Interoceptive Axes Dissociation in Anorexia Nervosa: A Single Case Study With Follow Up Post-recovery Assessment

Anorexia nervosa (AN) is a disorder characterized by alterations in body perception. Recent literature suggested that AN can also impair the processing of stimuli from inside the body (i.e., interoceptive) however, very few studies performed a complete interoceptive assessment exploring the evolution of the interoceptive dimensions before and after the subject’s recovery. To address this gap in knowledge, this study presented the case of Diana, a 25 years old woman affected by AN. At hospital admission, Diana performed a complete interoceptive assessment for accuracy (IAc), metacognitive awareness (IAw), sensibility (IAs), and interoceptive buffer saturation (IBs) – a new index that behaviourally evaluated the amount of interoceptive processing. Measures were repeated at the end of an outpatients rehabilitative hospital program, after Diana’s recovery. Results were confronted with a control (N = 4) of healthy female subjects. Analyses indicated severe deficits in accuracy, buffer saturation, and sensibility compared to control group. Conversely, metacognitive awareness was pathologically enhanced. After the rehabilitative hospital program, Diana’s clinical condition was largely improved and this reflected back on the interoceptive patterns that appeared restored, with no difference in interoceptive accuracy and metacognition compared to the control group. In conclusion, results indicated a very specific dissociation between interoceptive axes in AN with pervasive deficits in perception and processing that were accompanied by a pathologically enhanced confidence in the wrong perceptions. This case study reported an interesting and unique clinical pattern with a severe dissociation between interoceptive perceptions that nonetheless appeared restored after the subject’s recovery, highlighting the role of interoceptive assessment in the clinical evolution of AN.神经性厌食症（Anorexia nervosa, AN）是一类以躯体感知改变为特征的精神障碍。现有研究表明，AN还会损害机体内部刺激的加工过程（即内感受（interoceptive）加工），但极少有研究开展完整的内感受评估，以探索受试者康复前后内感受维度的动态变化。为填补这一研究空白，本研究报告了一例25岁AN女性患者戴安娜的临床案例。患者入院时，研究人员对其完成了四项完整的内感受评估：内感受准确性（Interoceptive Accuracy, IAc）、元认知觉知（Metacognitive Awareness, IAw）、内感受敏感性（Sensibility, IAs）以及内感受缓冲饱和（Interoceptive Buffer Saturation, IBs）——后者是一项通过行为学范式评估内感受加工负荷的新型指标。在戴安娜康复并完成门诊康复治疗项目后，研究人员重复开展了上述评估。本研究同时纳入4名健康女性作为对照（N=4）。分析结果显示，与对照组相比，患者在内感受准确性、缓冲饱和性及敏感性方面存在显著缺损；与之相反，其元认知觉知水平出现病理性提升。完成康复治疗项目后，戴安娜的临床症状得到大幅改善，内感受模式也随之恢复正常：其在内感受准确性与元认知觉知方面与对照组已无显著差异。综上，本研究结果表明，AN患者的内感受维度存在极为特异的分离现象：感知与加工过程存在广泛缺损，同时伴随对错误感知的病理性过度自信。本案例报告了一种独特且值得关注的临床模式——内感受感知存在严重分离，但在患者康复后可恢复正常，这凸显了内感受评估在AN临床病程监测中的重要价值。