The role of appearance-related comments and interoceptive deficits in eating disorders: an exploratory study in a 1-year cohort of outpatients

Background: Eating Disorders (EDs) are often marked by an altered body experience, stemming from a lack of integration between the first-person's (i.e., egocentric view) body representation-based also on internal bodily sensations (i.e., interoceptive signals)-and the third-person's (i.e., allocentric view) body representation, which may be influenced by the recall of comments from others on one's own appearance. This study examined the prevalence of retrospectively self-reported eating-, appearance-, and person-related comments among ED outpatients, and investigated whether the self-reported onset of appearance-related comments, interoceptive deficits (i.e., difficulty in perceiving internal bodily states), and interpersonal sensitivity were associated with the ED severity. It also explored the psychopathological profile of patients characterized by the co-occurrence of self-reported appearance-related comments received prior to the ED onset and clinical interoceptive deficits. Methods: Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona, including self-reported measures of ED and general psychopathology, as well as sociodemographic and clinical information. Descriptive and inferential analyses were performed. Results: A total of 89 ED outpatients satisfied the criteria for registry data extraction. Eating- and appearance-related comments were retrospectively reported by 94.4% of outpatients, whereas 57.1% of them retrospectively reported negative person-related comments. The severity of ED psychopathology was significantly associated with the self-reported onset of appearance-related comments prior to the ED onset and a clinical level of interoceptive deficit. Conclusions: Outpatients who experienced both these factors showed a more severe clinical presentation, particularly in terms of global psychopathology and restrictive symptoms, regardless of any ED diagnosis. The results showed the frequent occurrence of retrospectively self-reported eating- and appearance-related comments, even before the ED onset, as well as provided evidence for the importance of both internal bottom-up processes and external social factors in shaping altered body experience in EDs.