1) Ask patients to describe daily experiences of gastrointestinal, cardiovascular, and respiratory sensations. Are frequent bloating, cramping, palpitations, or dyspnea reported? How often do they focus their attention on these sensations? Is the attentional focus usually goal directed, as in frequent body scanning (top-down), or driven by the emergence of bodily signals (bottom-up)?
2) Where do these sensations occur? Do they incorrectly localize such sensations (eg, too diffusely, or in the wrong area)? Can they learn to correctly locate these sensations?
3) When do these sensations occur? Do they occur only during meal times, or during other notable changes in their external or internal environment? Examining the environmental settings under which these perceptions occur may help improve the understanding of context-specific factors.
4) How intensely do they perceive these sensations? Ask them to rate them on a scale of 0 to 10 (akin to rating the loudness of a speaker volume). Are there particular affective experiences associated with these sensations?
5) To what degree do they feel they are aware of their internal body sensations? Do they self-perceive the tendency to constantly focus on interoceptive signals? How does this attitude affect their eating disorder?
Psychometric assessments of interoceptive awareness are available. The first questionnaire developed to assess interoceptive awareness was the Interoceptive Deficits subscale within the Eating Disorders Inventory, a self-report measure intended to assess eating disorder symptom severity.14 However, only two of the ten items actually assess interoception-related symptoms (eg, confusion about hunger, bloating after small meals), with the remainder of the items preferentially measuring alexithymia (eg, confusion about the emotion being felt).
The Multidimensional Assessment of Interoceptive Awareness questionnaire captures a broader range of interoceptive experiences relevant for clinical settings. It has recently been validated in an eating disorders sample, with body trusting and self-regulation subscales showing the strongest correlations with clinical symptoms.15
Dr Khalsa is Director of Clinical Studies, Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK. Dr Khalsa reports no conflicts of interest concerning the subject matter of this article.
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