At EDAC we are committed to making research accessible. Our Plain Speaking Summaries include plain language text on published papers and an interview with the authors. In this Plain Speaking Summary, Laurence Cobbaert introduced her paper that was published in 2024 and is interviewed by an Ellen Maloney, EDAC peer researcher. Laurence Cobbaert (she/they) is the Chair of Eating Disorders Neurodiversity Australia and a PhD candidate at the University of New South Wales in Sydney, Australia. They are neurodivergent and have lived experience of an eating disorder.
Paper Synopsis
The full paper can be found here.
AIMS:
Sensory processing involves exteroception, which relates to environmental stimuli such as noise, lights, or tastes, and interoception, which is about internal bodily signals such as thirst, hunger, or fullness. Both exteroception and interoception influence cognition (e.g., self-perception, emotional awareness and responsiveness, goal-directed behaviours, etc.). Some people, many of whom are neurodivergent (e.g., autistic, ADHD), experience significant differences in sensory processing; for example, being either extremely sensitive or being much less sensitive than most people. Atypical patterns of sensory processing have been correlated with an increased risk of mental health distress and/or mental illness, including anxiety, issues with body image, and eating disorders. While there is growing evidence of this association, the underlying mechanisms linking atypical sensory processing with the development of eating disorders remain poorly understood. This review focuses on an investigation of the literature concerning eating disorder diagnoses and patterns of sensory processing via validated self-report measures..
KEY FINDINGS:
Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) demonstrated higher levels of exteroception, while individuals with eating disorders characterised by purging demonstrated increased difficulties re. Interoception. Specifically, those with binge-purging AN or BN reported with higher levels of interoceptive difficulties relative to restrictive AN or binge-eating disorder (BED). Findings suggest that future research incorporating comprehensive sensory profiles (including both interoception and exteroception) may aid in differentiating or distinguishing between differing ED diagnoses, or in providing person-centred treatment approaches.
METHOD:
This review incorporated a literature search strategy which assessed publications in English from January 1980 to November 2023 across Embase, Web of Science, PubMed, PsycINFO, and CINAHL. Search terminology incorporated various phrases in relation to EDs and sensory pathways/disabilities/perception/integration, with studies including participants at age 15+ selected for further analysis. Included self-report measurements in relation to EDs consisted of the Eating Attitude Test and Eating Disorder Examination Questionnaire were used, with AN, BN, BED, other specified eating/feeding disorder (OSFED) and avoidant/restrictive food intake disorder (ARFID) implemented as categorical feeding/ED diagnoses. Included sensory processing measurements consisted of self-report inventories evaluating interoception (via the Eating Disorder Inventory [EDI] and Multidimensional Assessment of Interoceptive Awareness [MAIA]) and exteroception (Adolescent/Adult Sensory Profile and the Sensory Responsiveness Questionnaire) in those with EDs. Quality assessment was conducted on selected publications using the Joanna Briggs Institute’s critical appraisal checklist.
RESULTS:
Literature search identified 831 original articles, with which 19 publications met inclusion criteria. Outside of 2 articles, all publications demonstrated moderate to high quality. Three studies investigated exteroception, in which sensory over-responsiveness was similarly highlighted across AN samples. AN and BN differed in sensory over-responsiveness relative to healthy controls, but also across ED groups. Acros studies, there were no publications examining exteroception in those with BED, OSFED or ARFID that fell within study inclusion criteria. Seventeen publications reported on interoception, reporting distinct characteristics of interoception in relation to different ED diagnoses. Those with BN reported the highest levels of interoceptive difficulties relative to those with AN or BED.
IMPACT:
The impact of this review benefits our understanding of the relationship between sensory processing and EDs. By systematically assessing the existing literature, the review is able to highlight key findings concerning 1. the identification of distinct sensory patterns according to ED presentation, 2. potential differences in pathophysiological mechanisms contributing to ED development, 3. possibilities for personalised treatment due to distinct patterns/characteristics of sensory processing in relation to ED diagnosis, 4. the importance of further considering sensory processing characteristics in the context of ED development and healthcare settings.
DISSEMINATION:
This study was published in the International Journal of Eating Disorders. The study is open access and can be read here!
SUMMARY:
This review examines the relationship across facets of sensory processing in relation to different ED diagnoses, focusing on exteroception and interoception. Post-literature search strategy, 19 publications were selected with participants aged 15+ covering ED diagnoses such as AN, BN, BED, OSFED and ARFID that reported on sensory processing via self-report measurements. Findings demonstrate that those with different ED diagnoses/presentations differed in characteristics of sensory processing. Those with AN and BN demonstrated heightened characteristics of exteroception, while those with binge-purge subtype AN and BN reported with increased interoceptive difficulties relative to BED and restrictive subtype AN. This systematic review underscores the importance of further evaluating comprehensive sensory profiles associated with different ED diagnoses, suggesting that a more comprehensive understanding of these mechanisms could aid in providing more person-centred and personalised treatments.
