Perception and Misperception of Bodily Symptoms From an Active Inference Perspective: Modelling the Case of Panic Disorder

We advance a novel computational model that characterizes formally the ways we perceive or misperceive bodily symptoms, in the context of panic attacks. The computational model is grounded within the formal framework of Active Inference, which considers top-down prediction and attention dynamics as key to perceptual inference and action selection. In a series of simulations, we use the computational model to reproduce key facets of adaptive and maladaptive symptom perception: the ways we infer our bodily state by integrating prior information and somatic afferents; the ways we decide whether or not to attend to somatic channels; the ways we use the symptom inference to make decisions about taking or not taking a medicine; and the ways all the above processes can go awry, determining symptom misperception and ensuing maladaptive behaviors, such as hypervigilance or excessive medicine use. While recent existing theoretical treatments of psychopathological conditions focus on prediction-based perception (predictive coding), our computational model goes beyond them, in at least two ways. First, it includes action and attention selection dynamics that are disregarded in previous conceptualizations but are crucial to fully understand the phenomenology of bodily symptom perception and misperception. Second, it is a fully implemented model that generates specific (and personalized) quantitative predictions, thus going beyond previous qualitative frameworks.