Psychometric evaluation of a revised version of the body appreciation scale-2 for autistic adults (BAS-2A).

Emerging evidence points to unique conceptualisations of positive body image in autistic individuals. However, there are no existing measures of positive body image that have been developed or validated for use with autistic adults. To rectify this, we developed a revised version of the BAS-2 - the BAS-2A - and examined its factorial validity and psychometric properties in a sample of autistic adults from the United Kingdom. Based on the results of exploratory factor analysis and scale purification, we extracted a 12-item, unidimensional model of BAS-2A scores in a first split-subsample (n = 273). Confirmatory factor analysis supported the unidimensional model of BAS-2A scores in a second split-subsample (n = 277). BAS-2A scores presented adequate composite reliability, measurement invariance across gender identity, and patterns of construct validity. For both women and men, BAS-2A scores correlated positively with self-esteem, well-being, quality of life, and adaptive coping, and inversely with dietary restraint, weight/shape overvaluation, body dissatisfaction, and depression. Finally, BAS-2A scores demonstrated incremental validity, predicting self-esteem over-and-above body dissatisfaction. However, temporal stability of the BAS-2A over three weeks was not supported. These results support the BAS-2A as a psychometrically robust measure of body appreciation for use in autistic adults from the United Kingdom.

Examining the association between depersonalisation traits and the bodily self in waking and dreaming.

Depersonalisation (DP) is characterized by fundamental alterations to the sense of self that include feelings of detachment and estrangement from one's body. We conducted an online study in healthy participants (n = 514) with DP traits to investigate and quantify the subjective experience of body and self during waking and dreaming, as the vast majority of previous studies focussed on waking experience only. Investigating dreams in people experiencing DP symptoms may help us understand whether the dream state is a 'spared space' where people can temporarily 'retrieve' their sense of self and sense of bodily presence. We found that higher DP traits-i.e. higher scores on the Cambridge Depersonalisation Scale (CDS)-were associated with more frequent dream experiences from an outside observer perspective (r = 0.28) and more frequent dream experiences of distinct bodily sensations (r = 0.23). We also found that people with higher CDS scores had more frequent dream experiences of altered bodily perception (r = 0.24), more frequent nightmares (r = 0.33) and higher dream recall (r = 0.17). CDS scores were negatively correlated with body boundary scores (r = - 0.31) in waking states and there was a negative association between CDS scores and the degree of trust in interoceptive signals (r = - 0.52). Our study elucidates the complex phenomenology of DP in relation to bodily selfhood during waking and dreaming and suggests avenues for potential therapeutic interventions in people with chronic depersonalisation (depersonalisation -derealisation disorder).

Heightened interoception in adults with fibromyalgia.

Previous research suggests that the processing of internal body sensations (interoception) affects how we experience pain. Some evidence suggests that people with fibromyalgia syndrome (FMS) - a condition characterised by chronic pain and fatigue - may have altered interoceptive processing. However, extant findings are inconclusive, and some tasks previously used to measure interoception are of questionable validity. Here, we used an alternative measure - the Phase Adjustment Task (PAT) - to examine cardiac interoceptive accuracy in adults with FMS. We examined: (i) the tolerability of the PAT in an FMS sample (N = 154); (ii) if there are differences in facets of interoception (PAT performance, PAT-related confidence, and scores on the Private Body Consciousness Scale) between an FMS sample and an age- and gender-matched pain-free sample (N = 94); and (iii) if subgroups of participants with FMS are identifiable according to interoceptive accuracy levels. We found the PAT was tolerable in the FMS sample, with additional task breaks and a recommended hand posture. The FMS sample were more likely to be classified as 'interoceptive' on the PAT, and had significantly higher self-reported interoception compared to the pain-free sample. Within the FMS sample, we identified a subgroup who demonstrated very strong evidence of being interoceptive, and concurrently had lower fibromyalgia symptom impact (although the effect size was small). Conversely, self-reported interoception was positively correlated with FMS symptom severity and impact. Overall, interoception may be an important factor to consider in understanding and managing FMS symptoms. We recommend future longitudinal work to better understand associations between fluctuating FMS symptoms and interoception.

"There's No Separating My View of My Body from My Autism": A qualitative study of positive body image in autistic individuals.

While scholars have investigated positive body image across diverse populations, extant theory largely excludes those with differing socio-cognitive experiences, such as autistic individuals. Using constructivist grounded theory, this study sought to develop a grounded theory of positive body image in autistic individuals. One-to-one interviews with photo-elicitation were conducted with 20 autistic adults (7 women, 8 men, 5 non-binary/agender; aged 18-53 years) from the United Kingdom. Through a process of open, axial, and focused coding, a grounded theory was developed around a core category of positive body image in autistic adults and was found to comprise six themes: body connection, body acceptance, appreciating body functionality and neurodivergent strengths, having a body-positive protective filter, taking care of the body, and body and appearance neutrality. Our findings suggest that some aspects of positive body image in autistic individuals are consistent with those found in neurotypical adults. However, positive body image in autistic individuals further encompasses both the sensory (i.e., how the body is felt) and aesthetic (i.e., how the body is seen) body. These findings may stimulate research aimed at improving positive body image in autistic populations.

Are some interoceptive sensibility components more central than others? Using item pool visualisation to understand the psychometric representation of interoception.

Interoception refers to the processing of stimuli originating within the body and is widely considered a multidimensional construct. However, there remains a lack of consensus regarding the definition and measurement of the subjective, self-reported component, referred to here as interoceptive sensibility. As a contribution to knowledge on the topic, we sought to examine the construct commonality and distinguishability of seven self-report measures of interoceptive sensibility using Item Pool Visualisation (IPV), an illustrative method that locates item pools from within the same dataset and illustrates these in the form of nested radar charts. Adults from the United Kingdom (N = 802) completed seven measures of interoceptive sensibility, and the data were subjected to IPV. Results demonstrated that, of the included measures, the Multidimensional Assessment of Interoceptive Awareness-2 provided the closest and most precise measurement of the core interoceptive sensibility construct (i.e., core of the entire investigated item pool). The Body Awareness Questionnaire and the Private Body Consciousness Scale were also centrally located measures, while the Body Perception Questionnaire and the Body Responsiveness Scale appear to tap more distal aspects of the core construct. We discuss implications for interpreting complicated data patterns using measures of interoceptive sensibility and, more generally, for measuring the construct of interoceptive sensibility.

How is pain associated with pelvic mesh implants measured? Refinement of the construct and a scoping review of current assessment tools.

BACKGROUND: Recommendations for the management of pain related to pelvic mesh implants are still under development. One limitation that has impeded progress in this area is that mesh-related pain has not been consistently defined or measured. Here, we reviewed the ways in which pain associated with pelvic mesh implants has been measured, and mapped the ways in which these existing measures capture the construct. METHODS: First, we reviewed existing accounts of the pain associated with pelvic mesh implants to develop a multifaceted construct definition, which includes aspects related to pain intensity, timing, body location, phenomenological qualities, impact/interference with daily living, and patient expectations and beliefs. Next, we reviewed the ways that the construct has been measured in the extant literature. RESULTS: Within 333 eligible studies, 28 different assessments of pain associated with pelvic mesh were identified, and 61% of studies reported using more than one measurement tool. Questionnaire measures included measures designed to assess urological and/or pelvic symptoms, generic measures and unvalidated measures. We did not identify any validated questionnaire measures designed to assess pain associated with pelvic mesh implants. The phenomenological, location, and expectation/belief components of the construct were not captured well by the identified questionnaire measures, and there is no evidence that any of the identified measures have appropriate psychometric properties for the assessment of pain related to pelvic mesh implants. CONCLUSIONS: We recommend further qualitative research regarding women's experiences of pelvic mesh-related pain assessment, and the development of a condition-specific patient reported outcome measure.

Mindfulness, Interoception, and the Body.

In recent years, there has been a surge of interest in the topics of interoception and mindfulness from researchers, clinicians, and the general public alike (e [...].

Weaker implicit interoception is associated with more negative body image: Evidence from gastric-alpha phase amplitude coupling and the heartbeat evoked potential.

Interoception refers to the processing of internal bodily stimuli, while body image refers to appearance-related perceptions, affect, and cognitions. Previous research has found that body image is associated with self-reported and behavioural indices of interoception. Here, we extended this research by examining associations between measures of positive (i.e., body appreciation, functionality appreciation) and negative body image (i.e., body shame, weight preoccupation) and two electrophysiological indices of interoceptive processing, namely the heartbeat evoked potential (HEP) and gastric-alpha phase-amplitude coupling (PAC), in a sample of 36 adults. Significant negative associations were identified between the indices of negative body image and the interoception variables. Specifically, more negative HEP amplitude and lower gastric-alpha PAC were both associated with greater body shame and weight preoccupation. However, no significant associations were identified for the indices of positive body image. These findings extend previous work by demonstrating that there are significant associations between negative body image and previously unexplored components of cardiac and gastric interoception. This, in turn, could have important clinical applications, such as the HEP and gastric-alpha PAC both serving as biomarkers of negative body image.

Greater gastric interoception is associated with more positive body image: Evidence from adults in Malaysia and the United Kingdom.

Gastric interoception refers to the processing of sensory stimuli originating in the gut. Previous research has found that gastric interoception (measured using a water load task) is associated with drive for thinness in young Western women. However, associations with broader facets of body image and in diverse national groups have not been previously investigated. To address these issues, we asked samples of adults in the United Kingdom (UK; N = 91, women n = 54) and Malaysia (N = 100, women n = 50) to complete a 2-stage water load task (WLT) and measures of positive body image (i.e., body appreciation, functionality appreciation). The results indicated that a greater change in the intensity of self-reported WLT-related sensations was associated with significantly higher body appreciation and functionality appreciation after accounting for gender identity, body mass index, and national group. Behavioural performance on the WLT was significantly associated with body appreciation and functionality appreciation for the Malaysian sample, but not the UK adults, after accounting for gender identity and body mass index. These findings extend previous research by demonstrating that there are significant associations between facets of gastric interoception and previously unexplored facets of body image in both Western and non-Western settings.

Translation and validation of a Bahasa Malaysia (Malay) version of the Multidimensional Assessment of Interoceptive Awareness (MAIA).

OBJECTIVES: The 32-item Multidimensional Assessment of Interoceptive Awareness (MAIA) is a widely-used measure of multidimensional interoception. In the present study, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the MAIA. METHODS: An online sample of 815 Malaysian Malays (women n = 403) completed a novel translation of the MAIA. Validated measures of trait mindfulness and self-esteem were also completed to facilitate a preliminary assessment of convergent validity. RESULTS: Exploratory factor analysis indicated that the MAIA items reduced to a 19-item, 3-factor model. The 3-factor model was further tested using confirmatory factor analysis (CFA) alongside the parent 8-factor model. Both models had good fit on some indices, but less-than-ideal fit on other indices. The 3-factor model evidenced comparatively better fit, with fit indices being adequate following modification. Multi-group CFA indicated both the 3-factor model and the 8-factor model had full strict invariance across sex. However, evidence for construct and convergent validity was mixed. CONCLUSIONS: Overall the 3-dimensional Malay MAIA was demonstrated to be both internally consistent and invariant across sex, but further evidence of construct and convergent validity is required. Issues that affect the dimensionality of MAIA scores in the present and extant work are discussed in conclusion.

Reduction of auditory input improves performance on the heartbeat tracking task, but does not necessarily enhance interoception.

Previous research utilising a between-subjects design has indicated that the use of noise-dampening ear protectors might enhance interoceptive accuracy (IAcc). In the present study, we further examined this effect using a repeated-measures, within-participants design, and investigated potential mechanisms that might explain the effect. 50 participants completed the heartbeat tracking task (HTT) with and without the use of industrial ear protectors, in a counter-balanced order. Participants were asked to count the number of heartbeats occurring in five discrete time intervals of 25, 35, 45, 55 and 95 s, without feeling for a manual pulse. HTT scores were significantly higher when ear protectors were worn, and the improvement in performance was greatest for participants with lower baseline IAcc. The ear protectors were associated with significantly increased self-reported heartbeat audibility, task-related confidence and concentration, and decreased levels of distractibility. Heartbeat audibility was also correlated with HTT performance when the ear protectors were worn. Because the use of industrial ear defenders resulted in increased heartbeat audibility, this manipulation should not be used to assess causal hypotheses related to changes in IAcc. However, it may serve as a simple, non-invasive manipulation to assess the effects of 'externalised' interoceptive signals.

Interoception and Empathy Impact Perspective Taking.

Adopting the perspective of another person is an important aspect of social cognition and has been shown to depend on multisensory signals from one's own body. Recent work suggests that interoceptive signals not only contribute to own-body perception and self-consciousness, but also to empathy. Here we investigated if social cognition - in particular adopting the perspective of another person - can be altered by a systematic manipulation of interoceptive cues and further, if this effect depends on empathic ability. The own-body transformation task (OBT) - wherein participants are instructed to imagine taking the perspective and position of a virtual body presented on a computer screen - offers an effective way to measure reaction time differences linked to the mental effort of taking an other's perspective. Here, we adapted the OBT with the flashing of a silhouette surrounding the virtual body, either synchronously or asynchronously with the timing of participants' heartbeats. We evaluated the impact of this cardio-visual synchrony on reaction times and accuracy rates in the OBT. Empathy was assessed with the empathy quotient (EQ) questionnaire. Based on previous work using the cardio-visual paradigm, we predicted that synchronous (vs. asynchronous) cardio-visual stimulation would increase self-identification with the virtual body and facilitate participants' ability to adopt the virtual body's perspective, thereby enhancing performance on the task, particularly in participants with higher empathy scores. We report that participants with high empathy showed significantly better performance during the OBT task during synchronous versus asynchronous cardio-visual stimulation. Moreover, we found a significant positive correlation between empathic ability and the synchrony effect (the difference in reaction times between the asynchronous and synchronous conditions). We conclude that synchronous cardio-visual stimulation between the participant's body and a virtual body during an OBT task makes it easier to adopt the virtual body's perspective, presumably based on multisensory integration processes. However, this effect depended on empathic ability, suggesting that empathy, interoception and social perspective taking are inherently linked.

An exploration of the associations between facets of interoceptive awareness and body image in adolescents.

Previous research suggests that lower interoceptive awareness is associated with more negative body image during adolescence. However, studies have not distinguished between adaptive and maladaptive modes of attention toward interoceptive signals, and relationships between interoceptive awareness and positive body image remain unexplored. To address these issues, a sample of 265 British adolescents (140 girls, 125 boys) aged 13-16 years completed measures of interoceptive awareness, body appreciation, functionality appreciation, body pride, body shame, and body surveillance. Correlational analyses broadly indicated that greater interoceptive awareness was significantly associated with more positive body image. Multiple regressions revealed significant predictive relationships between interoceptive awareness and all facets of body image in both girls and boys, except body surveillance, which was not statistically significant for girls. At the univariate level, the interoceptive awareness facets of Attention Regulation, Body Listening, Self-Regulation, and Trusting emerged as significant predictors for at least one facet of positive body image, whilst the Noticing and Emotional Awareness facets did not. These findings broadly align with previous research with adults, which has indicated that the way interoceptive stimuli are appraised and responded to might be more closely associated with facets of body image than the tendency to notice interoceptive stimuli.

Translation and validation of a Bahasa Malaysia (Malay) version of the Functionality Appreciation Scale.

The Functionality Appreciation Scale (FAS; Alleva et al., 2017) is a 7-item measure of an individual's appreciation of their body for what it can do and is capable of doing. To date, its psychometric properties have not been examined beyond the parent study and outside English-speaking samples. To rectify this, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the FAS. An online sample of 815 Malaysia citizens completed a Malay translation of the FAS, along with validated measures of body appreciation, weight discrepancy, drive for muscularity, perceived pressure from and internalisation of appearance ideals, self-esteem, and trait mindfulness. Exploratory factor analyses supported a 1-dimensional factor structure of FAS scores, which was upheld using confirmatory factor analysis. FAS scores were also invariant across sex and there was no significant sex difference in scores. Construct validity was generally supported through significant associations with the additional measures included in the study. Incremental validity was also established insofar as functionality appreciation predicted self-esteem over-and-above the variance accounted for by other body image measures. The availability of the Malay FAS will be of use to scholars in Malaysia, but establishing cross-linguistic invariance will be an important next step.

Enlarged representation of peripersonal space in pregnancy.

Our ability to maintain a coherent bodily self despite continuous changes within and outside our body relies on the highly flexible multisensory representation of the body, and of the space surrounding it: the peripersonal space (PPS). The aim of our study was to investigate whether during pregnancy - when extremely rapid changes in body size and shape occur - a likewise rapid plastic reorganization of the neural representation of the PPS occurs. We used an audio-tactile integration task to measure the PPS boundary at different stages of pregnancy. We found that in the second trimester of pregnancy and postpartum women did not show differences in their PPS size as compared to the control group (non-pregnant women). However, in the third trimester the PPS was larger than the controls' PPS and the shift between representation of near and far space was more gradual. We therefore conclude that during pregnancy the brain adapts to the sudden bodily changes, by expanding the representation of the space around the body. This may represent a mechanism to protect the vulnerable abdomen from injury from surrounding objects.

Altered interoceptive processing in smokers: Evidence from the heartbeat tracking task.

Neuroimaging evidence suggests that interoceptive processing might be altered in nicotine addiction, however this has not yet been confirmed with behavioural measures. Therefore, we investigated the perception of internal bodily states in smokers (n = 49) and people who had never smoked (n = 51), by measuring interoceptive accuracy (IAcc) and interoceptive sensibility (IS). IAcc was measured with a heartbeat tracking task and a heartbeat discrimination task. Performance on the heartbeat tracking task may be influenced by one's ability to estimate an elapsed time interval so this was controlled by also administering a time-estimation (TE) task. IS was measured using two sub-scales from the Multidimensional Assessment of Interoceptive Awareness (MAIA). All smokers completed the Revised Fagerström Test for Nicotine Dependence (FTND-R) to measure addiction severity. Non-smokers performed significantly better than smokers on the heartbeat tracking task. There were no significant group differences observed for the remaining variables. Furthermore, none of the variables predicted addiction severity. This is the first demonstration of behavioural differences in interoception between smokers and non-smokers.

Altered bodily self-consciousness and peripersonal space in autism.

There is some evidence that disordered self-processing in autism spectrum disorders is linked to the social impairments characteristic of the condition. To investigate whether bodily self-consciousness is altered in autism spectrum disorders as a result of multisensory processing differences, we tested responses to the full body illusion and measured peripersonal space in 22 adults with autism spectrum disorders and 29 neurotypical adults. In the full body illusion set-up, participants wore a head-mounted display showing a view of their 'virtual body' being stroked synchronously or asynchronously with respect to felt stroking on their back. After stroking, we measured the drift in perceived self-location and self-identification with the virtual body. To assess the peripersonal space boundary we employed an audiotactile reaction time task. The results showed that participants with autism spectrum disorders are markedly less susceptible to the full body illusion, not demonstrating the illusory self-identification and self-location drift. Strength of self-identification was negatively correlated with severity of autistic traits and contributed positively to empathy scores. The results also demonstrated a significantly smaller peripersonal space, with a sharper (steeper) boundary, in autism spectrum disorders participants. These results suggest that bodily self-consciousness is altered in participants with autism spectrum disorders due to differences in multisensory integration, and this may be linked to deficits in social functioning.

Multiple dimensions of interoceptive awareness are associated with facets of body image in British adults.

Previous research has identified a relationship between interoception and body image, where lower interoceptive awareness (IA) is associated with negative body image. However, relationships between facets of interoception and positive body image remain unexplored, and men and older adults remain underrepresented. To overcome these limitations, we assessed relationships between multiple dimensions of interoceptive awareness (IA) and multiple facets of body image in community adults. An online sample of 646 British adults (447 women) aged 18-76 years completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), the Body Appreciation Scale-2, the Functionality Appreciation Scale, the Authentic Pride subscale from the Body and Appearance Self-Conscious Emotions Scale, and the Appearance Orientation and Overweight Preoccupation subscales from the Multidimensional Body-Self Relations Questionnaire. Hierarchical regressions revealed significant predictive relationships between IA and all five facets of body image after controlling for sex, body mass index, and age. In the final models, the MAIA subscales emerged as significant predictors for at least one facet of body image, with the exception of the MAIA Body Listening subscale. These findings extend previous work by demonstrating significant relationships between IA and previously unexplored facets of body image, which may hold promise for practitioner-based interventions.