A Systematic Review and Meta-Analysis of Cardiac Interoceptive Accuracy in Anorexia Nervosa

Interoceptive impairments have been suggested as an etiological factor in anorexia nervosa (AN) but have not been consistently confirmed across interoceptive dimensions and bodily systems. This systematic review and meta-analysis provides a focused investigation of cardiac interoceptive accuracy (IAcc) in AN. We examined whether individuals with AN show reduced cardiac IAcc compared to healthy controls (HC) and whether this difference is moderated by age, sex, task type, guessing instructions, illness duration, or study quality.

A systematic literature search was conducted in the databases PsycINFO, PubMed, MEDLINE, Web of Science, and relevant journals. Studies measuring heartbeat perception using behavioral tasks in patients with AN and HC were included. Standardized mean differences were compared between groups using a random-effects model.

A meta-analysis with 16 studies revealed no significant difference in cardiac IAcc between individuals with AN and HC. Only illness duration emerged as a significant moderator, with lower IAcc in samples with shorter illness duration.

The findings do not confirm consistently reduced cardiac IAcc in AN. Cardiac IAcc may change over the course of illness, with deficits potentially limited to the early stages. A major limitation of the literature concerns the almost exclusive reliance on the heartbeat counting task, the validity of which has been questioned. Future research should develop and employ alternative tasks, consider a broader conceptualization of interoception across dimensions and bodily systems, and include longitudinal investigations.