Interoceptive-based interventions for eating disorders: A systematic review

Disruptions in interoception, the awareness of internal bodily signals, are strongly linked to various psychological and physiological conditions, including eating disorders (EDs) such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. Despite growing evidence that altered interoceptive processing is central to EDs, the use of interoceptive-based interventions (IBIs) in this population remains under-explored. This systematic review aims to evaluate the application and efficacy of IBIs in the treatment of eating disorders. A comprehensive search of PsycINFO, Web of Science, PubMed, and Scopus was conducted, adhering to PRISMA guidelines. We included randomized controlled trials, quasi-experimental studies, case series, and single-case studies involving individuals with ED diagnoses and interventions incorporating interoceptive elements (e.g., mindfulness, biofeedback, interoceptive exposure). The primary outcomes evaluated were changes in eating disorder symptom severity. Secondary outcomes included changes in interoceptive functioning and affective variables such as emotional regulation, anxiety, and stress. Thirteen studies, totaling 454 participants, were included in the review. Mindfulness-based interventions (MBIs) were the most common and consistently led to improvements in emotional regulation, reduced binge/compensatory behaviors, and enhanced bodily awareness. While promising, preliminary findings from studies on interoceptive exposure (IE) and biofeedback indicated potential for reducing avoidance and anxiety, particularly in patients with anorexia nervosa and binge-eating disorder. A key limitation across most studies was a high risk of bias and a lack of standardized measures for assessing interoceptive outcomes. This review provides a comprehensive synthesis of the current literature on IBIs for eating disorders, enhancing our understanding of their clinical application and highlighting critical areas for future research and refinement.