Keep your interoceptive streams under control: An active inference perspective on anorexia nervosa

Anorexia nervosa (AN) is a psychiatric disorder primarily characterized by "restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health" (DSM-5, n.d.). Here, we propose a novel interpretation of food restriction of AN, which elaborates on recent accounts of the brain as a predictive machine, continuously inferring and controling incoming signals, including bodily signals - i.e., interoceptive (active) inference. In this perspective, the extreme eating restrictions characterizing AN may serve the fundamental role of keeping under control (i.e., reducing excessively high levels of) interoceptive uncertainty, above and beyond controlling and mitigating concerns for body weight. In other words, noisy interoceptive streams may instantiate active strategies (i.e., eating restrictions) that amplify autonomic hunger signals, to minimize interoceptive uncertainty and maintain a more coherent sense of (interoceptive) self.