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Introduction to Difficulties with Interoception in Eating Disorders

From EverybodyWiki Bios & Wiki



Introduction to Difficulties with Interoception in Eating Disorders

Eating disorders involve disturbances in eating behaviors, such as undereating or overeating, that negatively affect mental or physical health. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) recognizes several eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID).[1]

Anorexia nervosa and ARFID are both restrictive eating disorders in which an individual does not eat enough variety or amount of food, leading to low body weight or inadequate nutrients, such as vitamins and minerals. The restrictive eating behavior in anorexia nervosa is tied to body image disturbance, meaning that individuals may fear gaining weight or believe they are overweight even when underweight. In ARFID, restrictive eating behavior is not primarily related to body image. Instead, it may driven by extreme dislike of specific foods based on texture or taste, fear that eating will cause problems like choking or vomiting, or a lack of appetite (interest in eating).

Binge eating disorder involves frequent eating binges, where an individual eats a large amount of food in a short period of time (for example, within about two hours) while experiencing a sense of loss of control over eating. In bulimia nervosa, individuals experience binge eating and repeatedly engage in compensatory behaviors aimed at preventing weight gain. These behaviors can include self-induced vomiting, misuse of laxatives, fasting for long periods between binges, or extreme exercise. Binge eating and compensatory behaviors can occur in anorexia nervosa. However, the defining feature in anorexia nervosa, including the binge/purge subtype, is that intentional restriction of food intake has led to low body weight.[1]

The causes of eating disorders are complex and not fully understood. A proposed contributing factor is disturbance in interoception. Interoception broadly refers to processes through which the brain and body communicate about the internal state of the body (for example, whether the stomach is empty or full).[2][3] It involves noticing and interpreting signals from the body. The body sends information to the brain, which then integrates this information with other bodily and contextual cues to generate the experience of hunger or fullness. Interoception involves signals from multiple organ systems, including the gastrointestinal, cardiovascular, pulmonary, and other visceral systems.[2]

Early History of Examining Interoception in Eating Disorders

The term ‘interoception’ was first introduced in the early 1900s, but did not begin to be widely applied to eating disorders until the late 20th century. In the eating disorders field, an early use of the concept appeared in the development of the Eating Disorder Inventory, a self-report measure of disordered eating behaviors and symptoms.[4] This inventory included items assessing difficulties identifying cues such as hunger and fullness and a tendency to confuse these bodily cues with emotions such as sadness or anger. This work was motivated by research suggesting that people with anorexia nervosa had difficulty recognizing when they were hungry or full.[5] Since the Eating Disorder Inventory was developed, the concept of interoception has expanded to cover a broad range of bodily processes.

Assessment of Interoception

For a general overview of how interoception is measured, see the interoception wiki page. In eating disorder research, interoception is commonly assessed using a variety of methods that differ in the body system examined, the specific feature of interoception being measured (for example, sensitivity or magnitude), and the type of measurement (such as self-report, behavioral tasks, or physiological recordings).[2]

Bodily Systems

Interoception involves signals from all major organ systems. The gastrointestinal tract has been a central focus in eating disorder research. After food is swallowed, it passes through the gastrointestinal system in the following order: esophagus (the tube that connects the throat to the stomach), stomach, small intestine, and large intestine.[6] Gastrointestinal interoception refers to the subjective sensations arising from any of these organs.[7]

The pulmonary (respiratory) system is responsible for breathing, which brings oxygen into the body and removes carbon dioxide. The lungs expand and contract as air is inhaled and exhaled. The cardiovascular (circulatory) system includes the heart and blood vessels and transports oxygen and nutrients throughout the body. 6 Interoception in these systems includes awareness of sensations such as heartbeats or breathing changes.[2]

Features of Interoception and Types of Measurement

Researchers measure interoception in eating disorders using self-report measures, behavioral tasks, and psychophysiological methods, such as recordings of heart rate or gastric activity.[2][3] Different tasks are designed to assess specific features of interoception, including how sensitive, accurate, and responsive individuals are to their body sensations.

Trait Measures and Interoceptive Sensibility

Trait measures of interoception, often referred to as measures of interoceptive sensibility, ask people to report on their usual experience of body signals (such as hunger, heart rate).[2] Some self-report scales focus on specific body systems, such as the Visceral Sensitivity Index,[8] which assesses the gastrointestinal system. Other scales assess general awareness of and responses to bodily sensations, such as the Multidimensional Assessment of Interoceptive Awareness (MAIA).[9]

Scores from self-report trait measures of interoception typically show moderate to strong internal reliability estimates, suggesting that the items measure related aspects of interoception. However, initial studies suggest self-report measures are not strongly related to behavioral performance on interoceptive tasks, such heartbeat counting.[10] Additionally, although the interoception questions on the Eating Disorder Inventory[4] are still widely used, concerns have been raised that it is not a “pure” measure of interoception because many items appear to reflect difficulty identifying emotions rather than bodily sensations.[11] Some researchers have advocated increased use of laboratory behavioral tasks and physiological data, such as heart rate and gastric contractions, to complement or replace certain self-report measures.[7]

Detection, Magnitude, and Discrimination

Detection refers to whether a person can consciously perceive a bodily sensation (for example, answering yes or no when asked if a sensation is present).[2] Magnitude refers to how strong a bodily signal feels.[2] For example, after eating a meal, a person may be asked to rate their fullness  from 0 (“not at all full”) to 7 (“extremely full”). Discrimination refers to the ability to distinguish among different bodily sensations or to differentiate bodily sensations from external stimuli.[2] This may involve identifying where in the body a sensation is located (for example, stomach versus intestines) or distinguishing between a stomach growl and an external noise.

Accuracy and Insight

Accuracy refers to how correctly a person can track changes in body signals.[2] A commonly used task is the heartbeat counting task,[12] in which participants are asked to silently count their heartbeats for a fixed period of time (for example, 45 seconds). Although the heartbeat counting task is widely used, several concerns have been raised about whether heartbeat counting accuracy scores reflect interoception.[10] Research shows people’s knowledge of their resting heart rate and actual heart rate appear strongly related to performance on the task, suggesting accuracy scores may reflect factors other than interoceptive monitoring.[10][13]

Insight refers to how well someone can judge their own interoceptive performance by comparing their confidence ratings (for example, how confident they feel in their heartbeat estimates) with their actual accuracy.[2] However, estimates of insight can be affected when tasks are very easy or very hard.[10] When performance is uniformly low or uniformly high, there is too little variability to detect relationships between confidence and accuracy.

Evidence for Altered Interoceptive Processing in Eating Disorders

General Self-Report Trait Measures

Across self-report trait measures of interoception, individuals with anorexia nervosa and bulimia nervosa report more difficulties with interoception than healthy individuals without eating disorders.[3][14][15][16] With these general self-report measures, low trust in one’s bodily sensations appears to be strongly related to disordered eating.[16][17] Individuals with eating disorders also often report a higher tendency to distract themselves from uncomfortable body sensations.[18]

Gastrointestinal

People with anorexia nervosa frequently report low feelings of hunger and early, pronounced fullness during meals compared to healthy individuals without an eating disorder.[7][14] This early fullness can contribute to eating small amounts of food and can make it difficult for individuals to eat larger meals during treatment. In contrast, individuals with bulimia nervosa and binge eating disorder often report delayed fullness,[7] which may contribute to eating a larger amount of food than needed.

People with eating disorders report high rates of gastrointestinal symptoms such as bloating, nausea, constipation, heartburn, and stomachaches.[7][19][20] Anorexia and ARFID are associated with malnutrition, which occurs when chronic undereating leads to insufficient calories and nutrients and results in physical problems. For example, these problems can include slowed movement of food through the gastrointestinal tract (including slowed movement through the stomach, intestines, and colon) and acute enlargement of the stomach. Binge eating, vomiting, and laxative use can also lead to many complications, such as gastroesophageal reflux and acute enlarged stomach.[21]

Importantly, elevated levels of gastrointestinal symptoms in eating disorders often remain even after accounting for these physical problems and after some physical issues improve with weight restoration.[19] Individuals in treatment for eating disorders, as well as people in the general population who report disordered eating, tend to endorse higher levels of sensitivity to and worry about uncomfortable gastrointestinal sensations.[22] New methods are being developed to objectively assess gastrointestinal interoception, including capsules that can be swallowed and then made to vibrate in the stomach.[7] These methods may help determine whether individuals with eating disorders differ from healthy individuals in their ability to detect stomach sensations or in how strongly they perceive the same level of gastric stimulation.

Cardiovascular

Most studies of cardiovascular interoception use tasks that assess heartbeat counting or heartbeat detection accuracy. In many studies, people with anorexia nervosa perform worse on these tasks than healthy individuals without an eating disorder.[3][14] In similar studies, people with bulimia nervosa often do not differ from healthy comparison groups.[3] There currently is less research available on cardiovascular interoception in individuals with binge eating disorder and ARFID.

Other Modalities

Beyond gastrointestinal and cardiovascular measures, pain tasks can assess interoception in eating disorders. Pain tasks usually involve exposure to a painful temperature (for example, hot or cold stimuli) or pressure (for example, increasing weight applied to a finger).[14] Findings are mixed as to whether individuals with eating disorders are more or less sensitive to pain than healthy individuals. Differences in results may be related to the specific type of pain task used (temperature versus pressure) and other methodological factors.

Evidence for Altered Brain Activity In Interoceptive Brain Regions

Human and animal studies indicate that the insular cortex is a key brain region involved in processing interoceptive signals.[3] Brain imaging studies consistently report differences in insula activity between people recovered from anorexia nervosa and healthy individuals without eating disorders during interoceptive tasks, such as tasks that require participants to hold their breath, track their heartbeats, or focus on sensations in their stomach.[14][23]

Individuals with bulimia nervosa show increased activity in the insula and striatum, a brain region involved in reward and motivation, when viewing images of food compared to healthy individuals.[24] A limitation of this work is that studies include small samples, which can reduce the reliability and generalizability of the findings.[23] Fewer studies have examined whether similar differences in insula activity are present in binge eating disorder or ARFID.

Evidence for Contributions of Altered Interoception to Body Image Disturbance

Body image disturbance refers to inaccurate perception of one’s body (for example, believing one’s body size is much larger than it is) or placing very high importance on body weight and shape in ways that cause distress, particularly when then individuals are dissatisfied with their appearance.[3] Body image disturbance is a core feature of anorexia nervosa and bulimia nervosa, and individuals with binge eating disorder also frequently report high levels of body image disturbance.[1] Several studies have found lower activity in brain areas related to interoception, such as the insula, is related to higher reports of body image disturbance.[3]

Theories of Altered Interoception in Eating Disorders

Active Inference and Predictive Processing Theories

According to active inference and predictive processing theories of interoception,[3][7] humans continuously generate predictions about how behaviors and experiences will affect their internal bodily states. Incoming sensory information from the body (for example, signals from the stomach or heart) is compared to the generated prediction. When predictions are inaccurate, they are updated based on new information.

For example, based on past eating experiences, people predict how eating specific amounts and types of food will affect stomach sensations (such as fullness or stomachache). These predictions shape how the person interprets stomach sensations while eating. If the actual sensations do not match the predicted sensations, predictions can be updated for future meals. Active inference theorists have suggested that different parts of the insula may support specific roles in this process: the mid-to-posterior insula may be associated with detecting discrepancies between predicted body states and actual body states, whereas the anterior insula may play a larger role in supporting the generation of predictions about bodily states.[3]

When applying active inference theory to eating disorders, some researchers propose individuals with eating disorders form inaccurate predictions about bodily states and fail to update these predictions adequately with newly available information. Behaviors such as self-induced vomiting and laxative use have been conceptualized within this framework as attempts to reduce mismatches between expected and actual internal states.[3][7] Although these theories often focus on examples with gastrointestinal interoception, proponents of these theories also emphasize that similar dysfunction may occur in other systems including cardiovascular and respiratory systems. For example, individuals with eating disorders show increased heart rate before eating a meal, which could impact how they interpret bodily signals while eating.[25]

Aversive Conditioning Theories

Aversive conditioning theories of eating disorders focus on how painful or uncomfortable gastrointestinal experiences, such as stomach aches, may lead to learned associations between eating and stomach pain.[26] Children who repeatedly experience discomfort after eating may begin to fear stomach pain and reduce their food intake or avoid specific foods. This process has been proposed as a possibly pathway contributing to the development of restrictive eating disorders such as anorexia nervosa and ARFID.[26]

Support for these theories include elevated reports of gastrointestinal symptoms (bloating, abdominal pain, constipation, nausea) and higher rates of medically diagnosed conditions impacting the gastrointestinal tract, such as Chron’s disease, irritable bowel syndrome, functional dyspepsia, and diabetes, among individuals with eating disorders and related populations.[27][28][29][30]

Difficulties with Interoception Causing Body Image Disturbance

Some researchers have proposed that difficulties with interoception may both contribute to disordered eating behaviors and cause body image disturbance. In this view, when individuals with eating disorders have trouble interpreting bodily signals, they may rely more heavily on external information (such as visual information) when judging their body.[3] That is, they may struggle to integrate internal information from their bodies with external information from the visual system.

This imbalance may lead to people focus on viewing their body as an object and to pay less attention to internal body sensations, a pattern that aligns with aspects of Objectification Theory of Eating Disorders.[3][31] Over time, this difficulty integrating internal and external information may contribute to inaccurate mental representations of body size and shape.[3] Consistent with this idea, individuals with anorexia nervosa often overestimate their body size relative to objective measures.[32][33]

Gaps and Limitations

It is not yet clear whether difficulties with interoception are causes, consequences, or both causes and consequences of eating disorders.[14] Interoceptive differences may contribute to the development of disordered eating, may arise as a result of prolonged illness and its medical complications, or may reflect a combination of both. Additionally, it is uncertain whether specific interoceptive alterations described in eating disorders are unique to these conditions or are also present in other psychological disorders.[23]

Applications

Biomarker Approaches to Eating Disorders

Understanding difficulties with interoception in eating disorders may inform biomarker-based approaches to diagnosis and treatment.[3] A biomarker is a biological correlate, such as variability in heart rate. Interoception-related biomarkers could include patterns of brain activity in the insula or physiological indicators such as heart rate responses during interoceptive tasks. These markers may, in principle, help identify individuals at increased risk for eating disorders, support diagnostic assessment, or aid in monitoring treatment response.

Psychotherapy for Eating Disorders

Findings that people with eating disorders often have difficulty with interoception have mobilized the field to target interoception during treatment. One such approach is interoceptive exposure therapy, which involves having patients repeatedly experience and tolerate feared bodily sensations, such as dizziness, nausea, fullness. This type of treatment is well known for treating panic disorder, in which individuals experience recurrent panic attacks and fear future attacks. Existing interoceptive exposure treatments developed for panic disorders have been adapted for eating disorders, and small studies have begun to test interoceptive exposure for anorexia nervosa and ARFID.[34][35][36] These studies are preliminary but suggest that such approaches may be feasible and acceptable.

Because individuals with binge eating disorder often report delayed fullness, mindfulness-based treatments have also been applied. Mindfulness involves paying attention to present-moment experiences without attempting to change them. In this context, people are encouraged to notice sensations of hunger and fullness and to allow these sensations to guide eating behavior. Eating in response to internal cues of hunger and satiety is sometimes referred to as intuitive eating. Mindfulness-based treatments for binge eating have been associated with reductions in reducing binge-eating episodes.[37]

To specifically address body image disturbance, new studies are investigating flotation therapy, in which people float in water.[38] Flotations is thought to reduce the impact of external sensory input, such as vision, sounds, and smell. Reducing external sensory input allows people to focus on internal bodily sensations. Ongoing research is examining whether flotation therapy can therapy help reduce body image disturbance and disordered eating.[38]

  1. ↑ 1.0 1.1 1.2 American Psychiatric Association (2022-03-18). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR ed.). American Psychiatric Association Publishing. doi:10.1176/appi.books.9780890425787. ISBN 978-0-89042-575-6. Search this book on
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Khalsa, Sahib S.; Adolphs, Ralph; Cameron, Oliver G.; Critchley, Hugo D.; Davenport, Paul W.; Feinstein, Justin S.; Feusner, Jamie D.; Garfinkel, Sarah N.; Lane, Richard D.; Mehling, Wolf E.; Meuret, Alicia E.; Nemeroff, Charles B.; Oppenheimer, Stephen; Petzschner, Frederike H.; Pollatos, Olga (June 2018). "Interoception and Mental Health: A Roadmap". Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 3 (6): 501–513. doi:10.1016/j.bpsc.2017.12.004. PMC 6054486. PMID 29884281.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 Choquette, Emily M; Khalsa, Sahib S (2025-10-01), Wierenga, Christina E; Steinglass, Joanna E, eds., "Interoception in Eating Disorders", The Handbook of the Neurobiology of Eating Disorders (1 ed.), Oxford University PressNew York, NY, pp. 162–188, doi:10.1093/9780197675212.003.0009, ISBN 978-0-19-767518-2, retrieved 2025-12-11
  4. ↑ 4.0 4.1 Garner, David M.; Olmstead, Marion P.; Polivy, Janet (1983). "Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia". International Journal of Eating Disorders. 2 (2): 15–34. doi:10.1002/1098-108X(198321)2:2<15::AID-EAT2260020203>3.0.CO;2-6. ISSN 1098-108X.
  5. ↑ Dean Coddington, R.; Bruch, Hilde (November 1970). "Gastric Perceptivity in Normal, Obese and Schizophrenic Subjects". Psychosomatics. 11 (6): 571–579. doi:10.1016/S0033-3182(70)71578-8.
  6. ↑ Carlson, Neil R.; Birkett, Melissa A. (2017). Physiology of behavior (Twelfth ed.). Boston: Pearson. ISBN 978-0-13-408091-8. Search this book on
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Khalsa, Sahib S.; Berner, Laura A.; Anderson, Lisa M. (January 2022). "Gastrointestinal Interoception in Eating Disorders: Charting a New Path". Current Psychiatry Reports. 24 (1): 47–60. doi:10.1007/s11920-022-01318-3. ISSN 1523-3812. PMC 8898253 Check |pmc= value (help). PMID 35061138 Check |pmid= value (help).
  8. ↑ Labus, Jennifer S.; Mayer, Emeran A.; Chang, Lin; Bolus, Roger; Naliboff, Bruce D. (January 2007). "The Central Role of Gastrointestinal-Specific Anxiety in Irritable Bowel Syndrome: Further Validation of the Visceral Sensitivity Index". Psychosomatic Medicine. 69 (1): 89–98. doi:10.1097/PSY.0b013e31802e2f24. ISSN 0033-3174.
  9. ↑ Mehling, Wolf E.; Price, Cynthia; Daubenmier, Jennifer J.; Acree, Mike; Bartmess, Elizabeth; Stewart, Anita (2012-11-01). Tsakiris, Manos, ed. "The Multidimensional Assessment of Interoceptive Awareness (MAIA)". PLOS ONE. 7 (11): e48230. Bibcode:2012PLoSO...748230M. doi:10.1371/journal.pone.0048230. ISSN 1932-6203. PMC 3486814. PMID 23133619.
  10. ↑ 10.0 10.1 10.2 10.3 Suksasilp, Chatrin; Garfinkel, Sarah N. (February 2022). "Towards a comprehensive assessment of interoception in a multi-dimensional framework". Biological Psychology. 168. doi:10.1016/j.biopsycho.2022.108262. Unknown parameter |article-number= ignored (help)
  11. ↑ Poovey, Kendall; Ahlich, Erica; Attaway, Sarah; Rancourt, Diana (April 2022). "General versus hunger/satiety-specific interoceptive sensibility in predicting disordered eating". Appetite. 171. doi:10.1016/j.appet.2022.105930. Unknown parameter |article-number= ignored (help)
  12. ↑ Schandry, Rainer (July 1981). "Heart Beat Perception and Emotional Experience". Psychophysiology. 18 (4): 483–488. doi:10.1111/j.1469-8986.1981.tb02486.x. ISSN 0048-5772.
  13. ↑ Zamariola, Giorgia; Maurage, Pierre; Luminet, Olivier; Corneille, Olivier (September 2018). "Interoceptive accuracy scores from the heartbeat counting task are problematic: Evidence from simple bivariate correlations". Biological Psychology. 137: 12–17. doi:10.1016/j.biopsycho.2018.06.006. PMID 29944964.
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 Martin, E.; Dourish, C.T.; Rotshtein, P.; Spetter, M.S.; Higgs, S. (December 2019). "Interoception and disordered eating: A systematic review". Neuroscience & Biobehavioral Reviews. 107: 166–191. doi:10.1016/j.neubiorev.2019.08.020. PMID 31454626.
  15. ↑ Jenkinson, Paul M.; Taylor, Lauren; Laws, Keith R. (July 2018). "Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory". Journal of Psychosomatic Research. 110: 38–45. doi:10.1016/j.jpsychores.2018.04.005.
  16. ↑ 16.0 16.1 Cobbaert, Laurence; Hay, Phillipa; Mitchell, Philip B.; Roza, Sabine J.; Perkes, Iain (July 2024). "Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories". International Journal of Eating Disorders. 57 (7): 1465–1488. doi:10.1002/eat.24184. ISSN 0276-3478. PMID 38511825 Check |pmid= value (help).
  17. ↑ Brown, Tiffany A.; Vanzhula, Irina A.; Reilly, Erin E.; Levinson, Cheri A.; Berner, Laura A.; Krueger, Angeline; Lavender, Jason M.; Kaye, Walter H.; Wierenga, Christina E. (July 2020). "Body mistrust bridges interoceptive awareness and eating disorder symptoms". Journal of Abnormal Psychology. 129 (5): 445–456. doi:10.1037/abn0000516. ISSN 1939-1846. PMC 8140607 Check |pmc= value (help). PMID 32202809 Check |pmid= value (help).
  18. ↑ Herbert, Beate M. (October 2020). "Interoception and Its Role for Eating, Obesity, and Eating Disorders: Empirical Findings and Conceptual Conclusions". European Journal of Health Psychology. 27 (4): 188–205. doi:10.1027/2512-8442/a000062. ISSN 2512-8442.
  19. ↑ 19.0 19.1 Gibson, Dennis; Watters, Ashlie; Mehler, Philip S. (June 2021). "The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review". International Journal of Eating Disorders. 54 (6): 1019–1054. doi:10.1002/eat.23553. ISSN 0276-3478.
  20. ↑ Riedlinger, Caroline; Schmidt, Greta; Weiland, Alisa; Stengel, Andreas; Giel, Katrin Elisabeth; Zipfel, Stephan; Enck, Paul; Mack, Isabelle (2020-04-20). "Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis". Frontiers in Psychiatry. 11. doi:10.3389/fpsyt.2020.00195. ISSN 1664-0640. PMC 7212454 Check |pmc= value (help). PMID 32425816 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  21. ↑ Sato, Yasuhiro; Fukudo, Shin (October 2015). "Gastrointestinal symptoms and disorders in patients with eating disorders". Clinical Journal of Gastroenterology. 8 (5): 255–263. doi:10.1007/s12328-015-0611-x. ISSN 1865-7257.
  22. ↑ Brown, Tiffany A.; Reilly, Erin E.; Murray, Helen Burton; Perry, Taylor R.; Kaye, Walter H.; Wierenga, Christina E. (June 2021). "Validating the visceral sensitivity index in an eating disorder sample". International Journal of Eating Disorders. 54 (6): 986–994. doi:10.1002/eat.23471. ISSN 0276-3478.
  23. ↑ 23.0 23.1 23.2 Datta, Nandini; Hughes, Anna; Modafferi, Mattia; Klabunde, Megan (January 2025). "An FMRI meta-analysis of interoception in eating disorders". NeuroImage. 305. doi:10.1016/j.neuroimage.2024.120933. PMID 39622461 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  24. ↑ Bronleigh, Madeline; Baumann, Oliver; Stapleton, Peta (2022-03-19). "Neural correlates associated with processing food stimuli in anorexia nervosa and bulimia nervosa: an activation likelihood estimation meta-analysis of fMRI studies". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 27 (7): 2309–2320. doi:10.1007/s40519-022-01390-x. ISSN 1590-1262. PMC 9556419 Check |pmc= value (help). PMID 35304713 Check |pmid= value (help).
  25. ↑ Khalsa, Sahib S.; Craske, Michelle G.; Li, Wei; Vangala, Sitaram; Strober, Michael; Feusner, Jamie D. (November 2015). "Altered interoceptive awareness in anorexia nervosa: Effects of meal anticipation, consumption and bodily arousal". International Journal of Eating Disorders. 48 (7): 889–897. doi:10.1002/eat.22387. ISSN 0276-3478. PMC 4898968. PMID 25712775.
  26. ↑ 26.0 26.1 Zucker, Nancy L.; Bulik, Cynthia M. (April 2020). "On bells, saliva, and abdominal pain or discomfort: Early aversive visceral conditioning and vulnerability for anorexia nervosa". International Journal of Eating Disorders. 53 (4): 508–512. doi:10.1002/eat.23255. ISSN 0276-3478. PMC 8344083 Check |pmc= value (help). PMID 32141642 Check |pmid= value (help).
  27. ↑ Gibson, Dennis; Watters, Ashlie; Mehler, Philip S. (June 2021). "The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review". International Journal of Eating Disorders. 54 (6): 1019–1054. doi:10.1002/eat.23553. ISSN 0276-3478.
  28. ↑ Stanculete, Mihaela Fadgyas; Chiarioni, Giuseppe; Dumitrascu, Dan Lucian; Dumitrascu, Dinu Iuliu; Popa, Stefan-Lucian (2021-06-28). "Disorders of the brain-gut interaction and eating disorders". World Journal of Gastroenterology. 27 (24): 3668–3681. doi:10.3748/wjg.v27.i24.3668. ISSN 1007-9327. PMC 8240049 Check |pmc= value (help). PMID 34239277 Check |pmid= value (help).
  29. ↑ Peters, Jessica E.; Basnayake, Chamara; Hebbard, Geoffrey S.; Salzberg, Michael R.; Kamm, Michael A. (August 2022). "Prevalence of disordered eating in adults with gastrointestinal disorders: A systematic review". Neurogastroenterology & Motility. 34 (8). doi:10.1111/nmo.14278. ISSN 1350-1925. PMID 34618988 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  30. ↑ Rezaei, Niloufar; Tamaskani Zahedi, Sina; Hajihashemi, Parisa; Nasiri-Dehsorkhi, Hamid; Zamani, Arefeh; Ebrahimi, Amrollah; Adibi, Peyman; Armstrong, David (2025-06-26). "The prevalence and association between avoidant/restrictive food intake disorder-(ARFID) and disorders of gut–brain interaction (DGBI): a scoping review". Eating Disorders: 1–19. doi:10.1080/10640266.2025.2519904. ISSN 1064-0266.
  31. ↑ Tiggemann, Marika (2013-07-01). "Objectification Theory: Of relevance for eating disorder researchers and clinicians?". Clinical Psychologist. 17 (2): 35–45. doi:10.1111/cp.12010. ISSN 1328-4207.
  32. ↑ Gardner, Rick M.; Brown, Dana L. (November 2014). "Body size estimation in anorexia nervosa: A brief review of findings from 2003 through 2013". Psychiatry Research. 219 (3): 407–410. doi:10.1016/j.psychres.2014.06.029.
  33. ↑ Brown, Tiffany A.; Shott, Megan E.; Frank, Guido K.W. (March 2021). "Body size overestimation in anorexia nervosa: Contributions of cognitive, affective, tactile and visual information". Psychiatry Research. 297. doi:10.1016/j.psychres.2021.113705. PMC 11537156 Check |pmc= value (help). PMID 33472094 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  34. ↑ Hildebrandt, Tom; Peyser, Deena; Sysko, Robyn (November 2021). "Lessons learned developing and testing family-based interoceptive exposure for adolescents with l ow-weight eating disorders". International Journal of Eating Disorders. 54 (11): 2037–2045. doi:10.1002/eat.23605. ISSN 0276-3478. PMC 8712094 Check |pmc= value (help). PMID 34528269 Check |pmid= value (help).
  35. ↑ Burton Murray, Helen; Weeks, Imani; Becker, Kendra R.; Ljótsson, Brjánn; Madva, Elizabeth N.; Eddy, Kamryn T.; Staller, Kyle; Kuo, Braden; Thomas, Jennifer J. (March 2023). "Development of a brief cognitive-behavioral treatment for avoidant/restrictive food intake disorder in the context of disorders of gut–brain interaction: Initial feasibility, acceptability, and clinical outcomes". International Journal of Eating Disorders. 56 (3): 616–627. doi:10.1002/eat.23874. ISSN 0276-3478. PMC 9992156 Check |pmc= value (help). PMID 36550697 Check |pmid= value (help).
  36. ↑ Godfrey, Kathryn M.; Gallo, Linda C.; Afari, Niloofar (April 2015). "Mindfulness-based interventions for binge eating: a systematic review and meta-analysis". Journal of Behavioral Medicine. 38 (2): 348–362. doi:10.1007/s10865-014-9610-5. ISSN 0160-7715.
  37. ↑ Godfrey, Kathryn M.; Gallo, Linda C.; Afari, Niloofar (April 2015). "Mindfulness-based interventions for binge eating: a systematic review and meta-analysis". Journal of Behavioral Medicine. 38 (2): 348–362. doi:10.1007/s10865-014-9610-5. ISSN 0160-7715.
  38. ↑ 38.0 38.1 Choquette, Emily M.; Flux, Michael C.; Moseman, Scott E.; Chappelle, Sheridan; Naegele, Jessyca; Upshaw, Valerie; Morton, Alexa; Paulus, Martin P.; Feinstein, Justin S.; Khalsa, Sahib S. (October 2023). "The impact of floatation therapy on body image and anxiety in anorexia nervosa: a randomised clinical efficacy trial". eClinicalMedicine. 64. doi:10.1016/j.eclinm.2023.102173. PMC 10626164 Check |pmc= value (help). PMID 37936658 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)


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