Precision psychiatry—What it means for eating disorders?

The validity of the fifth and the 10th Body Mass Index percentile as weight cut‐offs for anorexia nervosa in adolescence: No evidence from quantitative and network investigation of psychopathology

“…Therefore, the use of the fifth BMI percentile as the weight cut-off criterion to define psychopathology severity in adolescents does not seem to be supported by present research findings and literature evidence. This criterion may result in diagnosis being delayed or inadequate treatment being provided in the early stage of AN, contrary to the NICE guideline suggestions and the need to reduce chronic AN evolution (Kan et al, 2019). When we explored differences in psychopathology between the groups with a BMI above or below the 10th F I G U R E 3 Plot of Centrality indices of the network in patients with BMI below and above the fifth percentile; ADH, attention problems; AFF, affective problems; AGG, aggressive behaviour; ANX, anxiety; ASC, asceticism; BD, body dissatisfaction; BU, bulimia; DB, delinquent behaviour; DOC, obsessive-compulsive problems; DT, drive for thinness; ED, emotional dysregulation; ID, interoceptive deficits; InA, interpersonal alienation; INS, social insecurity; LSE, low self-esteem; P, perfectionism; PeA, personal alienation; PTSD, posttraumatic stress problems; MF, maturity fear; SOM, somatic complaints [Colour figure can be viewed at wileyonlinelibrary.com] F I G U R E 4 Plot of Centrality indices of the network in patients with BMI below and above the 10th percentile; ADH, attention problems; AFF, affective problems; AGG, aggressive behaviour; ANX, anxiety; ASC, asceticism; BD, body dissatisfaction; BU, bulimia; DB, delinquent behaviour; DOC, obsessive-compulsive problems; DT, drive for thinness; ED, emotional dysregulation; ID, interoceptive deficits; InA, interpersonal alienation; INS, social insecurity; LSE, low self-esteem; P, perfectionism; PeA, personal alienation; PTSD, posttraumatic stress problems; MF, maturity fear; SOM, somatic complaints [Colour figure can be viewed at wileyonlinelibrary.com] percentile, we observed the same group differences detected for the fifth percentile cut-off in terms of both psychopathology severity and psychopathology structure (as revealed by NA).…”

“…According to Kan, Cardi, Stahl, and Treasure (2019), there is a need of precision treatments for AN, which should consider the staging model of the disorder. It has been argued that illness duration of less than 3 years is associated with better outcomes (Ambwani et al., 2020; Kan et al., 2019). The duration of the untreated illness in people with AN is mostly due to both lack of recognition of the illness or low motivation to change (Fassino & Abbate‐Daga, 2013) and to the time needed to reach specialized care (Volpe et al., 2019).…”

Evidence and perspectives in eating disorders: a paradigm for a multidisciplinary approach

“…In accordance with the staging model of eating disorders, the persistence of the illness is associated with neurofunctional changes (especially with respect to reward learning habits) and social exclusion, which may contribute to the disorder evolving into a severe and enduring stage. These processes, as well as variables such as body mass index, binge‐purging behaviors, interpersonal functioning, psychiatric comorbidities, family problems and motivation to recovery, need to be taken into account by psychiatrists and specialized mental health professionals in order to tailor treatment to the individual patient. Although treatment guidelines provide specific parameters to assess the level of medical risk and hospital admission requirements, psychiatrists are advised to consider the current definition of eating disorder severity still in development.…”

Null hypothesis significance tests, a misleading approach to scientific knowledge: Some implications for eating disorders research

“…This is a key concept of evidence‐based medicine (EBM) (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996), which promotes the integration of clinical knowledge with the best available empirical evidence in order to make proficient decisions about the care of patients. The principles of EBM have represented a relevant step toward the implementation of valuable tools in ED clinical practice (Kan et al, 2019; Anastasiadou et al, 2018; Elske van den Berg et al, 2019; Linardon et al, 2019; Hilbert, Hoek, & Schmidt, 2017), with a growing body of literature including well‐designed, well‐analysed and well‐interpreted studies that constitute the basis for offering clinically useful, reliable and updated guidance.…”