Network Analysis of Eating Disorders Symptoms Co-occurring With Impulsive Personality Traits and Negative Mood States in Patients With Bulimia Nervosa

Abstract

BackgroundBulimia nervosa (BN) is characterized by recurrent episodes of eating large amounts of food without control. Studies have found positive correlations of BN symptoms with impulsive traits and negative affect. However, the network relationship supporting BN symptoms is unclear.MethodsThe study participants included female BN patients (146) and healthy controls (HCs, 146). The participants were matched for age. All participants completed the Eating Disorder Examination Questionnaire 6.0, Barratt Impulsiveness Scale-11, Beck Anxiety Inventory, and Beck Depression Inventory. We characterized the centrality parameters of BN, impulsiveness, and anxiety and depression symptoms of BN patients compared with HCs.ResultsAmong all symptoms in the constructed BN group network, Shape dissatisfaction had the highest strength. In the BN group network, three clusters of symptoms (“ED-specific symptoms,” “impulsivity,” and “anxiety and depression”) were linked to each other by several symptoms. Compared to the HC network, impulsiveness was strongly associated with Concerns about Others Seeing One Eat in the BN network.ConclusionThis study shows that ED-specific symptoms, i.e., Shape dissatisfaction, play a key role in BN. The cognition of “shape dissatisfaction” is a basis, and impulsivity and emotional symptoms are maintaining factors that may lead to BN development.

Network analysis studies in patients with eating disorders: A systematic review and methodological quality assessment

“…Seven (21.2%) studies examined exclusively adults and four (12.1%) studies examined exclusively children/adolescents. One (3.0%) study did not specify age range of the sample (Chen et al, 2022), thus it is not possible to isolate specific age groups (children, adolescents, adults) involved in the study. For more details, see Table A2.…”

“…Among the 33 reviewed studies, six studies (18.2%) modeled cross‐sectional networks from data obtained at different time points (i.e., pre‐ and posttreatment) and compared them, therefore adopting a longitudinal study design (Brown et al, 2020; Calugi et al, 2022; Elliott et al, 2020; Mares et al, 2022; Monteleone et al, 2022; Smith et al, 2019). The remaining 27 studies (81.8%) applied a cross‐sectional study design (Calugi et al, 2020, 2021; Cascino et al, 2019; Chen et al, 2022; de Vos et al, 2021; DuBois et al, 2017; Forrest et al, 2018, 2019; Goldschmidt et al, 2018; Hagan et al, 2021; Hilbert et al, 2020; Kerr‐Gaffney et al, 2020; Levinson et al, 2017; Meier et al, 2020; Monteleone et al, 2019, 2020, 2021; Olatunji et al, 2018; Ralph‐Nearman et al, 2021; Schlegl et al, 2021; Smith et al, 2020; Solmi et al, 2018, 2019; Vanzhula et al, 2019; Vervaet et al, 2021; Wang et al, 2019; Wong et al, 2021). Twenty‐five studies (75.7%) used network analysis as the primary data analysis procedure, involved treatment‐seeking patients and were uncontrolled (Brown et al, 2020; Calugi et al, 2020, 2021, 2022; Cascino et al, 2019; Chen et al, 2022; de Vos et al, 2021; DuBois et al, 2017; Forrest et al, 2018, 2019; Goldschmidt et al, 2018; Kerr‐Gaffney et al, 2020; Mares et al, 2022; Meier et al, 2020; Monteleone et al, 2019; Monteleone et al, 2020, 2021; Olatunji et al, 2018; Schlegl et al, 2021; Solmi et al,…”

“…The remaining 27 studies (81.8%) applied a cross‐sectional study design (Calugi et al, 2020, 2021; Cascino et al, 2019; Chen et al, 2022; de Vos et al, 2021; DuBois et al, 2017; Forrest et al, 2018, 2019; Goldschmidt et al, 2018; Hagan et al, 2021; Hilbert et al, 2020; Kerr‐Gaffney et al, 2020; Levinson et al, 2017; Meier et al, 2020; Monteleone et al, 2019, 2020, 2021; Olatunji et al, 2018; Ralph‐Nearman et al, 2021; Schlegl et al, 2021; Smith et al, 2020; Solmi et al, 2018, 2019; Vanzhula et al, 2019; Vervaet et al, 2021; Wang et al, 2019; Wong et al, 2021). Twenty‐five studies (75.7%) used network analysis as the primary data analysis procedure, involved treatment‐seeking patients and were uncontrolled (Brown et al, 2020; Calugi et al, 2020, 2021, 2022; Cascino et al, 2019; Chen et al, 2022; de Vos et al, 2021; DuBois et al, 2017; Forrest et al, 2018, 2019; Goldschmidt et al, 2018; Kerr‐Gaffney et al, 2020; Mares et al, 2022; Meier et al, 2020; Monteleone et al, 2019; Monteleone et al, 2020, 2021; Olatunji et al, 2018; Schlegl et al, 2021; Solmi et al, 2018, 2019; Vanzhula et al, 2019; Vervaet et al, 2021; Wang et al, 2019; Wong et al, 2021). Results from the remaining eight (24.3%) of the 33 studies included in this review are based on secondary analyses of data (Elliott et al, 2020; Hagan et al, 2021; Hilbert et...…”

“…Among the 33 reviewed studies, six studies (18.2%) modeled crosssectional networks from data obtained at different time points (i.e., preand posttreatment) and compared them, therefore adopting a longitudinal study design (Brown et al, 2020;Calugi et al, 2022;Elliott et al, 2020;Mares et al, 2022;Monteleone et al, 2022;Smith et al, 2019). The remaining 27 studies (81.8%) applied a cross-sectional study design (Calugi et al, 2020(Calugi et al, , 2021Cascino et al, 2019;Chen et al, 2022;de Vos et al, 2021;DuBois et al, 2017;Forrest et al, 2018Forrest et al, , 2019Goldschmidt et al, 2018;Hagan et al, 2021;Hilbert et al, 2020;Kerr-Gaffney et al, 2020;Levinson et al, 2017;Meier et al, 2020;Monteleone et al, 2019Monteleone et al, , 2020Olatunji et al, 2018;Ralph-3.6 | Assessment of methodological quality…”

“…The full text of the remaining 65 articles and 3 dissertations were assessed, leading to the exclusion of an additional 35 articles. The remaining 33 articles were thus included in the review (Brown et al, 2020;Calugi et al, 2020Calugi et al, , 2021Calugi et al, , 2022Cascino et al, 2019;Chen et al, 2022;de Vos et al, 2021;DuBois et al, 2017;Elliott et al, 2020;Forrest et al, 2018Forrest et al, , 2019Goldschmidt et al, 2018;Hagan et al, 2021;Hilbert et al, 2020;Kerr-Gaffney et al, 2020;Levinson et al, 2017;Mares et al, 2022;Meier et al, 2020;Monteleone et al, 2019Monteleone et al, , 2020Monteleone et al, , 2022Olatunji et al, 2018;Ralph-Nearman et al, 2021;Schlegl et al, 2021;Smith et al, 2019;Smith et al, 2020;Solmi et al, 2018Solmi et al, , 2019Vanzhula et al, 2019;Vervaet et al, 2021;Wang et al, 2019;Wong et al, 2021). See Figure 1 for the flowchart of the selection process, including reasons for exclusion at each step.…”