Saramandi, Alkistis; (2024) Understanding the Body from the Inside: The Role of Interoceptive Belief Updating in Anorexia Nervosa. Doctoral thesis (Ph.D), UCL (University College London).

Text AlkistisSaramandi_PhD_RPS.pdf - Accepted Version Access restricted to UCL open access staff until 1 August 2025. Download (5MB)

Abstract

Anorexia Nervosa (AN; an eating disorder) has been associated with disruptions in the way patients sense, interpret, and integrate internal physiological signals (i.e., interoception). Moreover, evidence has pointed towards a compromised ability of AN patients to evaluate their own cognition and reflect on related beliefs and abilities (metacognition). Yet, the way in which metacognitive beliefs about interoception are formed and updated both retrospectively (e.g., retrospective judgements of how well one perceived their heartbeat) and prospectively (e.g., how beliefs are used in combination with new information to predict future performance) in AN has not been examined. Moreover, despite the gastrointestinal system being directly linked to the AN symptomatology, little work has been carried out in this interoceptive modality. The two-fold aim of the present thesis was to study both retrospective and prospective metacognition in two interoceptive modalities, namely cardiac and gastrointestinal interoception. To this end, two interoceptive belief updating tasks were developed to study interoceptive belief updating in a group of women with and weight-restored from AN (AN, and AN-WR, respectively) and matched healthy controls (HCs). The experiments in the cardiac modality examined how participants formed and updated their beliefs regarding their ability to feel their own heartbeat. The experiment in the gastrointestinal modality assessed how the groups differed in predicting stomach fullness states before and after drinking certain fixed amounts of water. The results showed that interoceptive accuracy may be domain-specific (participants did not differ in their accuracy to feel their heartbeats, but the estimates of stomach fullness in AN were greater than those in the HCs). Domain-general deficits were observed in the metacognitive level, wherein AN and AN-WR participants maintained their pessimistic priors when updating their beliefs about cardiac perception abilities and when forming predictions about future stomach fullness states. This poor belief updating was partly explained by the greater reliance on pessimistic prior beliefs or the confidence regarding the accuracy of prior beliefs in light of new, interoceptive evidence. The results have wider implications for our understanding of the role of the different levels and modalities of interoception in AN, and the findings on the precision-weighting mechanism in AN suggest it should be therapeutically targeted in order to help patients improve their metacognitive beliefs about interoceptive abilities.

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