Different trajectories of disrupted allostasis exist, all of which ultimately give rise to metabolic and psychiatric pathology. This has repercussions for the conceptualisation of mental-metabolic comorbidity: rather than distinct disorders, they form part of a larger allostatic system. 6/6

When brought out of balance, a vicious cycle of energy dysregulation can arise. This can be triggered by disruptions at various levels of the system, from faulty interoceptive inputs to imprecise prediction errors. Importantly, neurocognitive processes play a key role in all of them. 5/6

However, brain-body interactions do not occur in isolation. We lay out a framework of interoceptive energy allostasis, explaining how the brain predicts and regulates energy balance based on internal bodily signals–an intricate regulatory system crucial to both mental and metabolic health. 4/6

Cognition may be a key variable in all these possible pathways. Metabolic disruption can impair cognition by affecting dopamine signalling, and cognitive changes in mental illness can precipitate metabolic ill-health through behaviour. Shared factors like genetics can amplify both directions. 3/6

Epidemiology has long shown that mental and metabolic health go hand-in-hand. But the nature of this relationship is unclear: Does poor metabolic health increase psychiatric risk, does mental illness cause metabolic dysfunction, or do both emerge from shared factors? And in any case, why? 2/6

Finally, the amazing Professor Camilla Nord presents on interoception - including some cool lived experience work on body sensations, and work on disgust and gastric rhythms, alongside work on energy conservation. #BAP2025