Anorexia nervosa as a disorder of the subcortical–cortical interoceptive-self

Lorenzo Lucherini Angeletti, Matteo Innocenti, Federica Felciai, Emanuele Ruggeri, Emanuele Cassioli, Eleonora Rossi, Francesco Rotella, Giovanni Castellini, Giovanni Stanghellini, Valdo Ricca, Georg Northoff

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose: Anorexia nervosa (AN) is characterized by a diminished capacity in perceiving the physiological correlates of interoceptive sensations, namely bodily self-consciousness. Given the neural division of self-processing into interoceptive-, exteroceptive- and mental-self, we hypothesize neural deficits in the interoceptive-processing regions in AN. Methods: To prove this, we reviewed resting state (rs), task and rest-task studies in AN literature. Results: Neuronal data demonstrate the following in AN: (i) decreased rs-functional connectivity (rsFC) of subcortical–cortical midline structures (SCMS); (ii) reduced rsFC between medial (default-mode network/DMN and salience network/SN) and lateral (executive-control network/ECN) cortical regions; (iii) decreased rsFC in mainly the regions of the interoceptive-self; (iv) altered activity with overall increased activity in response to sensory/body image stimuli, especially in the regions of the interoceptive-self; (v) lack of a clear task-related distinction between own’s and others’ body image. Conclusion: These data may indicate that rs-hypoconnectivity between SCMS, as neural correlate of a reduced intero-exteroceptive integration resulting in self-objectification, might be linked to overall increased activity in interoceptive regions during sensory/body image stimuli in AN, engendering an “anxious bodily self.” Level of evidence: I: Systematic review.

Original languageEnglish
Pages (from-to)3063-3081
Number of pages19
JournalEating and Weight Disorders
Volume27
Issue number8
DOIs
Publication statusPublished - Dec 2022
Externally publishedYes

Keywords

  • Anorexia nervosa
  • Interoception
  • Resting-state functional connectivity
  • Self-objectification
  • Task-induced activity
  • fMRI

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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