Interoception and Its Interaction with Self, Other, and Emotion Processing: Implications for the Understanding of Psychosocial Deficits in Borderline Personality Disorder

  • Annette Löffler
  • Jens Foell
  • Robin Bekrater-Bodmann
Personality Disorders (K Bertsch, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Personality Disorders

Abstract

Purpose of Review

We review evidence for the potential importance of interoception, i.e., the processing of signals arising from inside the body, for deficient psychosocial functioning in borderline personality disorder (BPD).

Recent Findings

Evidence suggests that variability in interoception interacts with higher-order psychological functions such as self, other, and emotion processing. These domains are characteristically impaired in BPD, suggesting a likely causal role of disturbed interoception in the etiology of the disorder. The inability to identify and describe one’s own emotional states represents a proxy of impaired interoception which might further mediate between the perception of inner physiological conditions and psychosocial functioning in BPD.

Summary

There is preliminary evidence explaining how early life stress might adversely affect central interoceptive representation and psychosocial functioning in BPD. Based on these findings and the specific pattern of disturbances in BPD, we propose the crucial role of interoception in an integrated biobehavioral model for BPD.

Keywords

Interoception Borderline personality disorder Emotion regulation Emotional awareness Anterior insula 

Notes

Acknowledgements

This work was supported by the ‘Mechanisms of disturbed emotion processing in borderline personality disorder’ project, which receives funding from the Clinical Research Unit program (KFO 256-IP4n, BE 5723/1-2, awarded to RBB) of the Deutsche Forschungsgemeinschaft. The funding source had no involvement in the writing of this article or in the decision to submit the article for publication.

Compliance with Ethical Standards

Conflict of Interest

Annette Löffler, Jens Foell, and Robin Bekrater-Bodmann declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Suzuki K, Garfinkel SN, Critchley HD, Seth AK. Multisensory integration across exteroceptive and interoceptive domains modulates self-experience in the rubber-hand illusion. Neuropsychologia. 2013;51(13):2909–17.  https://doi.org/10.1016/j.neuropsychologia.2013.08.014.PubMedCrossRefGoogle Scholar
  2. 2.
    • Tajadura-Jimenez A, Tsakiris M. Balancing the "inner" and the "outer" self: interoceptive sensitivity modulates self-other boundaries. J Exp Psychol Gen. 2014;143(2):736–44.  https://doi.org/10.1037/a0033171. This study shows that interoception is used to differentiate between oneself and others and that activity in anterior insula is underlying this process. PubMedCrossRefGoogle Scholar
  3. 3.
    Füstös J, Gramann K, Herbert BM, Pollatos O. On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal. Soc Cogn Affect Neurosci. 2012;8(8):911–7.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Schandry R. Heart beat perception and emotional experience. Psychophysiology. 1981;18(4):483–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Whitehead WE, Drescher VM, Heiman P, Blackwell B. Relation of heart rate control to heartbeat perception. Biofeedback Self Regul. 1977;2(4):371–92.CrossRefGoogle Scholar
  6. 6.
    Herbert BM, Muth ER, Pollatos O, Herbert C. Interoception across modalities: on the relationship between cardiac awareness and the sensitivity for gastric functions. PLoS One. 2012;7(5):e36646.  https://doi.org/10.1371/journal.pone.0036646.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Garfinkel SN, Critchley HD. Interoception, emotion and brain: new insights link internal physiology to social behaviour. Commentary on:: "anterior insular cortex mediates bodily sensibility and social anxiety" by Terasawa et al. (2012). Soc Cogn Affect Neurosci. 2013;8(3):231–4.  https://doi.org/10.1093/scan/nss140.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3(8):655–66.  https://doi.org/10.1038/nrn894.PubMedCrossRefGoogle Scholar
  9. 9.
    Critchley HD, Wiens S, Rotshtein P, Ohman A, Dolan RJ. Neural systems supporting interoceptive awareness. Nat Neurosci. 2004;7(2):189–95.  https://doi.org/10.1038/nn1176.PubMedCrossRefGoogle Scholar
  10. 10.
    Paulus MP, Stein MB. Interoception in anxiety and depression. Brain Struct Funct. 2010;214(5–6):451–63.  https://doi.org/10.1007/s00429-010-0258-9.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    DuBois D, Ameis SH, Lai MC, Casanova MF, Desarkar P. Interoception in autism Spectrum disorder: a review. Int J Dev Neurosci. 2016;52:104–11.  https://doi.org/10.1016/j.ijdevneu.2016.05.001.PubMedCrossRefGoogle Scholar
  12. 12.
    Badoud D, Tsakiris M. From the body's viscera to the body's image: is there a link between interoception and body image concerns? Neurosci Biobehav Rev. 2017;77:237–46.  https://doi.org/10.1016/j.neubiorev.2017.03.017.PubMedCrossRefGoogle Scholar
  13. 13.
    Brewer R, Cook R, Bird G. Alexithymia: a general deficit of interoception. R Soc Open Sci. 2016;3(10):150664.  https://doi.org/10.1098/rsos.150664.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Murphy J, Brewer R, Catmur C, Bird G. Interoception and psychopathology: a developmental neuroscience perspective. Dev Cogn Neurosci. 2017;23:45–56.  https://doi.org/10.1016/j.dcn.2016.12.006.PubMedCrossRefGoogle Scholar
  15. 15.
    Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010;167(7):748–51.  https://doi.org/10.1176/appi.ajp.2010.09091379.PubMedCrossRefGoogle Scholar
  16. 16.
    Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, et al. The hierarchical taxonomy of psychopathology (HiTOP): a dimensional alternative to traditional nosologies. J Abnorm Psychol. 2017;126(4):454.PubMedCrossRefGoogle Scholar
  17. 17.
    Schmahl C, Herpertz SC, Bertsch K, Ende G, Flor H, Kirsch P, et al. Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of knowledge and research agenda of the German clinical research unit. Borderline Personal Disord Emot Dysregul. 2014;1:12.  https://doi.org/10.1186/2051-6673-1-12.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Fonagy P, Bateman A. Attachment theory and mentalization-oriented model of borderline personality disorder. The American Psychiatric Publishing textbook of personality disorders. 2005. p. 187–207.Google Scholar
  19. 19.
    Linehan M. Cognitive-behavioral treatment of borderline personality disorder. Guilford press; 1993.Google Scholar
  20. 20.
    Farb NA, Segal ZV, Anderson AK. Mindfulness meditation training alters cortical representations of interoceptive attention. Soc Cogn Affect Neurosci. 2012;8(1):15–26.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Tsakiris M, Tajadura-Jimenez A, Costantini M. Just a heartbeat away from one's body: interoceptive sensitivity predicts malleability of body-representations. Proc Biol Sci. 2011;278(1717):2470–6.  https://doi.org/10.1098/rspb.2010.2547.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Ainley V, Maister L, Brokfeld J, Farmer H, Tsakiris M. More of myself: manipulating interoceptive awareness by heightened attention to bodily and narrative aspects of the self. Conscious Cogn. 2013;22(4):1231–8.  https://doi.org/10.1016/j.concog.2013.08.004.PubMedCrossRefGoogle Scholar
  23. 23.
    Ainley V, Tajadura-Jimenez A, Fotopoulou A, Tsakiris M. Looking into myself: changes in interoceptive sensitivity during mirror self-observation. Psychophysiology. 2012;49(11):1504–8.  https://doi.org/10.1111/j.1469-8986.2012.01468.x.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Filippetti ML, Tsakiris M. Heartfelt embodiment: changes in body-ownership and self-identification produce distinct changes in interoceptive accuracy. Cognition. 2017;159:1–10.  https://doi.org/10.1016/j.cognition.2016.11.002.PubMedCrossRefGoogle Scholar
  25. 25.
    Modinos G, Ormel J, Aleman A. Activation of anterior insula during self-reflection. PLoS One. 2009;4(2):e4618.  https://doi.org/10.1371/journal.pone.0004618.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Park HD, Bernasconi F, Salomon R, Tallon-Baudry C, Spinelli L, Seeck M et al. Neural sources and underlying mechanisms of neural responses to heartbeats, and their role in bodily self-consciousness: an intracranial EEG study. Cereb Cortex 2017:1–14. doi: https://doi.org/10.1093/cercor/bhx136.
  27. 27.
    Lange CG, James W. The emotions. Williams & Wilkins; 1922.Google Scholar
  28. 28.
    Craig AD. Human feelings: why are some more aware than others? Trends Cogn Sci. 2004;8(6):239–41.  https://doi.org/10.1016/j.tics.2004.04.004.PubMedCrossRefGoogle Scholar
  29. 29.
    Pollatos O, Kirsch W, Schandry R. On the relationship between interoceptive awareness, emotional experience, and brain processes. Brain Res Cogn Brain Res. 2005;25(3):948–62.  https://doi.org/10.1016/j.cogbrainres.2005.09.019.PubMedCrossRefGoogle Scholar
  30. 30.
    Pollatos O, Herbert BM, Matthias E, Schandry R. Heart rate response after emotional picture presentation is modulated by interoceptive awareness. Int J Psychophysiol. 2007;63(1):117–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Pollatos O, Gramann K, Schandry R. Neural systems connecting interoceptive awareness and feelings. Hum Brain Mapp. 2007;28(1):9–18.  https://doi.org/10.1002/hbm.20258.PubMedCrossRefGoogle Scholar
  32. 32.
    Pollatos O, Schandry R, Auer DP, Kaufmann C. Brain structures mediating cardiovascular arousal and interoceptive awareness. Brain Res. 2007;1141:178–87.  https://doi.org/10.1016/j.brainres.2007.01.026.PubMedCrossRefGoogle Scholar
  33. 33.
    Terasawa Y, Fukushima H, Umeda S. How does interoceptive awareness interact with the subjective experience of emotion? An fMRI study. Hum Brain Mapp. 2013;34(3):598–612.PubMedGoogle Scholar
  34. 34.
    Terasawa Y, Shibata M, Moriguchi Y, Umeda S. Anterior insular cortex mediates bodily sensibility and social anxiety. Soc Cogn Affect Neurosci. 2013;8(3):259–66.  https://doi.org/10.1093/scan/nss108.PubMedCrossRefGoogle Scholar
  35. 35.
    Ferri F, Ardizzi M, Ambrosecchia M, Gallese V. Closing the gap between the inside and the outside: interoceptive sensitivity and social distances. PLoS One. 2013;8(10):e75758.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Terasawa Y, Moriguchi Y, Tochizawa S, Umeda S. Interoceptive sensitivity predicts sensitivity to the emotions of others. Cogn Emot. 2014;28(8):1435–48.  https://doi.org/10.1080/02699931.2014.888988.PubMedCrossRefGoogle Scholar
  37. 37.
    Baltazar M, Hazem N, Vilarem E, Beaucousin V, Picq JL, Conty L. Eye contact elicits bodily self-awareness in human adults. Cognition. 2014;133(1):120–7.  https://doi.org/10.1016/j.cognition.2014.06.009.PubMedCrossRefGoogle Scholar
  38. 38.
    Hazem N, George N, Baltazar M, Conty L. I know you can see me: social attention influences bodily self-awareness. Biol Psychol. 2017;124:21–9.  https://doi.org/10.1016/j.biopsycho.2017.01.007.PubMedCrossRefGoogle Scholar
  39. 39.
    Maister L, Hodossy L, Tsakiris M. You fill my heart: looking at One's partner increases interoceptive accuracy. Psychol Conscious (Wash D C). 2017;4(2):248–57.  https://doi.org/10.1037/cns0000110.Google Scholar
  40. 40.
    •• Adolfi F, Couto B, Richter F, Decety J, Lopez J, Sigman M, et al. Convergence of interoception, emotion, and social cognition: a twofold fMRI meta-analysis and lesion approach. Cortex. 2017;88:124–42.  https://doi.org/10.1016/j.cortex.2016.12.019. Based on neuroimaging data obtained in healthy participants as well as in patients with central neural damage, this study reveals that an insula-anchored network contributes to the integration of interoceptive, affective, and social signals. PubMedCrossRefGoogle Scholar
  41. 41.
    Terasawa Y, Kurosaki Y, Ibata Y, Moriguchi Y, Umeda S. Attenuated sensitivity to the emotions of others by insular lesion. Front Psychol. 2015;6:1314.  https://doi.org/10.3389/fpsyg.2015.01314.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Ronchi R, Bello-Ruiz J, Lukowska M, Herbelin B, Cabrilo I, Schaller K, et al. Right insular damage decreases heartbeat awareness and alters cardio-visual effects on bodily self-consciousness. Neuropsychologia. 2015;70:11–20.  https://doi.org/10.1016/j.neuropsychologia.2015.02.010.PubMedCrossRefGoogle Scholar
  43. 43.
    Ondobaka S, Kilner J, Friston K. The role of interoceptive inference in theory of mind. Brain Cogn. 2017;112:64–8.  https://doi.org/10.1016/j.bandc.2015.08.002.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Herwig U, Kaffenberger T, Jancke L, Bruhl AB. Self-related awareness and emotion regulation. NeuroImage. 2010;50(2):734–41.  https://doi.org/10.1016/j.neuroimage.2009.12.089.PubMedCrossRefGoogle Scholar
  45. 45.
    Maister L, Slater M, Sanchez-Vives MV, Tsakiris M. Changing bodies changes minds: owning another body affects social cognition. Trends Cogn Sci. 2015;19(1):6–12.PubMedCrossRefGoogle Scholar
  46. 46.
    Lamm C, Singer T. The role of anterior insular cortex in social emotions. Brain Struct Funct. 2010;214(5–6):579–91.  https://doi.org/10.1007/s00429-010-0251-3.PubMedCrossRefGoogle Scholar
  47. 47.
    Carpenter RW, Trull TJ. Components of emotion dysregulation in borderline personality disorder: a review. Curr Psychiatry Rep. 2013;15(1):335.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Crowell SE, Beauchaine TP, Linehan MM. A biosocial developmental model of borderline personality: elaborating and extending linehan’s theory. Psychol Bull. 2009;135(3):495.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet. 2004;364(9432):453–61.  https://doi.org/10.1016/S0140-6736(04)16770-6.PubMedCrossRefGoogle Scholar
  50. 50.
    Coifman KG, Berenson KR, Rafaeli E, Downey G. From negative to positive and back again: polarized affective and relational experience in borderline personality disorder. J Abnorm Psychol. 2012;121(3):668.PubMedCrossRefGoogle Scholar
  51. 51.
    Leible TL, Snell WE Jr. Borderline personality disorder and multiple aspects of emotional intelligence. Pers Individ Dif. 2004;37(2):393–404.CrossRefGoogle Scholar
  52. 52.
    Suvak MK, Litz BT, Sloan DM, Zanarini MC, Barrett LF, Hofmann SG. Emotional granularity and borderline personality disorder. J Abnorm Psychol. 2011;120(2):414.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Sifneos PE. The prevalence of 'alexithymic' characteristics in psychosomatic patients. Psychother Psychosom. 1973;22(2):255–62.PubMedCrossRefGoogle Scholar
  54. 54.
    Silva AN, Vasco AB, Watson JC. Alexithymia and emotional processing: a mediation model. J Clin Psychol. 2017;73(9):1196–205.PubMedCrossRefGoogle Scholar
  55. 55.
    New AS, aan het Rot M, Ripoll LH, Perez-Rodriguez MM, Lazarus S, Zipursky E, et al. Empathy and alexithymia in borderline personality disorder: clinical and laboratory measures. J Personal Disord. 2012;26(5):660–75.  https://doi.org/10.1521/pedi.2012.26.5.660.CrossRefGoogle Scholar
  56. 56.
    Modestin J, Furrer R, Malti T. Study on alexithymia in adult non-patients. J Psychosom Res. 2004;56(6):707–9.  https://doi.org/10.1016/S0022-3999(03)00125-9.PubMedCrossRefGoogle Scholar
  57. 57.
    Herbert BM, Herbert C, Pollatos O. On the relationship between interoceptive awareness and alexithymia: is interoceptive awareness related to emotional awareness? J Pers. 2011;79(5):1149–75.  https://doi.org/10.1111/j.1467-6494.2011.00717.x.PubMedCrossRefGoogle Scholar
  58. 58.
    Bird G, Silani G, Brindley R, White S, Frith U, Singer T. Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain. 2010;133(Pt 5):1515–25.  https://doi.org/10.1093/brain/awq060.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Ernst J, Boker H, Hattenschwiler J, Schupbach D, Northoff G, Seifritz E, et al. The association of interoceptive awareness and alexithymia with neurotransmitter concentrations in insula and anterior cingulate. Soc Cogn Affect Neurosci. 2014;9(6):857–63.  https://doi.org/10.1093/scan/nst058.PubMedCrossRefGoogle Scholar
  60. 60.
    Goerlich-Dobre KS, Bruce L, Martens S, Aleman A, Hooker CI. Distinct associations of insula and cingulate volume with the cognitive and affective dimensions of alexithymia. Neuropsychologia. 2014;53:284–92.  https://doi.org/10.1016/j.neuropsychologia.2013.12.006.PubMedCrossRefGoogle Scholar
  61. 61.
    •• Hogeveen J, Bird G, Chau A, Krueger F, Grafman J. Acquired alexithymia following damage to the anterior insula. Neuropsychologia. 2016;82:142–8. The authors present convincing evidence that anterior insula damage is associated with the inability to identify and describe one's own emotional states. PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Maister L, Tang T, Tsakiris M. Neurobehavioral evidence of interoceptive sensitivity in early infancy. elife 2017;6.Google Scholar
  63. 63.
    Lemche E, Klann-Delius G, Koch R, Joraschky P. Mentalizing language development in a longitudinal attachment sample: implications for alexithymia. Psychother Psychosom. 2004;73(6):366–74.  https://doi.org/10.1159/000080390.PubMedCrossRefGoogle Scholar
  64. 64.
    Caseras X, Murphy K, Lawrence NS, Fuentes-Claramonte P, Watts J, Jones DK, et al. Emotion regulation deficits in euthymic bipolar I versus bipolar II disorder: a functional and diffusion-tensor imaging study. Bipolar Disord. 2015;17(5):461–70.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Fowler JC, Charak R, Elhai JD, Allen JG, Frueh BC, Oldham JM. Construct validity and factor structure of the difficulties in emotion regulation scale among adults with severe mental illness. J Psychiatr Res. 2014;58:175–80.PubMedCrossRefGoogle Scholar
  66. 66.
    van Zutphen L, Siep N, Jacob GA, Goebel R, Arntz A. Emotional sensitivity, emotion regulation and impulsivity in borderline personality disorder: a critical review of fMRI studies. Neurosci Biobehav Rev. 2015;51:64–76.PubMedCrossRefGoogle Scholar
  67. 67.
    Eshkevari E, Rieger E, Longo MR, Haggard P, Treasure J. Persistent body image disturbance following recovery from eating disorders. Int J Eat Disord. 2014;47(4):400–9.  https://doi.org/10.1002/eat.22219.PubMedCrossRefGoogle Scholar
  68. 68.
    Selby EA, Ward AC, Joiner TE Jr. Dysregulated eating behaviors in borderline personality disorder: are rejection sensitivity and emotion dysregulation linking mechanisms? Int J Eat Disord. 2010;43(7):667–70.  https://doi.org/10.1002/eat.20761.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Brewer R, Cook R, Cardi V, Treasure J, Bird G. Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia. Open Sci. 2015;2(1):140382.Google Scholar
  70. 70.
    Corbett BA, Carmean V, Ravizza S, Wendelken C, Henry ML, Carter C, et al. A functional and structural study of emotion and face processing in children with autism. Psychiatry Res. 2009;173(3):196–205.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Shah P, Hall R, Catmur C, Bird G. Alexithymia, not autism, is associated with impaired interoception. Cortex. 2016;81:215–20.  https://doi.org/10.1016/j.cortex.2016.03.021.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    • Murphy J, Catmur C, Bird G. Alexithymia is associated with a multidomain, multidimensional failure of Interoception: evidence from novel tests. J Exp Psychol Gen. 2017. doi: https://doi.org/10.1037/xge0000366. This study shows that alexithymia is associated with a global deficit in interoception.
  73. 73.
    Polk E, Liss M. Psychological characteristics of self-injurious behavior. Pers Individ Dif. 2007;43(3):567–77.CrossRefGoogle Scholar
  74. 74.
    Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev. 2007;27(2):226–39.PubMedCrossRefGoogle Scholar
  75. 75.
    Aust S, Härtwig EA, Heuser I, Bajbouj M. The role of early emotional neglect in alexithymia. Psychol Trauma. 2013;5(3):225.CrossRefGoogle Scholar
  76. 76.
    Swannell S, Martin G, Page A, Hasking P, Hazell P, Taylor A, et al. Child maltreatment, subsequent non-suicidal self-injury and the mediating roles of dissociation, alexithymia and self-blame. Child Abuse Negl. 2012;36(7):572–84.PubMedCrossRefGoogle Scholar
  77. 77.
    Paivio SC, McCulloch CR. Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse Negl. 2004;28(3):339–54.  https://doi.org/10.1016/j.chiabu.2003.11.018.PubMedCrossRefGoogle Scholar
  78. 78.
    Zanarini MC, Yong L, Frankenburg FR, Hennen J, Reich DB, Marino MF, et al. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. J Nerv Ment Dis. 2002;190(6):381–7.PubMedCrossRefGoogle Scholar
  79. 79.
    Berenbaum H. Childhood abuse, alexithymia and personality disorder. J Psychosom Res. 1996;41(6):585–95.PubMedCrossRefGoogle Scholar
  80. 80.
    Schulz A, Vogele C. Interoception and stress. Front Psychol. 2015;6:993.  https://doi.org/10.3389/fpsyg.2015.00993.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Stern ER, Grimaldi SJ, Muratore A, Murrough J, Leibu E, Fleysher L, et al. Neural correlates of interoception: effects of interoceptive focus and relationship to dimensional measures of body awareness. Hum Brain Mapp. 2017;38(12):6068–82.  https://doi.org/10.1002/hbm.23811.PubMedCrossRefGoogle Scholar
  82. 82.
    Baranauskas M, Grabauskaite A, Griskova-Bulanova I. Brain responses and self-reported indices of interoception: heartbeat evoked potentials are inversely associated with worrying about body sensations. Physiol Behav. 2017;180:1–7.  https://doi.org/10.1016/j.physbeh.2017.07.032.PubMedCrossRefGoogle Scholar
  83. 83.
    Haase L, Stewart JL, Youssef B, May AC, Isakovic S, Simmons AN, et al. When the brain does not adequately feel the body: links between low resilience and interoception. Biol Psychol. 2016;113:37–45.  https://doi.org/10.1016/j.biopsycho.2015.11.004.PubMedCrossRefGoogle Scholar
  84. 84.
    Helling J. Non-declarative representational and regulatory systems in alexithymia. J Trauma Dissociation. 2009;10(4):469–87.  https://doi.org/10.1080/15299730903143675.PubMedCrossRefGoogle Scholar
  85. 85.
    Wang T, Liu J, Zhang J, Zhan W, Li L, Wu M, et al. Altered resting-state functional activity in posttraumatic stress disorder: a quantitative meta-analysis. Sci Rep. 2016;6Google Scholar
  86. 86.
    Wingenfeld K, Spitzer C, Rullkotter N, Lowe B. Borderline personality disorder: hypothalamus pituitary adrenal axis and findings from neuroimaging studies. Psychoneuroendocrinology. 2010;35(1):154–70.  https://doi.org/10.1016/j.psyneuen.2009.09.014.PubMedCrossRefGoogle Scholar
  87. 87.
    Hart N, McGowan J, Minati L, Critchley HD. Emotional regulation and bodily sensation: interoceptive awareness is intact in borderline personality disorder. J Personal Disord. 2013;27(4):506–18.  https://doi.org/10.1521/pedi_2012_26_049.CrossRefGoogle Scholar
  88. 88.
    •• Müller LE, Schulz A, Andermann M, Gäbel A, Gescher DM, Spohn A, et al. Cortical representation of afferent bodily signals in borderline personality disorder: neural correlates and relationship to emotional dysregulation. JAMA psychiatry. 2015;72(11):1077–86. This study reveals state-dependent deficits in cortical representation of interoceptive signals and a relationship to emotional dysregulation in current borderline personality disorder. PubMedCrossRefGoogle Scholar
  89. 89.
    Bekrater-Bodmann R, Chung BY, Richter I, Wicking M, Foell J, Mancke F, et al. Deficits in pain perception in borderline personality disorder: results from the thermal grill illusion. Pain. 2015;156(10):2084–92.  https://doi.org/10.1097/j.pain.0000000000000275.PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Forkmann T, Scherer A, Meessen J, Michal M, Schachinger H, Vogele C, et al. Making sense of what you sense: disentangling interoceptive awareness, sensibility and accuracy. Int J Psychophysiol. 2016;109:71–80.  https://doi.org/10.1016/j.ijpsycho.2016.09.019.PubMedCrossRefGoogle Scholar
  91. 91.
    • Garfinkel SN, Seth AK, Barrett AB, Suzuki K, Critchley HD. Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biol Psychol. 2015;104:65–74. The authors report data which empirically support the existence of distinct dimensions of interoception which might have important implications for psychopathology. PubMedCrossRefGoogle Scholar
  92. 92.
    Garfinkel SN, Tiley C, O'Keeffe S, Harrison NA, Seth AK, Critchley HD. Discrepancies between dimensions of interoception in autism: implications for emotion and anxiety. Biol Psychol. 2016;114:117–26.PubMedCrossRefGoogle Scholar
  93. 93.
    Kaletsch M, Kruger B, Pilgramm S, Stark R, Lis S, Gallhofer B, et al. Borderline personality disorder is associated with lower confidence in perception of emotional body movements. Front Psychol. 2014;5:1262.  https://doi.org/10.3389/fpsyg.2014.01262.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Thome J, Liebke L, Bungert M, Schmahl C, Domes G, Bohus M, et al. Confidence in facial emotion recognition in borderline personality disorder. Personal Disord. 2016;7(2):159–68.  https://doi.org/10.1037/per0000142.PubMedCrossRefGoogle Scholar
  95. 95.
    Lorey B, Kaletsch M, Pilgramm S, Bischoff M, Kindermann S, Sauerbier I, et al. Confidence in emotion perception in point-light displays varies with the ability to perceive own emotions. PLoS One. 2012;7(8):e42169.  https://doi.org/10.1371/journal.pone.0042169.PubMedPubMedCentralCrossRefGoogle Scholar
  96. 96.
    Sowden S, Brewer R, Catmur C, Bird G. The specificity of the link between alexithymia, interoception, and imitation. J Exp Psychol Hum Percept Perform. 2016;42(11):1687–92.  https://doi.org/10.1037/xhp0000310.PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Krause-Utz A, Winter D, Niedtfeld I, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2014;16(3):438.  https://doi.org/10.1007/s11920-014-0438-z.PubMedCrossRefGoogle Scholar
  98. 98.
    van Zutphen L, Siep N, Jacob GA, Domes G, Sprenger A, Willenborg B, et al. Always on guard: emotion regulation in women with borderline personality disorder compared to nonpatient controls and patients with cluster-C personality disorder. J Psychiatry Neurosci. 2017;43(1):170008.  https://doi.org/10.1503/jpn.170008.PubMedGoogle Scholar
  99. 99.
    King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The rupture and repair of cooperation in borderline personality disorder. Science. 2008;321(5890):806–10.  https://doi.org/10.1126/science.1156902.PubMedPubMedCentralCrossRefGoogle Scholar
  100. 100.
    Lis S, Bohus M. Social interaction in borderline personality disorder. Curr Psychiatry Rep. 2013;15(2):338.  https://doi.org/10.1007/s11920-012-0338-z.PubMedCrossRefGoogle Scholar
  101. 101.
    Staebler K, Helbing E, Rosenbach C, Renneberg B. Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother. 2011;18(4):275–83.  https://doi.org/10.1002/cpp.705.PubMedCrossRefGoogle Scholar
  102. 102.
    Pollatos O, Matthias E, Keller J. When interoception helps to overcome negative feelings caused by social exclusion. Front Psychol. 2015;6:786.  https://doi.org/10.3389/fpsyg.2015.00786.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Bungert M, Koppe G, Niedtfeld I, Vollstadt-Klein S, Schmahl C, Lis S, et al. Pain processing after social exclusion and its relation to rejection sensitivity in borderline personality disorder. PLoS One. 2015;10(8):e0133693.  https://doi.org/10.1371/journal.pone.0133693.PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Durlik C, Tsakiris M. Decreased interoceptive accuracy following social exclusion. Int J Psychophysiol. 2015;96(1):57–63.  https://doi.org/10.1016/j.ijpsycho.2015.02.020.PubMedCrossRefGoogle Scholar
  105. 105.
    Dyer A, Borgmann E, Feldmann RE Jr, Kleindienst N, Priebe K, Bohus M, et al. Body image disturbance in patients with borderline personality disorder: impact of eating disorders and perceived childhood sexual abuse. Body Image. 2013;10(2):220–5.PubMedCrossRefGoogle Scholar
  106. 106.
    Smeijers D, Rinck M, Bulten E, van den Heuvel T, Verkes RJ. Generalized hostile interpretation bias regarding facial expressions: characteristic of pathological aggressive behavior. Aggress Behav. 2017;43(4):386–97.PubMedCrossRefGoogle Scholar
  107. 107.
    Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biol Psychiatry. 2013;73(2):153–60.  https://doi.org/10.1016/j.biopsych.2012.07.014.PubMedCrossRefGoogle Scholar
  108. 108.
    Indo Y. Neurobiology of pain, interoception and emotional response: lessons from nerve growth factor-dependent neurons. Eur J Neurosci. 2014;39(3):375–91.  https://doi.org/10.1111/ejn.12448.PubMedCrossRefGoogle Scholar
  109. 109.
    Picardi A, Fagnani C, Gigantesco A, Toccaceli V, Lega I, Stazi MA. Genetic influences on alexithymia and their relationship with depressive symptoms. J Psychosom Res. 2011;71(4):256–63.  https://doi.org/10.1016/j.jpsychores.2011.02.016.PubMedCrossRefGoogle Scholar
  110. 110.
    Walter NT, Montag C, Markett SA, Reuter M. Interaction effect of functional variants of the BDNF and DRD2/ANKK1 gene is associated with alexithymia in healthy human subjects. Psychosom Med. 2011;73(1):23–8.  https://doi.org/10.1097/PSY.0b013e31820037c1.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Annette Löffler
    • 1
  • Jens Foell
    • 2
  • Robin Bekrater-Bodmann
    • 1
  1. 1.Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  2. 2.Department of PsychologyFlorida State UniversityTallahasseeUSA

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