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Letters to the Editor   |    
Altered Insula Response to Sweet Taste Processing in Recovered Anorexia and Bulimia Nervosa: a Matter of Disgust Sensitivity?
Carmelo M. Vicario, Ph.D.
Am J Psychiatry 2013;170:1497-1497. doi:10.1176/appi.ajp.2013.13060748
View Author and Article Information

Dr. Vicario reports no financial relationships with commercial interests.

From the School of Psychology, The University of Queensland, St. Lucia, Brisbane, Australia.

Copyright © 2013 by the American Psychiatric Association

Accepted August , 2013.

To the Editor: In the June issue, the Journal published an interesting study on recovered anorexia nervosa and bulimia nervosa (1). The authors of this research used sweet tastes, with (sucrose) and without (sucralose) caloric content, to interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory-interoceptive-reward signals in response to palatable foods. In particular, the right anterior insula response to sucrose was diminished in anorexia nervosa and exaggerated in bulimia nervosa relative to comparison subjects.

This abnormal insula response associated with the exposure to sweet compounds led the authors to conclude that there may be a failure to accurately recognize hunger signals. This conclusion is consistent with the suggestion that an altered interoceptive awareness may be a precipitating and reinforcing factor in both populations, although this altered awareness leads to antithetical feeding behaviors.

The neural pattern observed by the authors suggests another, not mutually exclusive, interpretation of the result, which refers to the hypothesis of an altered disgust sensitivity.

As suggested by Chapman and Anderson (2), disgust may be particularly strongly associated with visceral changes, consistent with its apparent origins in defending against the ingestion of contaminated foods. Given the key role of the anterior insula in interoception (3) and disgust processing (4), one could argue that the reported abnormal activity of this neural region in response to sweet tastes may reflect an altered disgust processing at the visceral level.

This suggestion is supported by research examining disgust sensitivity in these clinical populations before recovery. For example, Aharoni and Hertz (5) reported that patients with anorexia nervosa scored consistently higher on all domains of disgust sensitivity, with a particular regard to the food domain. Moreover, Troop et al. (6) reported higher levels of disgust sensitivity to food in bulimia nervosa. On the other hand, Houben and Havermans (7) reported lower disgust sensitivity in overweight individuals.

Given the evidence of this relationship between disgust sensitivity and feeding behavior, an assessment of disgust sensitivity could provide important clues for interpreting the pattern of neural activity reported by Oberndorfer et al. (1) in the anterior insula of patients with recovered anorexia nervosa and bulimia nervosa.

Oberndorfer  TA;  Frank  GK;  Simmons  AN;  Wagner  A;  McCurdy  D;  Fudge  JL;  Yang  TT;  Paulus  MP;  Kaye  WH:  Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa.  Am J Psychiatry 2013; 170:1143–1151
[CrossRef] | [PubMed]
 
Chapman  HA;  Anderson  AK:  Understanding disgust.  Ann NY Acad Sci 2012; 1251:62–76
[CrossRef] | [PubMed]
 
Craig  AD:  How do you feel—now? the anterior insula and human awareness.  Nat Rev Neurosci 2009; 10:59–70
[CrossRef] | [PubMed]
 
Wicker  B;  Keysers  C;  Plailly  J;  Royet  JP;  Gallese  V;  Rizzolatti  G:  Both of us disgusted in my insula: the common neural basis of seeing and feeling disgust.  Neuron 2003; 40:655–664
[CrossRef] | [PubMed]
 
Aharoni  R;  Hertz  MM:  Disgust sensitivity and anorexia nervosa.  Eur Eat Disord Rev 2012; 20:106–110
[CrossRef] | [PubMed]
 
Troop  NA;  Murphy  F;  Bramon  E;  Treasure  JL:  Disgust sensitivity in eating disorders: a preliminary investigation.  Int J Eat Disord 2000; 27:446–451
[CrossRef] | [PubMed]
 
Houben  K;  Havermans  RC:  A delicious fly in the soup: the relationship between disgust, obesity, and restraint.  Appetite 2012; 58:827–830
[CrossRef] | [PubMed]
 
References Container
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References

Oberndorfer  TA;  Frank  GK;  Simmons  AN;  Wagner  A;  McCurdy  D;  Fudge  JL;  Yang  TT;  Paulus  MP;  Kaye  WH:  Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa.  Am J Psychiatry 2013; 170:1143–1151
[CrossRef] | [PubMed]
 
Chapman  HA;  Anderson  AK:  Understanding disgust.  Ann NY Acad Sci 2012; 1251:62–76
[CrossRef] | [PubMed]
 
Craig  AD:  How do you feel—now? the anterior insula and human awareness.  Nat Rev Neurosci 2009; 10:59–70
[CrossRef] | [PubMed]
 
Wicker  B;  Keysers  C;  Plailly  J;  Royet  JP;  Gallese  V;  Rizzolatti  G:  Both of us disgusted in my insula: the common neural basis of seeing and feeling disgust.  Neuron 2003; 40:655–664
[CrossRef] | [PubMed]
 
Aharoni  R;  Hertz  MM:  Disgust sensitivity and anorexia nervosa.  Eur Eat Disord Rev 2012; 20:106–110
[CrossRef] | [PubMed]
 
Troop  NA;  Murphy  F;  Bramon  E;  Treasure  JL:  Disgust sensitivity in eating disorders: a preliminary investigation.  Int J Eat Disord 2000; 27:446–451
[CrossRef] | [PubMed]
 
Houben  K;  Havermans  RC:  A delicious fly in the soup: the relationship between disgust, obesity, and restraint.  Appetite 2012; 58:827–830
[CrossRef] | [PubMed]
 
References Container
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