Influence of Visceral Interoceptive Experience on the Brain's Response to Food Images in Anorexia Nervosa

Objective The aim of the study was to determine how visceral sensations affect responses to food stimuli in anorexia nervosa (AN). Methods Twenty weight-restored, unmedicated adolescent and young adult women with AN and twenty healthy control participants completed an interoceptive attention task during which they focused on sensations from the heart, stomach, and bladder and made ratings of these sensations. They then underwent functional magnetic resonance imaging scanning while viewing pictures of food and nonfood objects. Between-groups t tests were employed to investigate group differences in the relationship between interoceptive sensation ratings and brain hemodynamic response to food pictures and, specifically, to highly palatable foods. Results In response to food pictures, AN participants exhibited a positive relationship between stomach sensation ratings and posterior insula activation (peak t = 4.30). AN participants displayed negative relationships between stomach sensation ratings and amygdala activation (peak t =-4.05) and heart sensation ratings and ventromedial prefrontal cortex activation (peak t =-3.52). In response to highly palatable foods, AN was associated with positive relationships between stomach sensation ratings and activity in the subgenual anterior cingulate (peak t = 3.88) and amygdala (peak t = 4.83), and negative relationships in the ventral pallidum (peak t =-3.99) and ventral tegmental area (peak t =-4.03). AN participants also exhibited negative relationships between cardiac sensations and activation in response to highly palatable foods in the putamen (peak t =-3.41) and ventromedial prefrontal cortex (peak t =-3.61). Healthy participants exhibited the opposite pattern in all of these regions. Conclusions Hedonic and interoceptive inferences made by individuals with AN at the sight of food may be influenced by atypical visceral interoceptive experience, which could contribute to restrictive eating.