Title: Diseases, Disorders, and Comorbidities of Interoception
Abstract: Interoception refers to the sense of the internal state of the body, mediated by body-to-brain signaling through neuronal and humoral afferent channels. Interoceptive information directs efferent brain-to-body control of physiology to maintain health and is integrated in sensory, emotional, cognitive, and motivational representations. Interoceptive dysfunction at any level of the neuraxis can affect the whole system and is implicated in the expression of psychological and physical symptoms across a spectrum of acquired, developmental, neurodegenerative, central, and peripheral conditions. Identification of interoceptive markers for diagnosis and prognosis, alongside new interventional targets, will advance psychological, behavioral, and pharmacological treatments and emergent approaches in bioelectronic medicine for managing complex symptoms. Interoception, the sense of the body’s internal physiological state, underpins homeostatic reflexes, motivational states, and sensations contributing to emotional experiences. The continuous nature of interoceptive processing, coupled to behavior, is implicated in the neurobiological construction of the sense of self. Aberrant integration and control of interoceptive signals, originating in the brain and/or the periphery, can perturb the whole system. Interoceptive abnormalities are implicated in the pathophysiology of psychiatric disorders and in the symptomatic expression of developmental, neurodegenerative, and neurological disorders. Moreover, interoceptive mechanisms appear central to somatic disorders of brain–body interactions, including functional digestive disorders, chronic pain, and comorbid conditions. The present article provides an overview of disorders of interoception and suggests future directions for better understanding, diagnosis, and management of these disorders. Interoception, the sense of the body’s internal physiological state, underpins homeostatic reflexes, motivational states, and sensations contributing to emotional experiences. The continuous nature of interoceptive processing, coupled to behavior, is implicated in the neurobiological construction of the sense of self. Aberrant integration and control of interoceptive signals, originating in the brain and/or the periphery, can perturb the whole system. Interoceptive abnormalities are implicated in the pathophysiology of psychiatric disorders and in the symptomatic expression of developmental, neurodegenerative, and neurological disorders. Moreover, interoceptive mechanisms appear central to somatic disorders of brain–body interactions, including functional digestive disorders, chronic pain, and comorbid conditions. The present article provides an overview of disorders of interoception and suggests future directions for better understanding, diagnosis, and management of these disorders. inability to detect, identify, and/or describe one’s own emotions or the emotions of others. a form of regulation that emphasizes the process of achieving stability through change, for example, by the dynamic and anticipatory (predictive) allocation of resources and generation of responses to ensure longer term stability of core regulatory targets. builds upon mechanistic insights into neural control of biological processes that underlie disease. It is based on the development of devices to modulate these specific neural circuits as a therapy using electromagnetic fields. controls the activity of preganglionic sympathetic and parasympathetic neurons in the dynamic control of visceral function. The visceromotor CAN is organized hierarchically and is integrated with interoceptive representations, encompassing the anterior cingulate cortex, insula, amygdala, forebrain regions, hypothalamus, brainstem, and spinal centers. any disorder affecting the function of the autonomic nervous system. This includes consequences of peripheral or central nervous damage (e.g., diabetic dysautonomia or spinal dysreflexia) and, increasingly, this term is applied to clinical conditions defined by primary maladaptive reactivity of the autonomic nervous system, including vasovagal syncope, hyperhidrosis, and postural tachycardia syndrome (PoTS). traumatic events experienced in early life, typically defined as up to 18 years of age. a medical condition that impairs the normal function or functioning of a bodily or cognitive process, in the absence of a structural pathology or other detectible organic process causing the impairment. Emotional psychological factors are often implicated in the pathogenesis. Functional symptoms also commonly comorbid with organic disorder. Examples within neurology include functional motor symptoms, functional (dissociative) seizures, and functional amnesia. the process of maintaining a stable constant internal physiological environment within a tight range optimized for survival. Homeostasis broadly involves self-adjusting reflexes and close loop control mechanisms; examples include pancreatic control of blood glucose, respiratory control of blood oxygenation, baroreflex control of blood pressure. the sense of the internal physiological condition of the body. Distinguished from exteroception (sensing the environment) and proprioception (sensing position and action within the environment). Interoception encompasses afferent signaling from the body via neural and humoral channels and the representation, integration, and conscious perception of these signals. Interoception is the afferent limb of homeostasis and allostasis, contributes to affective processing and motivational drives (including associated experiential feeling states), and is the putative substrate for the representation of ‘biological self’. ‘thinking about thinking’. The cognitive appraisal, representation, and control of cognitive processes, including self-monitoring. Interoceptive metacognition, also referred to as interoceptive insight or awareness, may refer to the knowledge about how accurately one can judge or be influenced by signals from the body. This therefore represents a higher-order belief within a hierarchy of interoceptive control. a nonspecific response of the body to demands and its reaction to changes that require a physical, mental, or emotional adjustment.