Recognition of others' interoceptive states in those with and without eating disorders.

BACKGROUND: The ability to recognize one's own emotions is associated with one's ability to recognize others' emotions. Beyond the domain of emotion, however, the relationship between recognition of one's own internal states (interoception) and others' interoceptive states has not been investigated, either in the typical population or clinical groups with interoceptive difficulties (e.g. eating disorders; EDs). METHOD: This study investigated recognition of one's own and others' internal states in adults with and without eating disorders, using a high frequency visual noise paradigm. Participants completed self-report measures of interoception, alexithymia (difficulties recognising one's own emotional internal states) and ED symptomatology, and the Heartbeat Counting Task measure of cardiac interoceptive accuracy. RESULTS: Alexithymia was significantly negatively correlated with recognition of others' interoceptive states. EDs were not associated with difficulties recognising others' interoceptive states. CONCLUSIONS: The ability to recognise one's own emotional internal states is associated with the recognition of others' interoceptive states, which may contribute to social skills and the ability to care for others.

Differences in own-face but not own-name discrimination between autistic and neurotypical adults: A fast periodic visual stimulation-EEG study.

Self-related processing is thought to be altered in autism, with several studies reporting that autistic individuals show a diminished neural response relative to neurotypicals for their own name and face. However, evidence remains scarce and is mostly based on event-related potential studies. Here, we used EEG to measure the neural activity of autistic adults (20 for faces, 27 for names) and neurotypical adults (24 for faces, 25 for names) while they were watching rapidly alternating faces and names, through a relatively new technique called Fast Periodic Visual Stimulation. We presented strangers' faces or names at a base frequency of 5.77 Hz, while one's own, a close other's, and a specific stranger's face/name was presented at an oddball frequency of 1.154 Hz. The neurotypical group showed a significantly greater response to their own face than both close other and stranger faces, and a greater response for close other than for stranger faces. In contrast, in the autism group, own and close other faces showed stronger responses than the stranger's face, but the difference between own and close other faces was not significant in a bilateral parieto-occipital cluster. No group differences in the enhanced response to familiar names were found. These results replicate and extend results obtained using traditional electroencephalographic techniques which suggest atypical responses to self-relevant stimuli in autism.

Non-autistic adults can recognize posed autistic facial expressions: Implications for internal representations of emotion.

Autistic people report that their emotional expressions are sometimes misunderstood by non-autistic people. One explanation for these misunderstandings could be that the two neurotypes have different internal representations of emotion: Perhaps they have different expectations about what a facial expression showing a particular emotion looks like. In three well-powered studies with non-autistic college students in the United States (total N = 632), we investigated this possibility. In Study 1, participants recognized most facial expressions posed by autistic individuals more accurately than those posed by non-autistic individuals. Study 2 showed that one reason the autistic expressions were recognized more accurately was because they were better and more intense examples of the intended expressions than the non-autistic expressions. In Study 3, we used a set of expressions created by autistic and non-autistic individuals who could see their faces as they made the expressions, which could allow them to explicitly match the expression they produced with their internal representation of that emotional expression. Here, neither autistic expressions nor non-autistic expressions were consistently recognized more accurately. In short, these findings suggest that differences in internal representations of what emotional expressions look like are unlikely to play a major role in explaining why non-autistic people sometimes misunderstand the emotions autistic people are experiencing.

Dissociations between self-reported interoceptive accuracy and attention: Evidence from the Interoceptive Attention Scale.

Models of interoception highlight the importance of considering participants' beliefs regarding their interoceptive ability. Research focusing on such beliefs suggests a dissociation between self-reported interoceptive accuracy and attention. However, it remains unclear whether such dissociations are driven by differences in the sensations rated across these questionnaires, or a genuine dissociation between different facets of self-reported interoception. Here we examined the relationship between self-report measures of interoceptive accuracy and attention using a novel measure- the Interoceptive Attention Scale- designed to match the interoceptive sensations included in an existing questionnaire measure of interoceptive accuracy. In addition, we examined whether the interpretation of questionnaire measures of interoception altered associations across measures. Results support the proposed distinction between self-reported interoceptive attention and accuracy and highlight the importance of considering the interpretation of questionnaire measures of interoception. The implications of these findings for theory, future research, and interpretation of existing research are discussed.

The Oxford Face Matching Test: A non-biased test of the full range of individual differences in face perception.

Tests of face processing are typically designed to identify individuals performing outside of the typical range; either prosopagnosic individuals who exhibit poor face processing ability, or super recognisers, who have superior face processing abilities. Here we describe the development of the Oxford Face Matching Test (OFMT), designed to identify individual differences in face processing across the full range of performance, from prosopagnosia, through the range of typical performance, to super recognisers. Such a test requires items of varying difficulty, but establishing difficulty is problematic when particular populations (e.g., prosopagnosics, individuals with autism spectrum disorder) may use atypical strategies to process faces. If item difficulty is calibrated on neurotypical individuals, then the test may be poorly calibrated for atypical groups, and vice versa. To obtain items of varying difficulty, we used facial recognition algorithms to obtain face pair similarity ratings that are not biased towards specific populations. These face pairs were used as stimuli in the OFMT, and participants were required to judge whether the face images depicted the same individual or different individuals. Across five studies the OFMT was shown to be sensitive to individual differences in the typical population, and in groups of both prosopagnosic individuals and super recognisers. The test-retest reliability of the task was at least equivalent to the Cambridge Face Memory Test and the Glasgow Face Matching Test. Furthermore, results reveal, at least at the group level, that both face perception and face memory are poor in those with prosopagnosia, and are good in super recognisers.

Development and validation of the Interoceptive States Static Images (ISSI) database.

Internal bodily signals provide an essential function for human survival. Accurate recognition of such signals in the self, known as interoception, supports the maintenance of homeostasis, and is closely related to emotional processing, learning and decision-making, and mental health. While numerous studies have investigated interoception in the self, the recognition of these states in others has not been examined despite its crucial importance for successful social relationships. This paper presents the development and validation of the Interoceptive States Static Images (ISSI), introducing a validated database of 423 visual stimuli for the study of non-affective internal state recognition in others, freely available to other researchers. Actors were photographed expressing various exemplars of both interoceptive states and control actions. The images went through a two-stage validation procedure, the first involving free-labelling and the second using multiple choice labelling and quality rating scales. Five scores were calculated for each stimulus, providing information about the quality and specificity of the depiction, as well as the extent to which labels matched the intended state/action. Results demonstrated that control action stimuli were more recognisable than internal state stimuli. Inter-category variability was found for the internal states, with some states being more recognisable than others. Recommendations for the utilisation of ISSI stimuli are discussed. The stimulus set is freely available to researchers, alongside data concerning recognisability.

Atypical interoception as a common risk factor for psychopathology: A review.

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Personal Identity After an Autism Diagnosis: Relationships With Self-Esteem, Mental Wellbeing, and Diagnostic Timing.

Adults are increasingly seeking autism diagnoses, although less is known about their experiences of diagnosis and personal identity (i.e., autism as part of "me"), and how this relates to self-esteem and wellbeing. One-hundred and fifty-one autistic adults completed an online survey including measures of self-esteem, psychological wellbeing, and autistic personal identity, which considered whether participants took pride in or were dissatisfied with being autistic. Fifty-four participants answered a qualitative question about the impact of receiving an autism diagnosis on their sense of self. Regression analyses found that greater time elapsed since diagnosis related to less dissatisfaction with autistic personal identity. We also found that more dissatisfaction with autistic personal identity predicted lower self-esteem, and more autism pride predicted higher self-esteem. Content analysis of participants' experiences supported the quantitative findings and was suggestive of an emotive post-diagnostic adjustment process. Future research should aim to identify ways to promote the development of a positive autistic personal identity post-diagnosis in adulthood.

Testing the independence of self-reported interoceptive accuracy and attention.

It has recently been proposed that measures of the perception of the state of one's own body ("interoception") can be categorised as one of several types depending on both how an assessment is obtained (objective measurement vs. self-report) and what is assessed (degree of interoceptive attention vs. accuracy of interoceptive perception). Under this model, a distinction is made between beliefs regarding the degree to which interoceptive signals are the object of attention and beliefs regarding one's ability to perceive accurately interoceptive signals. This distinction is difficult to test, however, because of the paucity of measures designed to assess self-reported perception of one's own interoceptive accuracy. This article therefore reports on the development of such a measure, the Interoceptive Accuracy Scale (IAS). Use of this measure enables assessment of the proposed distinction between beliefs regarding attention to, and accuracy in perceiving, interoceptive signals. Across six studies, we report on the development of the IAS and, importantly, its relationship with measures of trait self-reported interoceptive attention, objective interoceptive accuracy, confidence in the accuracy of specific interoceptive percepts, and metacognition with respect to interoceptive accuracy. Results support the distinction between individual differences in perceived attention towards interoceptive information and the accuracy of interoceptive perception.

No evidence for an opposite pattern of cognitive performance in autistic individuals with and without alexithymia: A response to Rødgaard et al. (2019).

Rødgaard and colleagues (2019) confirmed our finding of a negative relationship between performance on the Reading the Mind in the Eyes Test and alexithymia, regardless of autism diagnosis. In their analysis of our cognitive Theory of Mind data, however, they did not control for autistic traits, which covary with alexithymia. Here we demonstrate that when autistic traits are controlled for, there is no significant association between alexithymia and cognitive theory of mind performance in participants with autism. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

I feel it in my finger: Measurement device affects cardiac interoceptive accuracy.

In recent years, measures of cardiac interoceptive accuracy have been heavily scrutinised. The focus has been on potentially confounding physiological and psychological factors; little research has examined whether the device used to record objective heartbeats may influence cardiac interoceptive accuracy. The present studies assessed whether the device employed influences heartbeat counting (HCT) accuracy and the location from which heartbeats are perceived. In Study One, participants completed the HCT using a hard-clip finger pulse oximeter, electrocardiogram (ECG) and a smartphone application. In Study Two, an ECG, hard-clip and soft-clip oximeter were compared. Moderate-strong correlations were observed across devices, however, mean HCT accuracy and confidence varied as a function of device. Increased sensation in the finger when using a hard-clip pulse oximeter was related to increased accuracy relative to ECG. Results suggest that the device employed can influence HCT performance, and argue against comparing, or combining, scores obtained using different devices.

Face perception in autism spectrum disorder: Modulation of holistic processing by facial emotion.

Individuals with Autism Spectrum Disorder (ASD; autistic individuals) may exhibit atypical face perception because they fail to process faces holistically. In the context of this hypothesis, it is critical to determine whether autistic individuals exhibit diminished susceptibility to the composite face illusion, widely regarded as a key marker of holistic face processing. To date, however, previous studies have yielded inconsistent findings. In light of recent evidence suggesting that facial emotion cues increase the strength of the composite face illusion in typical individuals, the present study sought to determine whether the presence of facial emotion also modulates the strength of the composite face illusion in autistic individuals, many of whom experience difficulties recognizing facial expressions. We therefore measured composite face effects in a sample of autistic individuals (N = 20) and matched typical controls (N = 29) using an incidental emotion procedure in which distractor regions varied systematically in their emotion strength. As expected, the presence of facial emotion in the distractor regions of composite face arrangements increased the strength of the illusory distortion induced. The extent of the modulation by facial emotion was similar in the two groups. The composite effects seen in the ASD group were qualitatively and quantitatively similar to those seen in the typical group, suggestive of intact holistic processing in this population.

The importance of stimulus variability when studying face processing using fast periodic visual stimulation: A novel 'mixed-emotions' paradigm.

Fast Periodic Visual Stimulation (FPVS) with oddball stimuli has been used to investigate discrimination of facial identity and emotion, with studies concluding that oddball responses indicate discrimination of faces at the conceptual level (i.e., discrimination of identity and emotion), rather than low-level perceptual (visual, image-based) discrimination. However, because previous studies have utilised identical images as base stimuli, physical differences between base and oddball stimuli, rather than recognition of identity or emotion, may have been responsible for oddball responses. This study tested two new FPVS paradigms designed to distinguish recognition of expressions of emotion from detection of visual change from the base stream. In both paradigms, the oddball emotional expression was different from that of the base stream images. However, in the 'fixed-emotion' paradigm, stimulus image varied at every presentation but the emotion in the base stream remained constant, and in the 'mixed-emotions' paradigm, both stimulus image and emotion varied at every presentation, with only the oddball emotion (disgust) remaining constant. In the fixed-emotion paradigm, typical inversion effects were observed at occipital sites. In the mixed-emotions paradigm, however, inversion effects in a central cluster (indicative of higher level emotion processing) were present in typical participants, but not those with alexithymia (who are impaired at emotion recognition), suggesting that only the mixed-emotions paradigm reflects emotion recognition rather than detection of a lower-level visual change from baseline. These results have significant methodological implications for future FPVS studies (of both facial emotion and identity), suggesting that it is crucial to vary base stimuli sufficiently, such that simple physical differences between base and oddball stimuli cannot give rise to neural oddball responses.

Communicative misalignment in Autism Spectrum Disorder.

Communication deficits are a defining feature of Autism Spectrum Disorder (ASD), manifest during social interactions. Previous studies investigating communicative deficits have largely focused on the perceptual biases, social motivation, cognitive flexibility, or mentalizing abilities of isolated individuals. By embedding autistic individuals in live non-verbal interactions, we characterized a novel cause for their communication deficits. Adults with ASD matched neurotypical individuals in their ability and propensity to generate and modify intelligible behaviors for a communicative partner. However, they struggled to align the meaning of those behaviors with their partner when meaning required referencing their recent communicative history. This communicative misalignment explains why autistic individuals are vulnerable in everyday interactions, which entail fleeting ambiguities, but succeed in social cognition tests involving stereotyped contextual cues. These findings illustrate the cognitive and clinical importance of considering social interaction as a communicative alignment challenge, and how ineffective human communication is without this key interactional ingredient.

Adults with autism spectrum disorder are sensitive to the kinematic features defining natural human motion.

It has been hypothesized that individuals with Autism Spectrum Disorder (hereafter "autism") have problems perceiving biological motion, which contributes to their social difficulties. However, the ability to perceive the kinematic profile characteristic of biological motion has not been systematically examined in autism. To examine this basic perceptual ability we conducted two experiments comparing adults with autism with matched typical adults. In Experiment 1, participants indicated whether two movements-which differed in the quantity of formula-generated biological motion-were the same or different. In Experiment 2, they judged which of two movements was "less natural," where the stimuli varied in the degree to which they were a product of real movement data produced by autistic and typical models. There were no group differences in perceptual sensitivity in either experiment, with null effects supported by Bayesian analyses. The findings from these two experiments demonstrate that adults with autism are sensitive to the kinematic information defining biological motion to a typical degree-they are both able to detect the perceptual information in a same-different judgment, and as inclined to categorize biological motion derived from real models as natural. These findings therefore provide evidence against the hypothesis that individuals with autism exhibit low-level difficulties in perceiving the kinematics of others' actions, suggesting that atypicalities arise either when integrating this kinematic information with other perceptual input, or in the interpretation of kinematic information. Autism Res 2019, 12: 284-294 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: It has previously been suggested that autistic children and adults have problems perceiving the detailed manner in which others move-that is, the subtle changes in speed as we move from point to point-which may impact on their ability to learn from, and about, others in a typical fashion. However, the results from the present two studies demonstrate that adults with autism can perceive this information, suggesting that atypicalities in processing others' movement may arise mainly as a consequence of atypical interpretation rather than perception.

Brief Report: Typical Auditory-Motor and Enhanced Visual-Motor Temporal Synchronization in Adults with Autism Spectrum Disorder.

The perception of subsecond durations in adults with autism spectrum disorder (hereafter 'autism'; n = 25 Experiment 1, n = 21 Experiment 2) and matched typical adults (n = 24 Experiment 1, n = 22 Experiment 2) was examined by requiring participants to perform an action in time with auditory (Experiment 1) or visual (Experiment 2) events. Individuals with autism performed comparably to typical participants in the auditory task and exhibited less temporal error relative to their typical counterparts in the visual task. These findings suggest that perception of subsecond intervals is intact in autism, if not enhanced. Results support recent Bayesian theories of enhanced visual-perceptual precision in people with autism, and extend empirical support into the precision of subsecond temporal estimates.

Alexithymia explains increased empathic personal distress in individuals with and without eating disorders.

It is often assumed that empathy impairments are common in individuals with eating disorders (EDs), but empirical work has been limited and produced mixed results, making the clinical features and treatment needs of this population difficult to determine. Alexithymia, characterised by difficulties identifying and describing one's own emotions, frequently co-occurs with EDs and is associated with atypical recognition of, and empathy for, others' emotions. This study used an existing empathy for pain paradigm to determine whether atypical empathy in EDs stems from co-occurring alexithymia, rather than EDs per se. Empathy (specifically personal distress in response to others' pain) was assessed in individuals with EDs (N = 21) and an alexithymia-matched control group (N = 22). Participants were simultaneously members of a high alexithymia (N = 16) or low alexithymia (N = 27) group, allowing the independent contributions of alexithymia and EDs to be determined. Participants judged the laterality of hands and feet in painful and non-painful situations, and the degree of empathic interference on response times was measured. Results indicated that observation of painful stimuli affected task performance in those with high levels of alexithymia more than those with low levels, but no effect of ED diagnosis was observed. These findings suggest that co-occurring alexithymia explains increased empathic personal distress in ED populations. Atypical empathy may therefore not be a core feature of EDs, and interventions aimed at improving empathy-related social functioning may only be necessary for patients who also have alexithymia. These findings emphasise the importance of determining the influence of co-occurring alexithymia when assessing empathy in clinical populations.

Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the Heartbeat Counting Task.

Interoception, the perception of one's internal state, is commonly quantified using the heartbeat counting task (HCT) - which is thought to be a measure of cardiac interoceptive sensitivity (accuracy). Interoceptive sensitivity has been associated with a number of clinical traits and aspects of higher order cognition, including emotion processing and decision-making. It has been proposed that alexithymia (difficulties identifying and describing one's own emotions) is associated with impaired interoceptive sensitivity, but new research questions this association. Problematically, much evidence attesting to the absence of this association has been conducted using the HCT, a measure affected by various physiological and psychological factors. Here, we present novel data (N = 287) examining the relationship between alexithymia and HCT performance, controlling for a number of potential confounds. Inclusion of these control measures reveals the predicted negative relationship between alexithymia and HCT performance. Results are discussed with regard to difficulties quantifying interoceptive sensitivity using the HCT.

Fitness to plead: Development and validation of a standardised assessment instrument.

The ability of an individual to participate in courtroom proceedings is assessed by clinicians using legal 'fitness to plead' criteria. Findings of 'unfitness' are so rare that there is considerable professional unease concerning the utility of the current subjective assessment process. As a result, mentally disordered defendants may be subjected unfairly to criminal trials. The Law Commission in England and Wales has proposed legal reform, as well as the utilisation of a defined psychiatric instrument to assist in fitness to plead assessments. Similar legal reforms are occurring in other jurisdictions. Our objective was to produce and validate a standardised assessment instrument of fitness to plead employing a filmed vignette of criminal proceedings. The instrument was developed in consultation with legal and clinical professionals, and was refined using standard item reduction methods in two initial rounds of testing (n = 212). The factorial structure, test-retest reliability and convergent validity of the resultant instrument were assessed in a further round (n = 160). As a result of this iterative process a 25-item scale was produced, with an underlying two-factor structure representing the foundational and decision-making abilities underpinning fitness to plead. The sub-scales demonstrate good internal consistency (factor 1: 0·76; factor 2: 0·65) and test-retest stability (0·7) as well as excellent convergent validity with scores of intelligence, executive function and mentalising abilities (p≤0·01 in all domains). Overall the standardised Fitness to Plead Assessment instrument has good psychometric properties. It has the potential to ensure that the significant numbers of mentally ill and cognitively impaired individuals who face trial are objectively assessed, and the courtroom process critically informed.

Knowledge of resting heart rate mediates the relationship between intelligence and the heartbeat counting task.

Evidence suggests that intelligence is positively associated with performance on the heartbeat counting task (HCT). The HCT is often employed as measure of interoception - the ability to perceive the internal state of one's body - however it's use remains controversial as performance on the HCT is strongly influenced by knowledge of resting heart rate. This raises the possibility that heart rate knowledge may mediate the previously-observed association between intelligence and HCT performance. Study One demonstrates an association between intelligence and HCT performance (N = 94), and Study Two demonstrates that this relationship is mediated by knowledge of the average resting heart rate (N = 134). These data underscore the need to account for the influence of prior knowledge and beliefs when examining individual differences in cardiac interoceptive accuracy using the HCT.