Emotion Dysregulation Links Interoceptive Accuracy and Vagal Activity to Psychopathology in Male but not Female Adolescents

Background: Emotion dysregulation is a common feature of various psychiatric disorders. The biological mechanisms behind emotional vulnerability, however, are not fully understood. Cardiac vagal regulation and interoception, the ability to sense bodily signals, might be interconnected in the regulation of emotions. This study aimed to investigate if their interaction is related to emotion dysregulation and psychopathology in adolescent psychiatric inpatients.

Methods: A total of 279 adolescent psychiatric inpatients were examined. Cardiac vagal regulation was evaluated through heart rate variability, while interoceptive accuracy was measured using a perception of bodily signals. Structural equation modeling was employed to analyze associations among cardiac vagal regulation, interoceptive accuracy, emotion dysregulation, depressive symptoms, and personality dysfunction. The study also considered sex-specific pathways and interactions.

Results: The researchers found that the relationships between autonomic regulation, interoception, and psychopathology varied depending on the sex of the adolescents. In male adolescents, lower cardiac vagal regulation was linked to increased emotion dysregulation, which in turn was associated with higher depressive symptoms and greater personality dysfunction.

These associations were influenced by interoceptive accuracy and were most pronounced at low to intermediate levels of bodily signal perception. In contrast, similar pathways were not observed in female adolescents.

Conclusions: The findings suggest that interactions between cardiac regulation and bodily signal perception contribute to emotional vulnerability in a sex-dependent manner. Disruptions in body-brain communication could potentially explain the differing developmental pathways of psychopathology between males and females. Incorporating sex-specific autonomic and interoceptive processes may lead to more accurate models of emotion regulation and psychiatric risk assessment during adolescence.