Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories.

OBJECTIVE: This review investigated the extant literature regarding the relationship between eating disorder diagnoses and sensory processing as measured by validated and reliable self-report inventories. Increasing evidence highlights the role of sensory processing in cognitive functions. Sensory processing is implicated in mental-ill health, including eating disorders (ED) and body image disturbances. However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored. METHOD: We included studies involving participants aged 15 years or older with an eating disorder diagnosis confirmed by semi-structured or structured interviews. We further limited inclusion to articles using validated and reliable self-report instruments to measure sensory processing. Our meta-analysis focused on studies using the interoceptive awareness subscale from the second version of the Eating Disorder Inventory. We used the Critical Appraisal checklist for quasi-experimental studies to assess the quality of included articles. RESULTS: There were 19 studies that met our inclusion criteria. Most studies showed moderate-to-high quality. Anorexia nervosa (AN) and bulimia nervosa (BN) were associated with heightened exteroception. Moreover, people with AN reported a heightened sense of taste compared to those with BN. Our meta-analysis comprising 10 studies, 19 samples, and 6382 participants revealed that AN (binge-purge subtype) and BN were associated with increased interoceptive difficulties compared to AN (restrictive subtype) or binge-eating disorder. DISCUSSION: Overall, this review emphasizes the need for a deeper investigation into sensory processing, spanning both exteroception and interoception, in relation to ED. This may prove important for individualizing person-centered care. PUBLIC SIGNIFICANCE: How people process internal, for example, hunger, and external, for example, taste and sensations is known to influence cognition and mental-ill health, including ED and body image disturbances. However, the ways in which sensory processing may contribute to ED are incompletely understood. We found that individuals with AN or BN experienced heightened exteroception, while people with an eating disorder characterized by purging reported increased interoceptive difficulties. These patterns could inform the development of more personalized treatments.

OBJETIVO: Esta revisión investigó la literatura existente sobre la relación entre los diagnósticos de trastornos de conducta alimentaria y el procesamiento sensorial, medido mediante inventarios de autoreporte validados y fiables. Cada vez hay más evidencia que destaca el papel del procesamiento sensorial en las funciones cognitivas. El procesamiento sensorial está implicado en la salud mental, incluidos los trastornos de conducta alimentaria y las alteraciones de la imagen corporal. Sin embargo, los fundamentos fisiopatológicos del procesamiento sensorial, que abarcan la exterocepción y la interocepción, en relación con los trastornos alimentarios permanecen poco explorados. MÉTODO: Incluimos estudios con participantes de 15 años o más con un diagnóstico de trastorno de conducta alimentaria confirmado por entrevistas semiestructuradas o estructuradas. Además, limitamos la inclusión a artículos que utilizaran instrumentos de autoreporte validados y fiables para medir el procesamiento sensorial. Nuestro metaanálisis se centró en estudios que utilizaron la subescala de conciencia interoceptiva de la segunda versión del Inventario de Trastornos de Conducta Alimentaria. Utilizamos la lista de verificación de Evaluación Crítica para estudios cuasiexperimentales para evaluar la calidad de los artículos incluidos. RESULTADOS: Hubo 19 estudios que cumplieron con nuestros criterios de inclusión. La mayoría de los estudios mostraron una calidad moderada a alta. La anorexia nerviosa y la bulimia nerviosa se asociaron con una exterocepción elevada. Además, las personas que padecían anorexia nerviosa reportaron de un sentido del gusto más agudizado en comparación con aquellas que padecían bulimia nerviosa. Nuestro metaanálisis, que comprendió 10 estudios, 19 muestras y 6382 participantes, reveló que la anorexia nerviosa (subtipo atracones­purga) y la bulimia nerviosa se asociaron con dificultades interoceptivas aumentadas en comparación con la anorexia nerviosa (subtipo restrictivo) o el trastorno por atracón. DISCUSIÓN: En general, esta revisión enfatiza la necesidad de una investigación más profunda sobre el procesamiento sensorial, abarcando tanto la exterocepción como la interocepción, en relación con los trastornos de conducta alimentaria. Esto puede ser importante para personalizar la atención centrada en la persona.

Commentary: Bringing together lived experience, clinical and research expertise - a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?).

BACKGROUND: There is a wealth of evidence to suggest that the Borderline Personality Disorder (BPD, or similar Emotionally Unstable Personality Disorder, EUPD) construct is harmful. We provide a commentary on the ideas expressed in the May Debate issue, highlighting both concerns and alternatives. METHOD: We bring together lived experience, clinical and research expertise. This commentary was written collaboratively drawing on all these sources of evidence. RESULTS: We outline evidence that the BPD construct is invalid, harmful, not necessary for effective treatment and a potential block to the development and evaluation of alternatives. CONCLUSIONS: We ask readers to consider these concerns, perspectives and ideas.