Is interoceptive awareness really altered in somatoform disorders? Testing competing theories with two paradigms of heartbeat perception.

Alterations in the perception of body signals (i.e., interoceptive awareness [IA]) are considered crucial for the development and maintenance of somatoform disorders (SFDs). However, competing theories come to different conclusions about whether IA is increased or decreased in SFDs. The present study investigated IA in 23 patients with SFDs (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and in 27 healthy controls. IA was reliably assessed with two well-established heartbeat perception paradigms (heartbeat discrimination task and mental tracking task). The results of both paradigms showed no evidence for increased IA in patients with SFDs. Correlational analyses revealed that having a higher number of somatoform symptoms was significantly linked to lower (rather than higher) IA in SFDs. These findings are in line with recent cognitive approaches to SFDs that stress the importance of biased schema-guided processing of interoceptive information.