procedure used to detect truthful and deceptive responses. All participants were also screened for depression, anxiety, alexithymia and for moral sense (moral judgment task). RESULTS: The reaction times (RTs) were significantly longer for lie responses than for true responses (F(1,26) = 50.47; p < 0.001) in the two groups. Total RTs were significantly longer for patients with FMS than for HS, in true responses (F(1,25) = 4,36; p = 0.047) and lie responses (F(1,25) = 4.26; p = 0.05). No differences were found between the two groups for accuracy in producing true responses (F(1,25) = 0.09, p = 0.77), and lie responses (F(1,25) = 0,12, p = 0.73. CONCLUSIONS: When tested with the GKT, patients with FMS were slower than HS in producing truthful and lying responses. Current knowledge along with our new findings in patients with FMS - possibly arising from individually unrecognised extremely mild, cognitive difficulties - should help in designing specific rehabilitative programmes to improve cognitive and behavioural disturbances in these patients.

Anorexia Nervosa and Functional Motor Symptoms: Two Faces of the Same Coin?

The aim of this study was to compare anorexia nervosa (AN) patients and functional motor symptoms (FMS) patients by assessing their variability in demographic and clinical characteristics, risk factors, precipitators, and family history. The authors assessed levels of depression and anxiety, alexithymia, dissociation, body awareness, self-objectification, and interoception in the two groups, using 20 healthy controls (HCs) as a control group for psychometric assessment and for interoception. Unexpectedly, no differences in the three groups were observed for the measures related to awareness of physical state, including body awareness, self-objectification, and interoceptive ability via the heartbeat task. However, the AN and FMS groups were not different from each other but were different from the HC group with regard to anxiety, depression, alexithymia, and dissociation. In light of the similarities found, these data support the hypothesis of a common etiology involving emotional dysfunction in both disorders. These findings suggest that AN and FMS may be disorders belonging to the same spectrum (where emotional dysregulation is a key feature) and that there exist potential opportunities for collaborative, integrated investigations of etiology, diagnosis, and management of these disorders.

Psychogenic non-epileptic seizures and functional motor symptoms: A common phenomenology?

OBJECTIVE: Recent studies have attempted to compare patients affected by psychogenic non-epileptic seizures (PNES) to patients affected by functional motor symptoms (FMS) from a demographic, clinical and psychological perspective. Nevertheless, results are quite controversial and significant conclusions have not been drawn. The aim of our study was to evaluate the phenomenology of psychology of the two groups assessing levels of dissociation and its subcomponents, alexithymia and interoceptive sensitivity in patients with PNES and in patients with FMS. METHODS: We conducted a cross-sectional study recruiting 20 patients with PNES, 20 patients with FMS and 20 healthy subjects as a control group. All subjects underwent: Dissociative Experience Scale (DES), Somatoform Dissociation Questionnaire (SDQ-20), Cambridge Depersonalization Scale (CDS), Toronto Alexithymia Scale (TAS-20), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for anxiety (HAM-A), heart beat detection task. RESULTS: Our data suggest that PNES group scored significantly higher than the healthy control group on a measure of detachment (CDS). Also at the DES, a measure of psychoform dissociation, PNES patients scored significantly higher than healthy subjects. On the other hand patients affected by FMS scored significantly higher than the healthy control group on the SDQ but they did not report more experiences of detachment on the CDS. Patients affected by PNES and FMS were significantly more alexithymic than healthy controls, with a third of them scoring >61 on the TAS-20. SIGNIFICANCE: Our data show different psychological mechanisms underlying patients with PNES and patients with FMS. This might lead also to potential implications for treatment.