Recognition of non-emotional bodily states in the self and others: A novel investigation in autism and eating disorders

Many people with psychiatric conditions (e.g. Autism Spectrum Disorder, Eating Disorders, depression, schizophrenia, etc.) struggle to perceive signals from inside their body (such as feeling their heartbeat and their breathing, and sensing temperature, muscle ache, pain, sickness, and hunger). When people are unable to recognise their own emotions (e.g. disgust, happiness, and anger), they also struggle to recognise other people's emotions, for example from their facial expressions. This project will investigate individuals' ability to recognise others' non-emotional bodily states. It is likely that when people struggle to recognise their own non-emotional bodily states (like hunger, breathing, sickness, etc.), they will also find it difficult to recognise other people's non-emotional bodily states.

If somebody struggles to recognise that another person is tired, hungry, sick, cold, or in pain, this will affect how they behave towards that person; they may not offer a drink of water to someone who feels thirsty, or offer to turn up the heating for someone who feels cold. These effective behaviours help us to form friendships and relationships, so failing to behave in an appropriate way can have a negative effect on one's social life, and therefore their psychological wellbeing. More importantly, it is important to recognise these bodily states in other people if we have a caring role, for example if we are parents, caring for elderly people or those with disabilities, or work in the medical profession. We need to be able to recognise how the person we are caring for is feeling so that we can provide the right type of care for them. As people with psychiatric conditions/mental illnesses often struggle to recognise their own non-emotional bodily states, they may also struggle to recognise others' non-emotional bodily states. This could have a negative impact on their social life, as well as their ability to care for other people.

This project will investigate the ability to recognise one's own and others' non-emotional bodily states in three groups of people: people with Autism Spectrum Disorder, people with Eating Disorders (anorexia nervosa), and a control group who have no past or present mental illness or medical condition. The project will investigate recognition of different types of information, including photographs, movement, and voices of actors posing the non-emotional bodily states in order to communicate feelings to others, and video recordings of people who are genuinely experiencing the bodily states.

The results of this research programme will help us to know how our understanding of our own non-emotional bodily states is linked to our ability to recognise these states in others. This knowledge will make it possible to create interventions that could help those who find recognition of their own and others' non-emotional bodily states difficult. These interventions are likely to be helpful to those with Autism Spectrum Disorder or Eating Disorders, as well as those with other psychiatric conditions who struggle to perceive their own and other people's body states (e.g. those with depression, anxiety, and addiction disorders).

The project will investigate the ability to recognise one's own and others' non-emotional (as opposed to emotional) internal bodily states. Many individuals with psychological disorders, including Autism Spectrum Disorder (ASD) and Feeding and Eating Disorders (EDs), have impaired interoception - the process of perceiving signals from inside one's body (such as cardiac and respiratory signals, temperature, pain, nausea, hunger, and satiety). Difficulties recognising one's own emotions is associated with difficulties recognising others' emotions (e.g. from facial expressions). It is therefore likely that difficulties recognising one's own non-emotional bodily states are associated with difficulties recognising others' non-emotional bodily states, due to poor understanding of these states. Failing to recognise that another is experiencing nausea, pain, hunger, etc. will impair social interactions, as the observer would fail to respond to the individual appropriately. Further, one's ability to recognise these states in others is likely to affect one's ability to care for them, for example if one has a role caring (e.g. as a parent or in a medical setting).

The project will investigate recognition of one's own and others' non-emotional bodily states in three groups of people: those with ASD, those with EDs, and control participants with no past or present mental illness. Three tasks will be used to assess recognition of others' bodily states in different modalities (static images of body postures, dynamic point light displays and auditory vocalisations). A training study will determine whether improvement of one's own interoceptive abilities leads to better recognition of others' bodily states. A final study will determine whether individuals can recognise genuine, naturally evoked bodily states, rather than bodily states that are posed by actors. Findings are expected to inform clinical interventions to improve recognition of one's own and others' bodily states.

The main beneficiaries of this work will be:

a) those with ASD or EDs, due to increased understanding around interoceptive difficulties they may have, and how these may be associated with their social perception difficulties (recognising non-emotional bodily states in others), and therefore their social interaction difficulties. These individuals will also benefit from future interventions that target both recognition of their own non-emotional bodily states, and recognition of others' non-emotional bodily states, which should in turn lead to more successful social interactions and relationships.

b) families, carers and support networks of those with ASD or EDs, due to increased understanding of the difficulties faced by those with ASD or EDs, and the potential for developing interventions to alleviate these difficulties.

c) professionals working with those with ASD and EDs, e.g. psychiatrists, as gaining an understanding of the potential difficulties recognising one's own and others' non-emotional internal states in those with ASD and EDs will help professionals to detect these impairments in an individual, and in turn to treat these impairments, once interventions have been developed.

d) ASD and ED charities, through gaining a greater understanding of the range of difficulties that may be faced by those with ASD or EDs, and how these may also affect their support networks.

These stakeholders will be consulted throughout the project, and will benefit in the following ways:

1) The project will generate new knowledge about how those with ASD and EDs recognise their own non-emotional bodily states, and how they recognise these bodily states in others. As this is a novel research field, it is currently difficult for those with ASD and EDs to learn about these difficulties, and how this ability may be improved. Lack of previous research in this area also means clinical practioners do not have a good understanding of the difficulties recognising bodily states that those with ASD and EDs may face, how to interpret these abilities relative to the general population, and how to improve them where necessary.

2) The project will pave the way for development of a) clinician-administered tests of recognition of one's own and others' bodily states that are suitable for use in the autistic and ED populations, and b) interventions that target recognition of one's own and others' bodily states. New understanding of this novel area will therefore help clinical professionals to detect and intervene with difficulties recognising bodily states in those with ASD and EDs.

3) The project will create knowledge about a new area in which these individuals may require support from charities working with those with ASD or EDs.

Implications will be short-term and direct for individuals with ASD or EDs, clinicians, charities, and the commercial sector involved in developing interventions. This includes immediate increases in understanding of difficulties with recognition of others' bodily states, and an immediate opportunity to begin developing interventions. We also envisage longer-term and indirect implications for those with ASD or EDs and their families, for example through gradual increases in the general public's awareness of difficulties these individuals may experience with recognising others' bodily states, and how this might affect their behaviour in social situations. Throughout the project, we will undertake a range of activities to build on existing stakeholder networks, and draw on non-academic partners to co-produce knowledge (see Pathways to Impact).