A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive–behavioral model of eating-disorder symptoms

Abstract

Background In the past decade, network analysis (NA) has been applied to psychopathology to quantify complex symptom relationships. This statistical technique has demonstrated much promise, as it provides researchers the ability to identify relationships across many symptoms in one model and can identify central symptoms that may predict important clinical outcomes. However, network models are highly influenced by node selection, which could limit the generalizability of findings. The current study (N = 6850) tests a comprehensive, cognitive–behavioral model of eating-disorder symptoms using items from two, widely used measures (Eating Disorder Examination Questionnaire and Eating Pathology Symptoms Inventory). Methods We used NA to identify central symptoms and compared networks across the duration of illness (DOI), as chronicity is one of the only known predictors of poor outcome in eating disorders (EDs). Results Our results suggest that eating when not hungry and feeling fat were the most central symptoms across groups. There were no significant differences in network structure across DOI, meaning the connections between symptoms remained relatively consistent. However, differences emerged in central symptoms, such that cognitive symptoms related to overvaluation of weight/shape were central in individuals with shorter DOI, and behavioral central symptoms emerged more in medium and long DOI. Conclusions Our results have important implications for the treatment of individuals with enduring EDs, as they may have a different core, maintaining symptoms. Additionally, our findings highlight the importance of using comprehensive, theoretically- or empirically-derived models for NA.

Exposure to thin and non-thin bodies elicits ‘feeling fat’: Validation of a novel state measure

“…Network analyses have identified 'feeling fat' as among the most central eating disorder (ED) symptoms in clinical samples of adults (Christian et al, 2020;Elliott et al, 2020) and children/adolescents (Goldschmidt et al, 2018). These results are consistent with research indicating that 'feeling fat' predicts both ED symptom severity (Linardon et al, 2018) and treatment outcome (Calugi et al, 2018).…”

“…Despite evidence highlighting the relevance of 'feeling fat' to eating pathology, the modest body of extant literature is limited by measurement issues. Indeed, most studies have measured 'feeling fat' using a single item from the Eating Disorders Examination Questionnaire (EDE-Q; Calugi et al, 2018;Christian et al, 2020;Goldschmidt et al, 2020;Levinson et al, 2020;Linardon et al, 2018;Mehak & Racine, 2019). In addition to known limitations of singleitem measures, the EDE-Q only assesses frequency of 'feeling fat' over the past 28 days.…”

Transdiagnostic vulnerability factors in eating disorders: A network analysis

“…The network theory hypothesizes that symptoms influence each other irrespective of traditional diagnosis DSM boundaries (Borsboom, 2017). In network models, ED symptoms such as body checking (Forbush, Siew, & Vitevitch, 2016), fear of weight gain and feeling fat (Christian et al, 2020; Forrest, Jones, Ortiz, & Smith, 2018; Goldschmidt et al, 2018; Levinson, Brosof, Ma, Fewell, & Lenze, 2017) and shape and weight overvaluation (DuBois, Rodgers, Franko, Eddy, & Thomas, 2017; Forrest et al, 2018; Wang, Jones, Dreier, Elliott, & Grilo, 2019; for a review see; Levinson et al, 2018) emerged as the core symptoms with the highest centrality. The authors have interpreted such (statistically) central symptoms as (theoretically) underlying clinical manifestation of ED psychopathology.…”

Inpatients with severe-enduring anorexia nervosa: Understanding the “enduringness” specifier

“…In keeping with earlier research from our group [47] patients with LD showed a therapeutic alliance comparable to that of the younger ones. Interestingly, those with a shorter DOI improved less in the drive for thinness and body shape concerns, mirroring a network analysis showing patients with a shorter DOI reporting overvaluation of weight or shape as key elements [48].…”