Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis

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Objective Eating disorders (EDs) are complex, heterogeneous, and severe psychiatric syndromes. They are highly comorbid with obsessive–compulsive disorder (OCD) which exacerbates the course of illness and impedes treatment. However, the direct functional relations between EDs and OCD symptoms remain largely unexplored. Hence, using network analysis, we investigated the relationship between ED and OCD at the level of symptoms in a heterogeneous clinical sample. Method We used cross sectional data of 303 treatment‐seeking patients with clinically relevant ED and OCD pathology. We constructed a regularized partial correlation network that featured both ED and OCD symptoms as nodes. To determine each symptom's influence, we calculated expected influence (EI) as an index of symptom centrality (i.e., “importance”). Bridge symptoms (i.e., symptoms from one syndromic cluster that have strong connections to symptoms of another syndromic cluster) were identified by computing bridge expected influence metrics. Results Fear of weight gain and dietary restraint were especially important among the ED symptoms. Interference due to obsessions was the key feature of OCD. ED and OCD clustered distinctly with few potential bridges between clusters. Discussion This study underscores the importance of cognitive symptoms for both ED and OCD although direct functional links between the two clusters are missing. Potentially, a network incorporating nodes capturing features of personality may account for diagnostic comorbidity better than specific symptoms of EDs or features of OCD do.

Section: Discussionsupporting

confidence: 93%

Obsessive–compulsive symptoms in eating disorders: A network investigation

Meier

Kossakowski

Jones

et al. 2019

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“…For instance, shape overvaluation and desiring weight loss were among the most central symptoms in the current study, and either or both of these symptoms have emerged as central in several other studies (Forrest et al, 2018;Levinson, Zerwas, et al, 2017;Wang et al, in press). For instance, shape overvaluation and desiring weight loss were among the most central symptoms in the current study, and either or both of these symptoms have emerged as central in several other studies (Forrest et al, 2018;Levinson, Zerwas, et al, 2017;Wang et al, in press).…”

Section: Similarities and Differences With Past Studiessupporting

confidence: 63%

“…The premise that some ED symptoms play a more fundamental role in maintenance and treatment aligns well with network theory, which holds that symptom interactions are what cause psychopathology (Borsboom & Cramer, 2013). In the ED field, multiple studies have identified central ED symptoms, such as desiring weight loss, shape and weight overvaluation, weight dissatisfaction, body checking, and dietary restraint (DuBois, Rogers, Franko, Eddy, & Thomas, 2017;Forbush, Siew, & Vitevitch, 2016;Forrest, Jones, Ortiz, & Smith, 2018;Goldschmidt et al, 2018;Wang, Jones, Dreier, Elliott, & Grilo, in press). In the ED field, multiple studies have identified central ED symptoms, such as desiring weight loss, shape and weight overvaluation, weight dissatisfaction, body checking, and dietary restraint (DuBois, Rogers, Franko, Eddy, & Thomas, 2017;Forbush, Siew, & Vitevitch, 2016;Forrest, Jones, Ortiz, & Smith, 2018;Goldschmidt et al, 2018;Wang, Jones, Dreier, Elliott, & Grilo, in press).…”

Section: Intoductionmentioning

confidence: 77%

“…That is, the proportion of men in ED network analysis studies ranges from 0% (Forrest et al, 2018;Olatunji, Levinson, & Calebs, 2018) to a maximum of only 25.8% (Wang et al, in press). That is, the proportion of men in ED network analysis studies ranges from 0% (Forrest et al, 2018;Olatunji, Levinson, & Calebs, 2018) to a maximum of only 25.8% (Wang et al, in press).…”

Section: Intoductionmentioning

confidence: 99%

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Using network analysis to identify central eating disorder symptoms among men

Forrest

Perkins

Lavender

et al. 2019

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Objective: The network theory of psychopathology has been described as an "innovative framework" that may "transform" clinical psychological science. Several network studies have identified central eating disorder (ED) symptoms, yet studies have been comprised primarily of women. Using two large samples, we constructed ED symptom networks among men to identify central symptoms.Method: Participants were recruited from three universities and using Amazon's Mechanical Turk. Participants completed the Eating Disorder Examination-Questionnaire (EDE-Q), Male Body Attitudes Scale, and Drive for Muscularity Scale.ED symptom networks were jointly estimated among men with (n = 248) and without core ED symptoms (n = 902). Core ED symptoms were defined by (a) scoring above a suggested male EDE-Q clinical cutoff and (b) reporting symptoms consistent with probable ED diagnoses. Expected influence and predictability (proportion of each node's variance explained by other nodes in the network) were calculated for each node.Results: Shape overvaluation, desiring weight loss, fear of losing control over eating, feeling guilty for missing weight training, and using supplements had the greatest expected influence and predictability. Network structures did not significantly differ between participants with versus without core ED symptoms.Discussion: The centricity of body dissatisfaction items in the networks supports some components of cognitive behavioral theories of EDs. However, the findings also suggest the importance of muscularity-and leanness-oriented concerns, which have been traditionally neglected from leading ED theories that tend to focus on thinness pursuits as a main driver of body dissatisfaction. K E Y W O R D Seating disorder, leanness, men, muscularity, network analysis

“…Existing research on network analyses in EDs supports the Transdiagnostic Model (DuBois, Rodgers, Franko, Eddy, & Thomas, ). In multiple studies of individuals with EDs, items related to overvaluation of weight, shape, and the strict control of weight and shape emerged among the most central nodes of the network (DuBois et al, ; Forbush, Siew, & Vitevitch, ; Forrest, Jones, Ortiz, & Smith, Goldschmidt et al, ; Wang, Jones, Dreier, Elliott, & Grilo, ). Past research also suggests that dietary restraint plays an important role in the maintenance of eating pathology (DuBois et al, ; Forrest et al, ).…”

Section: Network Analysismentioning

confidence: 99%

Application of network analysis to investigate sex differences in interactive systems of eating‐disorder psychopathology

Perko

Forbush

Siew

et al. 2019

Objective Although men comprise 25% of persons with eating disorders (EDs), most research has focused on understanding EDs in women. The theoretical framework underlying common ED treatment has not been rigorously tested in men. The purpose of this study was to compare the interconnectivity among ED symptoms in men versus women. Method Participants (N = 1,348; 50% men) were individuals with anorexia nervosa, bulimia nervosa, binge‐eating disorder, or other specified feeding or eating disorder who were users of Recovery Record, a smartphone app for monitoring ED symptoms. Participants were matched on age and duration of illness. Network analysis was used to create networks of symptoms for both sexes. Strength centrality, network stability, and bootstrapped centrality differences were tested. The network comparison test (NCT) was used to identify sex differences between networks. Key players analysis was used to compare fragmentation of each network. Results For both sexes, items related to binge eating and restricting emerged as highest in strength centrality. The NCT identified significant differences global strength (p = .03) but not network invariance (p = .06) suggesting that although the structure of the networks was not statistically different, the strength of the connections within the network was greater for women. Key players analysis indicated that both networks were similarly disrupted when important nodes within the network were removed. Discussion Findings suggested that there are more similarities than differences in networks of EDs in men and women. Results have important clinical implications by supporting theoretical underpinnings of cognitive‐behavioral models of EDs in both men and women.