Longitudinal group and individual networks of eating disorder symptoms in individuals diagnosed with an eating disorder.

Abstract

Eating disorders (EDs) are serious psychiatric illnesses with high mortality and societal cost. Despite their severity, there are few evidence-based treatments, and only 50% of individuals respond to existing treatments. This low response rate may be due to the fact that EDs are highly heterogeneous disorders. Precision treatments are needed that can intervene on individual maintenance factors. The first step in such treatment development is identification of central treatment targets, both at the group (i.e., on average) and individual level. The current study (N = 102 individuals with an ED) utilized intensive longitudinal data to model several types of group-level and individual network models. Overall, we identified several group-level central symptoms, with the most common central symptoms of fear of weight gain, desire for thinness, feeling like one is overeating, thinking about dieting, and feeling guilty. We also found that these symptoms, specifically fear of weight gain, a desire to be thinner, thinking about dieting, feeling like one is overeating, and feeling guilty, predicted ED severity at a 1- and 6-month follow-up. We modeled 97 individual networks and found that central symptoms were highly heterogeneous, regardless of ED diagnosis. This work adds to the growing literature using intensive longitudinal data to model ED pathology and implicates fear of weight gain, thinking about dieting, and feelings of guilt as symptoms needing further treatment development work. Additionally, this work contributes essential knowledge on how group and individual network modeling can be used to conceptualize the maintenance of EDs on average and at the individual level.

Change in eating-disorder psychopathology network structure in patients with binge-eating disorder: Findings from treatment trial with 12-month follow-up.

“…Results may not generalize to demographic groups not well represented in the study [e.g., men, people of color (Perez et al, 2021)]. Moreover, results may not generalize to individual people, who demonstrate variable eating disorder symptom centrality at baseline (Levinson et al, 2022). Constructing group-based networks, as in the present study, could serve as a comparator to determine the extent to which group-based networks are representative of individual experiences throughout treatment (e.g., Levinson et al, 2022).…”

“…Moreover, results may not generalize to individual people, who demonstrate variable eating disorder symptom centrality at baseline (Levinson et al, 2022). Constructing group-based networks, as in the present study, could serve as a comparator to determine the extent to which group-based networks are representative of individual experiences throughout treatment (e.g., Levinson et al, 2022). We also recognize that although binge-eating abstinence serves as either the primary or secondary outcome in virtually all BED treatment studies, the absence of eating-disorder behaviors may not be necessary to achieve eating-disorder recovery (Slof-Op ’t Landt et al, 2019).…”

“…This approach to identifying central symptoms has advanced the fields for major psychiatric disorders, including depression, anxiety, and schizophrenia (Galderisi et al, 2018; Rouquette et al, 2018; van Borkulo et al, 2015). For example, network analysis has identified novel markers that may signal risk for future anxiety (Rouquette et al, 2018) and persistence of depression (van Borkulo et al, 2015) and provides empirical insights that may guide personalized psychopathology conceptualizations and interventions (Galderisi et al, 2018; Levinson et al, 2022). With respect to intervention, we generally know what evidence-based treatments do: They reduce symptom intensities.…”

Latent profiles of dietary restraint among individuals with binge‐spectrum eating disorders: Associations with eating disorder symptom severity

“…Frontline treatments for binge‐spectrum eating disorders (B‐EDs; eating disorders [EDs] characterized by recurrent loss of control over eating, including bulimia nervosa and binge ED) yield remission in only 30%–60% of individuals (Linardon et al, 2018; Peat et al, 2017). Preliminary evidence suggests that poor treatment outcomes may be due to the highly heterogeneous factors that maintain B‐EDs (Levinson et al, 2022). Subtyping of individuals with B‐EDs has consistently identified distinct subgroups, associated with differential clinical severity and treatment responses, further indicating that B‐EDs are heterogeneous (Dounchis et al, 2021; Goldschmidt et al, 2008; Stice et al, 2001).…”

“…Subtyping of individuals with B‐EDs has consistently identified distinct subgroups, associated with differential clinical severity and treatment responses, further indicating that B‐EDs are heterogeneous (Dounchis et al, 2021; Goldschmidt et al, 2008; Stice et al, 2001). Personalized treatment approaches, which are designed to target idiographic maintenance factors based on an individual's symptoms, may improve treatment outcomes and efficiency, reducing the public health burden and suffering associated with B‐EDs (Levinson et al, 2022). However, to implement personalized treatments, the field must understand the unique relationships between facets of eating pathology among subgroups with B‐EDs.…”