The Developmental Role of Atypical Interoception in Youth Anxiety and Eating Disorders

Anxiety and eating disorders are dangerous, impairing conditions that are increasingly common in youth. Etiology of anxiety and eating disorders may overlap, as both conditions may develop from avoidance of feared situations and sensations. Awareness of feared sensations is related to interoception, the ability to sense internal signals including feared sensations. Atypical interoception in the gastrointestinal domain may be a shared risk factor for anxiety and eating disorders. Gastric sensations are implicated in both eating disorders and anxiety for some individuals. Fear learning may partially explain the relationships among interoceptive deficits and anxiety and eating disorders, such that individuals begin to fear gastric sensations and associated emotional states or situations. Fear of these experiences may generalize to other experiences or sensations associated with gastric discomfort, which may eventually lead to the development of an anxiety and/or eating disorders. Identification of interoceptive deficits in youth presents opportunities for prevention and early intervention of anxiety and eating disorders before they become impairing. This review characterizes interoceptive sensitivity and its role in the onset and maintenance of anxiety and eating disorders. Atypical interoception is defined, fear learning is discussed as it relates to interoception and psychopathology, and the existing research on interoception in children and relationships among interoceptive deficits and anxiety and eating disorders is reviewed respectively. Current gaps in the existing literature are addressed by identifying a recent series of proposed conceptual models, reviewing the evidence for such models, and proposing future research to test these models in youth.