Eating disorder core symptoms and symptom pathways across developmental stages: A network analysis.

Abstract

Eating disorders (EDs) often develop during adolescence and early adulthood but may persist, arise, or reemerge across the life span. Research and treatment efforts primarily focus on adolescent and young adult populations, leaving large knowledge gaps regarding ED symptoms across the entire developmental spectrum. The current study uses network analysis to compare central symptoms (i.e., symptoms that are highly connected to other symptoms) and symptom pathways (i.e., relations among symptoms) across five developmental stages (early adolescence, late adolescence, young adulthood, early-middle adulthood, middle-late adulthood) in a large sample of individuals with EDs (N = 29,902; N = 32,219) in two network models. Several symptoms related to overeating, food avoidance, feeling full, and overvaluation of weight and shape emerged as central in most or all developmental stages, suggesting that some core symptoms remain central across development. Despite similarities in central symptoms, significant differences in network structure (i.e., how symptom pathways are connected) emerged across age groups. These differences suggest that symptom interconnectivity (but not symptom severity) might increase across development. Future research should continue to investigate developmental symptom differences in order to inform treatment for individuals with EDs of all ages.

Eating disorder psychopathology in adults and adolescents with anorexia nervosa: A network approach

“…This observation is confirmed by the results of the NCTs, which indicated no significant differences in network structure between the two groups. This finding suggests that anorexia nervosa psychopathology is similar in adults and adolescents, and contrasts with recent data provided by Christian et al (), who they found significant differences in eating disorder psychopathology networks across developmental stages. However, their data pertain to a transdiagnostic sample, including patients with a diagnosis of binge‐eating disorder, in which, as mentioned, overvaluation of shape and weight is only present in half of cases (Coffino, Udo, & Grilo, ).…”

“…Borsboom, Robinaugh, The Psychosystems Group, Rhemtulla, and Cramer () stated that if inconsistent findings arise, this may either be because the phenomenon is unstable or illusory (i.e., the finding is not replicable) or because of substantively meaningful differences between studies (i.e., the finding is not generalizable to the context of another study). In our context, we suggest that the differences in findings between our study and the transdiagnostic study by Christian et al () could be explained by the fact that we included only patients with a clinical diagnosis of anorexia nervosa, thereby limiting the clinical differences across the adolescent and the adult samples.…”

“…The main strength of our investigation was the use of network analysis to examine a large sample of patients with anorexia nervosa to investigate the interconnections in both adult and adolescent eating disorder psychopathology. As in similar studies (Christian et al, ; Forrest et al, ; Forrest, Sarfan, Ortiz, Brown, and Smith, ), the use of the same instrument to evaluate psychopathological features in the two groups enabled us to make an accurate comparison between their clinical characteristics. Nevertheless, to our knowledge, all previous studies using a network approach included a transdiagnostic groups of patients with eating disorders (Christian et al, ) or did not compare different age groups (Forrest et al, ).…”

Psychopathological Networks in Cognitive-Behavioral Treatments for Binge-Eating Disorder

“…At pretreatment, 3 distinct network communities of eating disorder psychopathology, general psychopathology (also including dispositional sensitivity to punishment and reward), and restraint and BMI were identified, which is consistent with cross-sectional network research on BED, mixed eating disorders, and obesity [15][16][17]38]. In line with most literature on these disorders [15][16][17][39][40][41][42], eating disorder-related impairment, low self-esteem, and shape concern were among the most central indicators, whereas BMI and binge eating were the least central. The relatively low centrality of punishment and reward sensitivity is consistent with previous evidence on mixed eating disorders [16], likely associated with their general, non-eating-disorder-related formulation.…”

Time to Intervene: A Continuous-Time Approach to Network Analysis and Centrality

“…In clinical psychology in particular, dynamical network analyses have been promoted as an aid in developing personalized treatments for psychopathology. To facilitate this, centrality measures calculated from parameter estimates are often used to identify which variable in the network represents the most promising target for future interventions (Bringmann et al, 2013;Fisher & Boswell, 2016;Kroeze et al, 2017;Epskamp, van Borkulo, et al, 2018;Rubel, Fisher, Husen, & Lutz, 2018;Bak, Drukker, Hasmi, & van Os, 2016;Bringmann, Lemmens, Huibers, Borsboom, & Tuerlinckx, 2015;Bastiaansen et al, 2019;Fisher, Reeves, Lawyer, Medaglia, & Rubel, 2017;Christian et al, 2019).…”