Laureate Institute for Brain Research, Tulsa, OK, United States of America.
Department of Psychology, University of Tulsa, Tulsa, OK, United States of America.
PLoS One. 2020 Jul 15;15(7):e0235346. doi: 10.1371/journal.pone.0235346. eCollection 2020.
Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.
几项研究最近表明，呼吸内感受和伤害性（疼痛）刺激的异常处理可能有助于进食障碍（ED）的病理生理学。心境和焦虑障碍（MA）也以异常的呼吸症状为特征，并与 ED 存在大量共病。然而，尚无研究在 ED 和 MA 中同时检查呼吸和疼痛处理。本研究在一个跨诊断 ED 样本（n=51）中系统评估了对呼吸和伤害性信号扰动的反应，该样本与 MA 个体（n=51）和健康对照组（HC；n=51）个体匹配。参与者接受吸气性屏息挑战作为呼吸内感受的探针，以及冷加压挑战作为疼痛处理的探针。我们预计，在没有生理和行为反应差异的情况下，两个临床组在对呼吸和伤害性扰动的反应中报告的压力和恐惧都大于 HC。在屏息过程中，ED 和 MA 组报告的压力、窒息感和窒息恐惧明显多于 HC 组，ED 组报告的症状最严重。此外，焦虑敏感性仅与 ED 组的窒息恐惧相关。在本研究中，在行为（屏息时间、冷加压时间）和生理（呼气末二氧化碳、呼气末氧气、心率、皮肤电导）反应没有组间差异的情况下，出现了增强的情感反应。出乎我们的意料，在冷痛刺激反应中没有组间差异。针对神经性厌食症患者（n=30）的匹配亚组分析得出了类似的结果。这些发现强调了 MA 中存在异常的呼吸内感受，并且表明对呼吸信号的高反应性可能是 ED 的一个潜在被忽视的临床特征。
