Interoception in anxiety and depression.pdfVIP

REVIEW Interoception in anxiety and depression Martin P. Paulus ? Murray B. Stein Received: 8 December 2009 / Accepted: 21 April 2010 / Published online: 21 May 2010  The Author(s) 2010. This article is published with open access at S Abstract We review the literature on interoception as it relates to depression and anxiety, with a focus on belief, and alliesthesia. The connection between increased but noisy afferent interoceptive input, self-referential and belief-based states, and top-down modulation of poorly predictive signals is integrated into a neuroanatomical and processing model for depression and anxiety. The advan- tage of this conceptualization is the ability to specifically examine the interface between basic interoception, self- referential belief-based states, and enhanced top-down modulation to attenuate poor predictability. We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a conse- quence of noisily amplified self-referential interoceptive predictive belief states. Keywords Anxiety  Depression  Interoception  Insula  Belief  Alliesthesia Depression and anxiety Depression is a common mental health condition that affects many aspects of daily life. Recent epidemiological data estimate the lifetime prevalence of major depressive disorder (MDD) at about 16% and the 12-month prevalence at 6% (Kessler et al. 2003). MDD is about twice as com- mon in females relative to males (Kessler et al. 1993), manifests as an episodic but often recurrent illness with a mean duration of 16 weeks, and is comorbid with many other mental health conditions especially anxiety and alcohol use disorders. The current classification of depressive disorders (American Psychiatric Association 1994) is based on operational criteria that have been arrived at via consensus decisions by subject matter experts (Kendler and Gardner Jr. 1998). However, there is little evidence that these criteria delineate distinct