Emotion Dysregulation Links Interoceptive Accuracy and Vagal Activity to Psychopathology in Male but not Female Adolescents
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Emotion dysregulation is common across psychiatric disorders, but the biological mechanisms underlying emotional vulnerability remain poorly understood. Cardiac vagal regulation and interoception, the perception of bodily signals, may jointly contribute to emotion regulation. We examined whether their interaction is associated with emotion dysregulation and psychopathology in adolescents receiving psychiatric inpatient treatment. Methods We studied 279 adolescent psychiatric inpatients. Cardiac vagal regulation was assessed using heart rate variability and interoceptive accuracy using a measure of bodily signal perception. Structural equation modeling tested associations between cardiac vagal regulation, interoceptive accuracy, emotion dysregulation, depressive symptoms, and personality dysfunction, including sex-specific pathways and interactions. Results Here we show that associations between autonomic regulation, interoception, and psychopathology differ by sex. In male adolescents, lower cardiac vagal regulation is associated with greater emotion dysregulation, which is associated with higher depressive symptoms and greater personality dysfunction. These associations depend on interoceptive accuracy and are most evident at low to intermediate levels of bodily signal perception. Comparable pathways are absent in female adolescents. Conclusions These findings indicate that interactions between cardiac regulation and bodily signal perception contribute to emotional vulnerability in a sex-dependent manner. Altered body–brain communication may contribute to divergent developmental pathways of psychopathology. Integrating sex-specific autonomic and interoceptive processes may improve models of emotion regulation and psychiatric risk during adolescence. Plain Language Summary Difficulties in regulating emotions are common across mental health conditions, but the biological factors underlying vulnerability remain poorly understood. This study investigated whether heart activity and the ability to perceive bodily signals are linked to emotional and mental health problems during adolescence. We examined 279 adolescents receiving psychiatric inpatient treatment and assessed their heart activity, perception of bodily signals, emotion regulation, and psychological symptoms. In male adolescents, lower vagal regulation of the heart was linked to greater emotion dysregulation, which was associated with more depressive symptoms and personality dysfunction. These relationships were strongest among those with lower to moderate accuracy in perceiving bodily signals and were not observed in females. The findings suggest that heart–brain communication may contribute to emotional and psychological vulnerability during adolescence, with potential implications for sex-specific prevention and treatment.
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Universität zu Köln
OpenAlex ID: W7213888688