Interoceptive awareness in eating disorders: Distinguishing lack of clarity from non-acceptance of internal experience

Abstract

Poor interoceptive awareness is often cited as a key feature of eating disorders, yet the precise nature of the deficits and their relationship to eating pathology remains unclear. Interoceptive awareness includes both acceptance of affective experience and clarity regarding emotional responses. The aim of the current study was to parse these components and examine the association between these deficits and two representative eating disorder symptoms: dietary restraint and binge eating. Participants were 50 eating disorder patients who completed a medical examination, clinical interview and symptom self-report measures. Results of regression analyses controlling for BMI and illness duration indicated that non-acceptance, not lack of clarity, was significantly associated with dietary restraint. Neither predicted binge eating. Findings suggest that negative reactions to emotional responses may contribute to the development or maintenance of dietary restraint. Results highlight the need to investigate the experience of emotional arousal in individuals with eating disorders using experimental methods that deconstruct the components of interoceptive awareness, and the potential utility of treatments that increase comfort with affective experience for individuals with more restrictive patterns.

Keywords:

• Eating disorders
• Non-acceptance
• Dietary restraint
• Interoceptive deficits
• Experiential avoidance

Notes

¹We know of no published studies that assess interoceptive abilities in eating disorder populations using laboratory-based measures, although there is one recent paper that assesses IA in individuals diagnosed with AN using a heartbeat paradigm (Pollatos et al., 2008).

²Non-acceptance of Emotional Responses Subscale score for the women in the Gratz and Roemer (2004) sample: M=11.65, SD=4.72. Non-acceptance of Emotional Responses Subscale score for the men in the Gratz and Roemer (2004) sample: M=11.55, SD=4.20.

³Lack of Clarity Subscale scores for women in the Gratz and Roemer (2004) sample: M=10.61, SD=3.80. Lack of Clarity Subscale scores for men in the Gratz and Roemer (2004) sample: M=10.74, SD=3.67.

⁴Principle axis factoring with promax oblique rotation was used to extract factors of the DERS. A scree plot was examined to assess adequacy of extraction and number of factors. Only items from the Non-acceptance and Lack of Clarity DERS Subscales were included in the analysis. Items from other, non-relevant DERS subscales (e.g., Impulse Control Difficulties) were not factor analysed.