(PS5-62) Linking Exteroceptive Sensitivity and Eating Disorder Symptoms in Children: The Moderating Role of Interoceptive Sensitivity

Abstract Text: Eating disorder (ED) symptoms affect over 22% of children worldwide (López-Gil et al., 2023). EDs can pose serious health concerns that may lead to hospitalization or death, underscoring the importance of identifying childhood risk factors for ED development. Interoceptive sensitivity—defined as heightened or blunted sensitivity to internal sensations (e.g., pain)—in early childhood predict adolescent ED symptoms (Bufferd et al., 2022). Sensitivity to external stimuli (e.g., sounds), or exteroception, may also contribute to the development of ED symptoms (Adams et al., 2024). Interoception and exteroception interact to influence eating behavior in adults (Boesveldt & Parma, 2021), but it is not known if they interact to predict ED symptoms in children. It is likely that atypical sensitivity to both internal and external stimuli, whether heightened or blunted, contributes to risk for psychopathology, including EDs (Harrison et al., 2019). The present study utilized ecological momentary assessment (EMA) to investigate the moderating effect of interoceptive deficits on the association between exteroceptive sensitivity and ED symptoms. We hypothesized that higher levels of interoceptive deficits would strengthen the connection between exteroceptive sensitivity and ED symptoms.

Participants were 145 mother-daughter dyads (a subset of whom were high risk for EDs) from a metropolitan area, recruited for a longitudinal study. Mothers (Mage = 39.3 years, 86.6% white) were randomly prompted three times per day for ten days to report their daughter’s (Mage = 9.4 years, 80.1% white) recent behaviors. Items were administered to the mothers’ phones and rated on a scale ranging from 0 to 100. Analyses were completed using the lmerTest package in R (Kuznetsova et al., 2017).

Contemporaneous moderation effects were tested using generalized linear mixed models. Both exteroceptive sensitivity (B = 10.14, SE = 0.35, p < .01) and interoceptive deficits (B = 3.39, SE = 0.30, p < .01) were positively associated with ED symptoms. Interoceptive deficits moderated the association between exteroceptive sensitivity and ED symptoms (B = 2.35, SE = 0.41, p < .01). Simple slopes analysis showed that exteroceptive sensitivity was positively associated with ED symptoms across all levels of interoceptive deficits. Supporting our hypothesis, as interoceptive deficits increased, the association between exteroceptive sensitivity and ED symptoms strengthened (B = .31, SE = 0.01, p < .01).

Our findings revealed strengthened associations between exteroceptive sensitivity and ED in children with elevated interoceptive deficits, suggesting sensitivity to both external and internal stimuli are associated with ED symptoms. These results provide evidence supporting exteroceptive sensitivity as a potential risk factor for ED symptoms in children, expanding previous research conducted in adults. Childhood ED interventions generally focus on sensitivity to internal rather than external stimuli (e.g., Feeding and Body Investigators; Zucker et al., 2020). Thus, incorporating treatment for external sensory sensitivity into ED interventions may enhance current approaches for children at risk of ED development.