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Alho J, Gutvilig M, Niemi R, Komulainen K, Böckerman P, Webb RT, Elovainio M, Hakulinen C. Transmission of Mental Disorders in Adolescent Peer Networks. JAMA Psychiatry 2024:2818735. [PMID: 38776092 PMCID: PMC11112494 DOI: 10.1001/jamapsychiatry.2024.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/15/2024] [Indexed: 05/25/2024]
Abstract
Importance Previous research indicates that mental disorders may be transmitted from one individual to another within social networks. However, there is a lack of population-based epidemiologic evidence that pertains to the full range of mental disorders. Objective To examine whether having classmates with a mental disorder diagnosis in the ninth grade of comprehensive school is associated with later risk of being diagnosed with a mental disorder. Design, Setting, and Participants In a population-based registry study, data on all Finnish citizens born between January 1, 1985, and December 31, 1997, whose demographic, health, and school information were linked from nationwide registers were included. Cohort members were followed up from August 1 in the year they completed ninth grade (approximately aged 16 years) until a diagnosis of mental disorder, emigration, death, or December 31, 2019, whichever occurred first. Data analysis was performed from May 15, 2023, to February 8, 2024. Exposure The exposure was 1 or more individuals diagnosed with a mental disorder in the same school class in the ninth grade. Main Outcomes and Measures Being diagnosed with a mental disorder during follow-up. Results Among the 713 809 cohort members (median age at the start of follow-up, 16.1 [IQR, 15.9-16.4] years; 50.4% were males), 47 433 had a mental disorder diagnosis by the ninth grade. Of the remaining 666 376 cohort members, 167 227 persons (25.1%) received a mental disorder diagnosis during follow-up (7.3 million person-years). A dose-response association was found, with no significant increase in later risk of 1 diagnosed classmate (HR, 1.01; 95% CI, 1.00-1.02), but a 5% increase with more than 1 diagnosed classmate (HR, 1.05; 95% CI, 1.04-1.06). The risk was not proportional over time but was highest during the first year of follow-up, showing a 9% increase for 1 diagnosed classmate (HR, 1.09; 95% CI, 1.04-1.14), and an 18% increase for more than 1 diagnosed classmate (HR, 1.18; 95% CI, 1.13-1.24). Of the examined mental disorders, the risk was greatest for mood, anxiety, and eating disorders. Increased risk was observed after adjusting for an array of parental, school-level, and area-level confounders. Conclusions and Relevance The findings of this study suggest that mental disorders might be transmitted within adolescent peer networks. More research is required to elucidate the mechanisms underlying the possible transmission of mental disorders.
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Affiliation(s)
- Jussi Alho
- Department of Psychology, University of Helsinki, Helsinki, Finland
| | - Mai Gutvilig
- Department of Psychology, University of Helsinki, Helsinki, Finland
| | - Ripsa Niemi
- Department of Psychology, University of Helsinki, Helsinki, Finland
| | | | - Petri Böckerman
- School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
| | - Roger T. Webb
- Centre for Mental Health and Safety, Division of Psychology & Mental Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, Manchester, United Kingdom
| | - Marko Elovainio
- Department of Psychology, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Christian Hakulinen
- Department of Psychology, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Meneguzzo P, Ajello A, Consolati MD, Ceccato E, Vita A, Sala A, Santonastaso P. Effects of the COVID-19 pandemic on youth mental health: a cross-sectional study on eating disorder patients and their unaffected siblings. Child Adolesc Psychiatry Ment Health 2024; 18:6. [PMID: 38184616 PMCID: PMC10771694 DOI: 10.1186/s13034-023-00698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Adolescence has emerged as a particularly vulnerable phase during the COVID-19 pandemic, with eating disorders (EDs) representing a prominent psychopathological challenge linked to the restrictions imposed by the pandemic. Emerging evidence suggests that not only individuals with EDs but also their healthy siblings (HS) may experience unique psychological effects in this context. However, the existing literature on this topic remains limited. This study seeks to examine and compare the effects of the pandemic on adolescents and adults, with a specific focus on the impact of containment measures, disruptions in daily routines, and alterations in life trajectories, for both individuals with EDs and their HS. METHODS We enrolled 273 individuals, including those diagnosed with EDs and their HS. Among the participants, 120 were under the age of 19. Multiple self-report questionnaires were administered to assess the psychological impact of 1 year of the COVID-19 pandemic. These assessments covered a range of psychological constructs, including posttraumatic symptoms, general psychopathology, and eating-related concerns. RESULTS Notably, adolescent patients with EDs demonstrated the highest psychopathological scores within our sample. They were the sole subgroup to surpass clinical cutoffs, exhibiting more pronounced issues concerning eating-related concerns and general psychological well-being. Our findings also shed light on the unique experiences of HS during the pandemic. CONCLUSION Our findings highlight the specific psychological burden endured by adolescents with EDs throughout the COVID-19 pandemic, emphasizing the vulnerability of this demographic. Moreover, the experiences of HS, often overlooked in the literature, warrant increased attention in future health programs and interventions.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Alessio Ajello
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mauro Domenico Consolati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Enrico Ceccato
- Mental Health Department, Vicenza Eating Disorders Center, Azienda ULSS8 "Berica", Vicenza, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Sala
- Mental Health Department, Vicenza Eating Disorders Center, Azienda ULSS8 "Berica", Vicenza, Italy
| | - Paolo Santonastaso
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Fear of weight gain during cognitive behavioral therapy for binge-spectrum eating disorders. Eat Weight Disord 2023; 28:29. [PMID: 36879078 PMCID: PMC9988191 DOI: 10.1007/s40519-023-01541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/12/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE Fear of weight gain may play a central role in maintaining eating disorders (EDs), but research on the role of fear of weight gain during cognitive behavioral therapy (CBT-E) for binge-spectrum EDs is sparse. We examined changes in fear of weight gain during CBT-E for binge-spectrum EDs. We investigated whether fear of weight gain predicted loss of control (LOC) eating or weight change. METHODS Participants (N = 63) were adults of any gender recruited as part of a larger trial. Participants received 12 sessions of CBT-E, completed diagnostic assessments at pre-, mid-, and post-treatment, and completed brief surveys before sessions. RESULTS Fear of weight gain decreased across treatment, moderated by diagnosis. Those with bulimia nervosa spectrum EDs (BN-spectrum), compared to binge eating disorder, reported higher fear of weight gain at baseline and experienced a larger decrease in fear across treatment. Those reporting higher fear of weight gain at a given session experienced more frequent LOC episodes the following week. Fear of weight gain was not associated with session-by-session changes in BMI. CONCLUSION CBT-E results in decreases in fear of weight gain, but levels remain high at post-treatment, especially for those with BN-spectrum EDs. Future interventions should consider targeting fear of weight gain as a maintaining factor for LOC episodes TRIAL REGISTRATION: NCT04076553. LEVEL OF EVIDENCE Level II controlled trial without randomization.
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St-Pierre MJ, Therriault PY, Faghihi U, Monthuy-Blanc J. Eating disorders: When food "Eats" time. Appetite 2023; 185:106509. [PMID: 36871602 DOI: 10.1016/j.appet.2023.106509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
The presence of a physical or mental health issue, such as an eating disorder (ED), impacts daily activities, also known as occupations. For example, an overinvestment in body shape and weight undoubtedly can lead to an underinvestment in other, more meaningful occupations. To address ED-related perceptual disturbances, a detailed log of daily time use can pinpoint food-related occupational imbalances. This study aims to characterize the daily occupations associated with EDs. The first specific objective (SO.1) is to categorize and quantify the temporal organization of a typical day's occupations as self-reported by individuals with an ED. The second specific objective (SO.2) is to compare daily occupational time use among people with different ED types. This retrospective study based on time-use research principles was conducted by analyzing data from an anonymized secondary dataset (Loricorps's Databank). Data were collected between 2016 and 2020, from 106 participants, with descriptive analysis completed to determine the average daily time use for each occupation. A series of one-way analyses of variance (ANOVAs) were performed to compare perceived time use in each occupation for participants with different types of EDs. The outcomes show a marked underinvestment in leisure categories compared to the general population. In addition, personal care and productivity can represent the blind dysfunctional occupations (SO.1). Moreover, compared to those with binge eating disorder (BED), individuals with anorexia nervosa (AN) are significantly more invested in occupations that focus explicitly on perceptual disturbances, such as personal care (SO.2). The highlight of this study is the distinction between marked versus blind dysfunctional occupation, which offers specific avenues for clinical intervention.
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Affiliation(s)
- M-J St-Pierre
- GR2TCA-Loricorps, Groupe de Recherche Transdisciplinaire des Troubles du Comportement Alimentaire, Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Institut universitaire en santé mentale de Montréal, 7401 Rue Hochelaga, Montréal, QC H1N 3M5, Canada; Département d'ergothérapie, Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, C.P. 500, Trois-Rivières, QC G9A 5H7, Canada.
| | - P-Y Therriault
- Département d'ergothérapie, Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, C.P. 500, Trois-Rivières, QC G9A 5H7, Canada
| | - U Faghihi
- GR2TCA-Loricorps, Groupe de Recherche Transdisciplinaire des Troubles du Comportement Alimentaire, Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - J Monthuy-Blanc
- GR2TCA-Loricorps, Groupe de Recherche Transdisciplinaire des Troubles du Comportement Alimentaire, Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Institut universitaire en santé mentale de Montréal, 7401 Rue Hochelaga, Montréal, QC H1N 3M5, Canada
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5
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Harper JA, Palka JM, McAdams CJ. Interpersonal attribution bias and social evaluation in adolescent eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:258-270. [PMID: 36349493 PMCID: PMC9898092 DOI: 10.1002/erv.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Improved understanding of adolescent eating disorders (EDs), including identification and refinement of treatment and recovery targets, may help improve clinical outcomes. Interpersonal function is a proposed risk and maintenance factor that may be particularly relevant given the significance of adolescence for both psychosocial development and ED onset. This study examined self-referential thinking in adolescents with EDs compared to healthy adolescents. METHOD Twenty-nine adolescents with EDs and 31 healthy controls completed a self-report measure of interpersonal attributions as well as a verbal appraisal task that required conducting direct and indirect evaluations about oneself and direct evaluations about others. RESULTS The ED group had a more negative self-attribution bias than the control group (p = 0.006) even when controlling for depression severity. Additionally, the ED group exhibited less positive direct self (p < 0.001), direct social (p = 0.015), and social reflected self-appraisals (p = 0.011) than the healthy cohort. After including depression as a covariate in the verbal appraisal model, the model was no longer significant, suggesting group differences related to social appraisals may be mediated by depression. CONCLUSIONS Adolescents with EDs have more negative interpersonal beliefs than comparison adolescents. Future studies are needed to determine how the constructs identified here relate to clinical course.
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Affiliation(s)
- Jessica A. Harper
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
| | - Jayme M. Palka
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Carrie J. McAdams
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
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Sahlan RN, Sala M. Eating disorder psychopathology and resilience in Iranian college students: A network analysis. J Clin Psychol 2023; 79:497-513. [PMID: 35975401 DOI: 10.1002/jclp.23428] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorder (ED) psychopathology is common among Iranian college students. Resilience (i.e., the ability to bounce back and adapt in the face of adverse and stressful conditions) has been found to be a protective factor against ED psychopathology in the West. However, no research to date has examined resilience as a protective factor against ED psychopathology in Iran. The current study used network analysis to examine an ED and resilience network in an Iranian sample. METHOD Participants were Iranian college students (N = 478) who completed the Farsi-Eating Disorder Examination-Questionnaire and Farsi-Brief Resilience Scale. We estimated a network of ED symptoms and resilience processes and identified central and bridge symptoms. RESULTS Central ED and resilience nodes were discomfort in seeing one's own body, feeling guilty about eating due to shape/weight, and thinking about shape and weight making it difficult to concentrate. Having a hard time making it through stressful events bridged with binge eating and fear of losing control over eating. CONCLUSION Processes related to managing stress and binge eating appear to maintain the association between ED symptoms and resilience processes.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
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Punzi C, Tieri P, Girelli L, Petti M. Network-based validation of the psychometric questionnaire EDI-3 for the assessment of eating disorders. Sci Rep 2023; 13:1578. [PMID: 36709357 PMCID: PMC9884211 DOI: 10.1038/s41598-023-28743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
Assessing the validity of a psychometric test is fundamental to ensure a reliable interpretation of its outcomes. Few attempts have been made recently to complement classical approaches (e.g., factor models) with a novel technique based on network analysis. The objective of the current study is to carry out a network-based validation of the Eating Disorder Inventory 3 (EDI-3), a questionnaire designed for the assessment of eating disorders. Exploiting a reliable, open source sample of 1206 patients diagnosed with an eating disorder, we set up a robust validation process encompassing detection and handling of redundant EDI-3 items, estimation of the cross-sample psychometric network, resampling bootstrap procedure and computation of the median network of the replica samples. We then employed a community detection algorithm to identify the topological clusters, evaluated their coherence with the EDI-3 subscales and replicated the full validation analysis on the subpopulations corresponding to patients diagnosed with either anorexia nervosa or bulimia nervosa. Results of the network-based analysis, and particularly the topological community structures, provided support for almost all the composite scores of the EDI-3 and for 2 single subscales: Bulimia and Maturity Fear. A moderate instability of some dimensions led to the identification of a few multidimensional items that should be better located in the intersection of multiple psychological scales. We also found that, besides symptoms typically attributed to eating disorders, such as drive for thinness, also non-specific symptoms like low self-esteem and interoceptive deficits play a central role in both the cross-sample and the diagnosis-specific networks. Our work adds insights into the complex and multidimensional structure of EDI-3 by providing support to its network-based validity on both mixed and diagnosis-specific samples. Moreover, we replicated previous results that reinforce the transdiagnostic theory of eating disorders.
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Affiliation(s)
- Clara Punzi
- Data Science Program, Sapienza University of Rome, Via Ariosto 25, 00185, Rome, Italy
| | - Paolo Tieri
- Data Science Program, Sapienza University of Rome, Via Ariosto 25, 00185, Rome, Italy. .,CNR National Research Council, IAC Institute for Applied Computing, Via dei Taurini 19, 00185, Rome, Italy.
| | - Laura Girelli
- Department of Humanities, Philosophy and Education, University of Salerno, via Giovanni Paolo II 132, 84084, Fisciano, Italy
| | - Manuela Petti
- Data Science Program, Sapienza University of Rome, Via Ariosto 25, 00185, Rome, Italy.,Department of Computer, Control, and Management Engineering "Antonio Ruberti", Sapienza University of Rome, Via Ariosto 25, 00185, Rome, Italy
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Wilson S, Mehak A, Racine SE. Exposure to thin and non-thin bodies elicits 'feeling fat': Validation of a novel state measure. Eat Behav 2023; 48:101700. [PMID: 36608389 DOI: 10.1016/j.eatbeh.2022.101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
'Feeling fat' refers to the subjective experience of carrying excess weight and relates to severity of eating pathology. Despite research suggesting that 'feeling fat' fluctuates across contexts, this construct is almost exclusively assessed in terms of frequency or as a trait. Examining state 'feeling fat' in response to external stimuli can inform us of the nature of this construct. In an experimental study, 290 community women were exposed to five categories of affective (pleasant, aversive, and neutral) and body (thin and non-thin) images in quasi-random order. Self-Assessment Manikin (SAM) valence and arousal rating scales as well as a novel SAM 'feeling fat' scale were rated for each image. Theoretically-relevant constructs (i.e., trait 'feeling fat', thin-ideal internalization, body dissatisfaction, eating pathology) were also measured. Body images elicited greater state 'feeling fat' than affective images, with images of non-thin bodies producing higher state 'feeling fat' than thin bodies. Positive correlations were observed between state 'feeling fat' in response to thin and all variables of interest, whereas associations between these variables and 'feeling fat' in response to non-thin images were small or non-significant. The development of a state measure of 'feeling fat' allows for the investigation of triggers of this bodily experience and will facilitate future research.
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Affiliation(s)
- Samantha Wilson
- Department of Psychology, McGill University, 2001 avenue McGill College, Montréal, QC H3A 1G1, Canada.
| | - Adrienne Mehak
- Department of Psychology, McGill University, 2001 avenue McGill College, Montréal, QC H3A 1G1, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, 2001 avenue McGill College, Montréal, QC H3A 1G1, Canada
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Hagan KE, Matheson BE, Datta N, L’Insalata AM, Onipede ZA, Gorrell S, Mondal S, Bohon CM, Grange DL, Lock JD. Understanding outcomes in family-based treatment for adolescent anorexia nervosa: a network approach. Psychol Med 2023; 53:396-407. [PMID: 33952357 PMCID: PMC8820974 DOI: 10.1017/s0033291721001604] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. METHODS Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). RESULTS The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. CONCLUSIONS Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.
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Affiliation(s)
- Kelsey E. Hagan
- Stanford University School of Medicine, Division, Stanford, CA, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Nandini Datta
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | | | | | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Sangeeta Mondal
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | - Cara M. Bohon
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - James D. Lock
- Stanford University School of Medicine, Division, Stanford, CA, USA
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Hoover LV, Ackerman JM, Cummings JR, Gearhardt AN. The Association of Perceived Vulnerability to Disease with Cognitive Restraint and Compensatory Behaviors. Nutrients 2022; 15:nu15010008. [PMID: 36615665 PMCID: PMC9824184 DOI: 10.3390/nu15010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Individual differences exist in perceived vulnerability to disease (PVD). PVD is associated with negative responses (e.g., disgust) towards individuals with obesity and heightened sensitivity regarding personal appearance. Through increasing fear of fat (FOF), PVD may be associated with cognitive restraint and compensatory behaviors. We utilized an adult sample (n = 247; 53.3% male sex assigned at birth) recruited through Amazon's MTurk prior to the COVID-19 pandemic to investigate associations between PVD, cognitive restraint and compensatory behaviors. Participants completed the Perceived Vulnerability to Disease Scale, Eating Disorder Diagnostic Scale, Dutch Eating Behaviors Questionnaire, and Goldfarb's Fear of Fat Scale. Mediation analyses were used to test our hypotheses. Perceived infectability (PVD-Infection) was associated with cognitive restraint and compensatory behaviors through increased FOF. Perceived germ aversion (PVD-Germ) was associated with cognitive restraint, but FOF did not mediate this association. Sex-stratified analyses revealed no significant sex differences. PVD may be an overlooked factor associated with cognitive restraint and compensatory behaviors in males and females. FOF was an important mediating factor in these associations. Increased engagement in cognitive restraint and compensatory behaviors may reflect attempts to reduce FOF. Future longitudinal research should explore whether PVD is a risk factor for cognitive restraint and compensatory behaviors.
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11
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Tomei G, Pieroni MF, Tomba E. Network analysis studies in patients with eating disorders: A systematic review and methodological quality assessment. Int J Eat Disord 2022; 55:1641-1669. [PMID: 36256543 DOI: 10.1002/eat.23828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Network psychometrics has been enthusiastically embraced by researchers studying eating disorders (ED), but a rigorous evaluation of the methodological quality of works is still missing. This systematic review aims to assess the methodological quality of cross-sectional network analysis (NA) studies conducted on ED clinical populations. METHODS PRISMA and PICOS criteria were used to retrieve NA studies on ED. Methodological quality was evaluated based on five criteria: variable-selection procedure, network estimation method, stability checks, topological overlap checks, and handling of missing data. RESULTS Thirty-three cross-sectional NA studies were included. Most studies focused on populations that were female, white and, with an anorexia nervosa (AN) diagnosis. Depending on how many criteria were satisfied, 27.3% of studies (n = 9) were strictly adherent, 30.3% (n = 10) moderately adherent, 33.3% (n = 11) sufficiently adherent, and 9.1% (n = 3) poorly adherent. Missing topological overlap checks and not reporting missing data represented most unreported criteria, lacking, respectively, in 63.6% and 48.5% of studies. CONCLUSIONS Almost all reviewed cross-sectional NA studies on ED report those methodological procedures (variable-selection procedure, network estimation method, stability checks) necessary for a network study to provide reliable results. Nonetheless these minimum reporting data require further improvement. Moreover, elements closely related to the validity of an NA study (controls for topological overlap and management of missing data) are lacking in most studies. Recommendations to overcome such methodological weaknesses in future NA studies on ED are discussed together with the need to conduct NA studies with longitudinal design, to address diversity issues in study samples and heterogeneity of assessment tools. PUBLIC SIGNIFICANCE The present work aims to evaluate the quality of ED NA studies to support applications of this approach in ED research. Results show that most studies adopted basic procedures to produce reliable results; however, other important procedures linked to NA study validity were mostly neglected. Network methodology in ED is extremely promising, but future studies should consistently include topological overlap control procedures and provide information on missing data.
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Affiliation(s)
- Giuliano Tomei
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
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12
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Sahlan RN, Sala M. Eating disorder psychopathology and negative affect in Iranian college students: a network analysis. J Eat Disord 2022; 10:164. [PMID: 36376982 PMCID: PMC9664660 DOI: 10.1186/s40337-022-00683-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND ED psychopathology is becoming more prevalent in Iran. Negative affect has been found to be an important risk factor in eating disorder (ED) onset in research conducted in Western countries, and is also emerging as a potential vulnerability factor to ED psychopathology in Iran. Network theory offers a novel framework to understand the association between negative affect and ED psychopathology in Iran. The primary aim of the current study was to use network analysis to identify bridge symptoms (i.e., symptoms that activate or weaken symptoms in another cluster) across a negative affect and ED psychopathology network among Iranian college students. We also aimed to identify core symptoms (i.e., nodes that demonstrate the strongest connections to other nodes). METHOD Participants were Iranian college students (n = 637; 60.3% women) who completed the Farsi-eating disorder examination-questionnaire and Farsi-negative affect. We estimated a network of ED symptoms and negative affective states and identified bridge and central symptoms. RESULTS Hostility and shame emerged as central bridge symptoms across the negative affect and ED psychopathology clusters. The most central nodes were strong desire to lose weight, definite fear of losing control over eating, and binge eating episodes. CONCLUSION The negative affective states of hostility and shame may increase vulnerability to ED psychopathology among Iranian college students. Findings have important implications for ED prevention programs that should be examined in future research.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
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13
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Kinkel-Ram SS, Williams BM, Ortiz SN, Forrest L, Magee JC, Smith AR, Levinson CA. Testing intrusive thoughts as illness pathways between eating disorders and obsessive-compulsive disorder symptoms: a network analysis. Eat Disord 2022; 30:647-669. [PMID: 34711137 DOI: 10.1080/10640266.2021.1993705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obsessive-compulsive disorder (OCD) and eating disorders (EDs) frequently co-occur. Intrusive thoughts are a mechanism that may maintain this comorbidity. This study used network analysis to identify central ED-related intrusive thoughts and tested which intrusive thoughts connected ED and OCD symptoms. Two cross-sectional graphical LASSO networks were computed using a sample of 353 non-clinical participants (mean age = 35.38, SD = 9.9, 40% female, 81.6% Caucasian) with elevated disordered eating symptoms. Model 1 included just ED-related intrusive thoughts, and Model 2 included ED-related intrusive thoughts, ED, and OCD symptoms. In Model 1, we found that thoughts about one's bodily appearance (i.e., looking horrible, getting fat, gaining weight) were most central. In Model 2, we found that desire to lose weight, eating in secret, and shape dissatisfaction were most central. We identified one illness pathway (i.e., difficulty concentrating due to thoughts of food/calories) connecting intrusive thoughts, ED symptoms, and OCD symptoms. However, intrusive thoughts did not bridge ED and OCD symptoms. Hence, we found some evidence that ED-related intrusive thoughts may contribute to ED and OCD symptoms based on thought content and frequency. However, other aspects of intrusive thoughts should be considered to ascertain whether they do in fact significantly contribute to ED and OCD comorbidity. Prevention efforts targeting ED-related intrusive thoughts may attenuate ED and OCD symptoms among subclinical individuals.
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Affiliation(s)
| | - Brenna M Williams
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | - Lauren Forrest
- Department of Psychology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua C Magee
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | - April R Smith
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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14
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Punzi C, Petti M, Tieri P. Network-based methods for psychometric data of eating disorders: A systematic review. PLoS One 2022; 17:e0276341. [PMID: 36315522 PMCID: PMC9621460 DOI: 10.1371/journal.pone.0276341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Network science represents a powerful and increasingly promising method for studying complex real-world problems. In the last decade, it has been applied to psychometric data in the attempt to explain psychopathologies as complex systems of causally interconnected symptoms. One category of mental disorders, relevant for their severity, incidence and multifaceted structure, is that of eating disorders (EDs), serious disturbances that negatively affect a person's eating behavior. AIMS We aimed to review the corpus of psychometric network analysis methods by scrutinizing a large sample of network-based studies that exploit psychometric data related to EDs. A particular focus is given to the description of the methodologies for network estimation, network description and network stability analysis providing also a review of the statistical software packages currently used to carry out each phase of the network estimation and analysis workflow. Moreover, we try to highlight aspects with potential clinical impact such as core symptoms, influences of external factors, comorbidities, and related changes in network structure and connectivity across both time and subpopulations. METHODS A systematic search was conducted (February 2022) on three different literature databases to identify 57 relevant research articles. The exclusion criteria comprehended studies not based on psychometric data, studies not using network analysis, studies with different aims or not focused on ED, and review articles. RESULTS Almost all the selected 57 papers employed the same analytical procedures implemented in a collection of R packages specifically designed for psychometric network analysis and are mostly based on cross-sectional data retrieved from structured psychometric questionnaires, with just few exemptions of panel data. Most of them used the same techniques for all phases of their analysis. In particular, a pervasive use of the Gaussian Graphical Model with LASSO regularization was registered for in network estimation step. Among the clinically relevant results, we can include the fact that all papers found strong symptom interconnections between specific and nonspecific ED symptoms, suggesting that both types should therefore be addressed by clinical treatment. CONCLUSIONS We here presented the largest and most comprehensive review to date about psychometric network analysis methods. Although these methods still need solid validation in the clinical setting, they have already been able to show many strengths and important results, as well as great potentials and perspectives, which have been analyzed here to provide suggestions on their use and their possible improvement.
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Affiliation(s)
- Clara Punzi
- Data Science MSc Program, Sapienza University of Rome, Rome, Italy
| | - Manuela Petti
- DIAG Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Paolo Tieri
- Data Science MSc Program, Sapienza University of Rome, Rome, Italy
- CNR National Research Council, IAC Institute for Applied Computing, Rome, Italy
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15
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Sahlan RN, Keshishian AC, Christian C, Levinson CA. Eating disorder and social anxiety symptoms in Iranian preadolescents: a network analysis. Eat Weight Disord 2022; 27:1855-1867. [PMID: 34787832 DOI: 10.1007/s40519-021-01329-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Network studies of eating disorder (ED) symptoms have identified central and bridge symptoms in Western samples, yet few network models of ED symptoms have been tested in non-Western samples, especially among preadolescents. The current study tested a network model of ED symptoms in Iranian preadolescents (ages 9 to 13), as well as a model of co-occurring social anxiety disorder (SAD) and ED symptoms. METHOD Preadolescent boys (n = 405) and girls (n = 325) completed the Children Eating Attitudes Test-20 and Social Anxiety Scale for Children. We estimated two network models (ED and ED/SAD networks) and identified central and bridge symptoms, as well as tested if these models differed by sex. RESULTS We found that discomfort eating sweets were the most central symptoms in ED networks. Concern over being judged was central in networks including both ED and SAD symptoms. Additionally, concern over being judged was the strongest bridge symptoms. Networks did not differ by sex. CONCLUSION Future research is needed to test if interventions focused on bridge symptoms (i.e., concern over being judged) as primary intervention points target comorbid ED-SAD pathology in preadolescents at risk for ED and SAD. LEVEL OF EVIDENCE Level III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Ani C Keshishian
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Caroline Christian
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.
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16
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Alleva JM, Paraskeva N, Craddock N, Stuijfzand BG, Diedrichs PC. A longitudinal study investigating positive body image, eating disorder symptoms, and other related factors among a community sample of men in the UK. Body Image 2022; 41:384-395. [PMID: 35525157 DOI: 10.1016/j.bodyim.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Emerging research suggests that positive body image-an overall love and respect for one's body- may be a protective factor for eating disorder (ED) symptoms. This study aimed to explore the relationships between positive body image, ED symptoms, and related factors among men across time. A community sample of 440 British men completed questionnaires at Time 1 and Time 2 (1 year later). Linear models showed that, unexpectedly, positive body image at Time 1 did not predict change in ED symptoms at Time 2, and ED symptoms at Time 1 did not predict change in positive body image at Time 2. However, positive body image at Time 1 did predict increased appearance satisfaction and decreased appearance-ideal internalisation at Time 2. Increased positive body image at Time 2 was only predicted by appearance satisfaction at Time 1. Although no evidence for a longitudinal relationship between positive body image and ED symptoms was found, positive body image did predict change in established risk factors for disordered eating among men. Future research on positive body image and eating behaviour among men could be improved by including assessments of muscularity-oriented and adaptive eating behaviours.
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Affiliation(s)
- Jessica M Alleva
- Department of Clinical Psychological Science, Maastricht University, The Netherlands.
| | - Nicole Paraskeva
- Centre for Appearance Research, University of the West of England, United Kingdom
| | - Nadia Craddock
- Centre for Appearance Research, University of the West of England, United Kingdom
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17
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Keshishian AC, Christian C, Williams BM, Spoor SP, Peiper NC, Levinson CA. A Network Analysis Investigation of Disordered Eating Across Demographic and Developmental Subpopulations Using a National Epidemiological Sample of High School Students. Behav Ther 2022; 53:535-545. [PMID: 35473655 DOI: 10.1016/j.beth.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/09/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022]
Abstract
Disordered eating (DE) poses a large societal burden, yet limited research has examined DE from a developmental epidemiological perspective. It is important to consider how demographics influence DE symptoms to inform prevention and early intervention programs across diverse subpopulations. Therefore, we conducted network analyses using a large nationally representative epidemiological sample of high school students (Youth Risk Behavior Survey, United States; n = 59,582) to identify the most important symptoms and symptom relationships among six DE behaviors. We compared networks by sex, grade, and race to identify differences in symptom networks. Dieting for weight loss was highly central across networks. Networks significantly differed across sex, grade, and race. Our results suggest that dieting for weight loss may be an early intervention target for eating disorders, regardless of demographic and developmental factors. In addition, sex, race, and age should be accounted for when researching and developing prevention programs for DE and eating disorders. Public health officials, as well as mental health professionals, should present a more balanced message about dieting and weight loss to high school students to prevent the detrimental impact of DE on physical and mental health. Notably, this study is the first large, nationwide epidemiological sample using DE symptoms in network analysis.
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Affiliation(s)
| | | | | | | | - Nicholas C Peiper
- University of Louisville School of Public Health and Information Sciences
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18
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Nelson JD, Cuellar AE, Cheskin LJ, Fischer S. Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity. Behav Ther 2022; 53:310-322. [PMID: 35227406 DOI: 10.1016/j.beth.2021.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/02/2022]
Abstract
Eating disorders (EDs) and posttraumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first-year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating.
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19
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Kenny B, Orellana L, Fuller-Tyszkiewicz M, Moodie M, Brown V, Williams J. Depression and eating disorders in early adolescence: A network analysis approach. Int J Eat Disord 2021; 54:2143-2154. [PMID: 34625986 DOI: 10.1002/eat.23627] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Eating disorders (EDs) and depression are among the most debilitating and pervasive mental illnesses. Although they often co-occur, the relationship between EDs and depression remains poorly understood. This study used network analysis to explore the symptom-level relationship between EDs and depression among a sample of Australian adolescents completing their first year of secondary school. METHOD Adolescents (N = 4,421) aged between 10 and 15 years completed the Centre for Epidemiological Depression Scale and the Eating Disorder Examination-Questionnaire. Network structure was estimated using the Gaussian graphical model and node centrality was assessed using one-step expected influence (EI) and bridge EI. RESULTS "Depressed," "lonely," and "low energy" were identified as core symptoms of depression. "Shape and weight dissatisfaction," "desire to lose weight," and "preoccupation with shape or weight" were identified as core ED symptoms. "Irritable," "social eating," and "depressed" were identified as the most important nodes connecting (i.e., bridging) symptoms of depression and EDs. DISCUSSION This study provides an important symptom-level conceptualization of the association between depression and ED symptoms in a community sample of adolescents. This preliminary evidence may guide the development of public health prevention and early intervention programs. Future research should be conducted to address the study limitations (e.g., cross-sectional design).
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Affiliation(s)
- Bridget Kenny
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development, Deakin University, Melbourne, Victoria, Australia.,Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Faculty of Health, Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Vicki Brown
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Faculty of Health, Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Joanne Williams
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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20
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Messer M, Linardon J. Exploring the role of feeling fat in individuals categorized with bulimia nervosa, binge-eating disorder and overweight/obesity. Eat Weight Disord 2021; 26:2617-2623. [PMID: 33570744 DOI: 10.1007/s40519-021-01119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Despite featuring in prominent theoretical models, the role of "feeling fat" in certain eating and weight disorder presentations remains poorly understood. This study compared levels of feeling fat between people categorized with referable bulimia nervosa (BN) symptoms, binge-eating disorder (BED) symptoms, and overweight/obesity, and examined the unique associations of feeling fat on measures of eating pathology and functional impairment within each of these subgroups. METHODS Data were analyzed from 977 participants who met criteria referable to BN symptoms (n = 419), BED symptoms (n = 346), or overweight/obesity without ED psychopathology (n = 212) based on self-report symptom frequency. RESULTS Analysis of variance revealed that feeling fat levels were highest in the referable BN group, followed by the referable BED group, and then the overweight/obese subgroup. Multiple regressions revealed that feeling fat contributed additional variance to functional impairment and key cognitive (e.g., eating concerns) and behavioural (e.g., dietary restraint) symptoms only among those who met criteria referable to BN. CONCLUSION Overall, findings suggest that the experience of feeling fat may be an important component of body image particularly among individuals with BN-type symptoms. Present findings may also have implications for the assessment and treatment of feeling fat among different eating and weight disorder presentations. LEVEL OF EVIDENCE Cross-sectional descriptive study, Level V.
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Affiliation(s)
- Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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21
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Eating-related guilt and mental health across middle childhood to early adolescence. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Ralph-Nearman C, Williams BM, Ortiz AML, Smith AR, Levinson CA. Pinpointing core and pathway symptoms among sleep disturbance, anxiety, worry, and eating disorder symptoms in anorexia nervosa and atypical anorexia nervosa. J Affect Disord 2021; 294:24-32. [PMID: 34256182 DOI: 10.1016/j.jad.2021.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep, anxiety, and worry are strongly related to psychiatric illness and in particular to eating disorder (ED) symptoms. However, it is unclear how these specific sleep and anxiety symptoms are interrelated with anorexia nervosa (AN) pathology. METHODS We utilized network analysis to test our theoretically-based conceptual model, by identifying core features and illness (i.e., bridge) pathways among sleep disturbance, anxiety, worry, and ED symptoms in 267 participants with a diagnosis of AN or atypical AN. RESULTS The following core symptoms were identified: shape judgement, restriction, and feeling tired. The strongest bridge symptoms included worry, feeling tired, loss of energy, and physical anxiety. Worry was connected positively to fasting, fear of gaining weight or becoming fat, loss of energy, and feeling tired, and negatively to changes in sleeping patterns. Feeling tired was connected to restriction, fasting, binge eating, and worry. Loss of energy was connected to loss of control over eating and worry. Physical anxiety was negatively connected to restriction. CONCLUSIONS We identified specific core symptoms and illness pathways supporting our theoretical conceptual model of how ED symptoms, anxiety, worry, and sleep disturbances inter-relate in AN and atypical AN. In particular we found that symptoms associated with sleep and anxiety were central and had strong connections with AN symptoms. In addition to targeting AN symptoms, these data suggest that targeting sleep disturbance, anxiety, and worry could improve treatment for AN.
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Affiliation(s)
| | - Brenna M Williams
- University of Louisville, Department of Psychological and Brain Sciences, United States
| | | | - April R Smith
- Auburn University, Department of Psychological Sciences, United States
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, United States
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23
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Calugi S, Dametti L, Chimini M, Dalle Grave A, Dalle Grave R. Change in eating-disorder psychopathology network structure in patients with anorexia nervosa treated with intensive cognitive behavior therapy. Int J Eat Disord 2021; 54:1800-1809. [PMID: 34331465 DOI: 10.1002/eat.23590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study was designed to compare the change in eating-disorder feature networks in patients with anorexia nervosa after treatment with intensive enhanced cognitive behavior therapy (CBT-E). METHODS Patients seeking treatment for anorexia nervosa were consecutively recruited from January 2016 to September 2020. All patients aged ≥16 years who completed a 20-week intensive CBT-E program (13 weeks of inpatient followed by 7 weeks of day-hospital treatment) were included in the study. Body mass index (BMI) was measured, and the Eating Disorder Examination Questionnaire completed for each patient, both at baseline and the end of treatment. RESULTS The sample comprised 214 patients with anorexia nervosa. Treated patients showed significant improvements in BMI and eating-disorder psychopathology. Network analysis revealed a significant reduction in the network global and connection strengths at the end of treatment. The most central and highly interconnected nodes in the network at baseline were related to the drive for thinness, but at the end of treatment to body image concerns. Some edge connections were significantly stronger at baseline than at the end of treatment, while others were significantly stronger at the end of treatment than at baseline. DISCUSSION CBT-E reduces the psychopathology network connectivity over time in patients with anorexia nervosa. The differences in central nodes and edge connections between baseline and end of treatment, not detected by classical inferential analysis, may be informative for understanding the centrality of symptoms in the psychopathology network, and how a specific treatment may act to reduce symptoms and change their connections over time.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Mirko Chimini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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24
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Schlegl S, Smith KE, Vierl L, Crosby RD, Moessner M, Neumayr C, Voderholzer U. Using network analysis to compare diagnosis-specific and age-specific symptom networks in eating disorders. Int J Eat Disord 2021; 54:1463-1476. [PMID: 33949717 DOI: 10.1002/eat.23523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The network theory of mental disorders conceptualizes eating disorders (EDs) as networks of interacting symptoms. Network analysis studies in EDs mostly have examined transdiagnostic and/or mixed age samples. The aim of our study was to investigate similarities and differences of networks in adolescents and adults with anorexia nervosa (AN) or bulimia nervosa (BN). METHOD Participants were 2,535 patients (n = 991 adults with AN, n = 821 adolescents with AN, n = 473 adults with BN, and n = 250 adolescents with BN) who completed the Eating Disorder Inventory-2. Twenty-seven items were selected. Cross-sectional networks were estimated via Joint Graphical Lasso. Core symptoms were identified using strength centrality. Spearman correlations and network comparison tests (NCTs) were used to compare groups. RESULTS Across diagnoses and ages, feeling ineffective, desire to be thinner, worries that feelings will get out of control, guilt after overeating as well as doing things perfectly emerged as most central symptoms. There were moderate to high correlations between symptom profiles (0.62-0.97, mean: 0.78) as well as high correlations between network structures (0.83-0.93, mean: 0.87) and network strengths (0.73-0.95, mean: 0.85). Global strength significantly differed in two of the six NCTs, and 2.5-10% of edges differed between networks. DISCUSSION Considerable similarities in network structures and strengths across diagnoses and ages speak in favor of the transdiagnostic approach to EDs. Besides drive for thinness, ineffectiveness, emotion regulation difficulties, and perfectionism might be the most consistent factors in ED networks. These symptoms as well as their symptom connections should be especially focused in treatment regardless of age and diagnosis.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Science, University of Southern California, Los Angeles, California, USA
| | - Larissa Vierl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany.,Schoen Clinic Roseneck, Prien, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
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25
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Monteleone AM, Cascino G. A systematic review of network analysis studies in eating disorders: Is time to broaden the core psychopathology to non specific symptoms. EUROPEAN EATING DISORDERS REVIEW 2021; 29:531-547. [PMID: 33942439 PMCID: PMC8251923 DOI: 10.1002/erv.2834] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
Objective Network theory considers mental disorders as the product of symptom interaction. A growing number of studies employing this methodology has been conducted in eating disorders (EDs). We aimed to review those studies to provide evidence and limitations for a novel conceptualisation of EDs. Methods According to PRISMA guidelines and PICOS criteria, studies eligible for inclusion were those employing network analysis in people with a clinically defined diagnosis of ED. Twenty‐five studies were included and were analysed in relation to diagnosis, comorbidity, and treatment outcome. Results Despite the central role of overvaluation of body shape and weight and cognitive restraint across ED diagnoses, ineffectiveness, interoceptive awareness and affective problems appear central symptoms. Ineffectiveness and interoceptive awareness emerge as bridge symptoms promoting comorbidity in people with anorexia nervosa and in mixed ED samples. Although few studies assessed treatment outcome, there is evidence supporting the predictive role of central network nodes. Conclusions Ineffectiveness, interoceptive ability and affective problems may be included in the core ED psychopathology, in addition to ED‐specific symptoms. Network analysis is a promising method to reconceptualize comorbidity. Future studies are recommended to include general psychopathology in ED networks, to assess connections with the external field and clinical meaning of network connectivity. Overvaluation of body shape and weight and cognitive restraint appear as central nodes across eating disorder diagnoses and ages. In addition to specific symptoms, ineffectiveness, low interoceptive ability and affective problems also emerge as central nodes in eating disorders. There is some evidence to point to ineffectiveness and low interoceptive ability as bridge nodes promoting psychiatric comorbidity. Only few studies assessed treatment outcome through the network analysis approach
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Affiliation(s)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
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Byrne ME, Tanofsky-Kraff M, Lavender JM, Parker MN, Shank LM, Swanson TN, Ramirez E, LeMay-Russell S, Yang SB, Brady SM, Zenno A, Chivukula KK, Kelly NR, Yanovski JA. Bridging executive function and disinhibited eating among youth: A network analysis. Int J Eat Disord 2021; 54:721-732. [PMID: 33502799 PMCID: PMC8119329 DOI: 10.1002/eat.23476] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Poorer executive function (EF) has been linked to disinhibited eating in youth, suggesting poor EF predisposes toward obesity, yet the specific nature and extent of interconnections between facets of these domains is unclear. Network analysis provides a promising framework for elucidating the relationship between poor EF and disinhibited eating, and offers insights into potential maintenance processes. METHOD Among youth ages 8-17 years, a regularized partial correlation network of EF and disinhibited eating facets was estimated to examine expected influence centrality and bridge expected influence. Computerized neurocognitive tasks assessed EF variables, including decision-making, general and food-related inhibitory control, delayed gratification, cognitive flexibility, and working memory. Disinhibited eating variables included total carbohydrate-fat intake at a laboratory test meal and self-reported eating in the absence of hunger, emotional eating, and loss-of-control eating severity. RESULTS In the current sample (N = 248; Mage = 12.5; 54.8% female; 43.5% non-Hispanic White; 25.8% non-Hispanic Black; BMI %ile = 65.8 ± 27.8), emotional eating in response to depressive symptoms emerged as a central symptom in the network. Carbohydrate-fat intake had the highest bridge expected influence and was most strongly connected to general inhibitory control (part r = .14). DISCUSSION The link between general inhibitory control and objective palatable food intake may be particularly salient in maintaining maladaptive eating behavior. Interventions targeting behavioral disinhibition may disrupt associations among a network of disinhibited eating facets in youth and should be targets for longitudinal research.
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Affiliation(s)
- Meghan E. Byrne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892,Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814,Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Megan N. Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Lisa M. Shank
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892,Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814,Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Taylor N. Swanson
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892,Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814
| | - Eliana Ramirez
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Sarah LeMay-Russell
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Shanna B. Yang
- Nutrition Department, Clinical Center, NIH, DHHS, 10 Center Drive, Bethesda, MD, 20892
| | - Sheila M. Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Anna Zenno
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - K. Karthik Chivukula
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, Prevention Science Institute, College of Education, University of Oregon, 1215 University of Oregon, Eugene, OR, 97403
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
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Christian C, Williams BM, Hunt RA, Wong VZ, Ernst SE, Spoor SP, Vanzhula IA, Tregarthen JP, Forbush KT, Levinson CA. A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive-behavioral model of eating-disorder symptoms. Psychol Med 2021; 51:815-824. [PMID: 31907093 DOI: 10.1017/s0033291719003817] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the past decade, network analysis (NA) has been applied to psychopathology to quantify complex symptom relationships. This statistical technique has demonstrated much promise, as it provides researchers the ability to identify relationships across many symptoms in one model and can identify central symptoms that may predict important clinical outcomes. However, network models are highly influenced by node selection, which could limit the generalizability of findings. The current study (N = 6850) tests a comprehensive, cognitive-behavioral model of eating-disorder symptoms using items from two, widely used measures (Eating Disorder Examination Questionnaire and Eating Pathology Symptoms Inventory). METHODS We used NA to identify central symptoms and compared networks across the duration of illness (DOI), as chronicity is one of the only known predictors of poor outcome in eating disorders (EDs). RESULTS Our results suggest that eating when not hungry and feeling fat were the most central symptoms across groups. There were no significant differences in network structure across DOI, meaning the connections between symptoms remained relatively consistent. However, differences emerged in central symptoms, such that cognitive symptoms related to overvaluation of weight/shape were central in individuals with shorter DOI, and behavioral central symptoms emerged more in medium and long DOI. CONCLUSIONS Our results have important implications for the treatment of individuals with enduring EDs, as they may have a different core, maintaining symptoms. Additionally, our findings highlight the importance of using comprehensive, theoretically- or empirically-derived models for NA.
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Affiliation(s)
- Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Valerie Z Wong
- Department of Psychology, Yale University New Haven, CT, United States of America
| | - Sarah E Ernst
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Samantha P Spoor
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Irina A Vanzhula
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, United States of America
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
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28
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Sahlan RN, Williams BM, Forrest LN, Saunders JF, Fitzsimmons-Craft EE, Levinson CA. Disordered eating, self-esteem, and depression symptoms in Iranian adolescents and young adults: A network analysis. Int J Eat Disord 2021; 54:132-147. [PMID: 32865853 PMCID: PMC8159574 DOI: 10.1002/eat.23365] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The network theory of psychopathology examines networks of interconnections across symptoms. Several network studies of disordered eating have identified central and bridge symptoms in Western samples, yet network models of disordered eating have not been tested in non-Western samples. The current study tested a network model of disordered eating in Iranian adolescents and college students, as well as models of co-occurring depression and self-esteem. METHOD Participants were Iranian college students (n= 637) and adolescents (n = 1,111) who completed the Eating Disorder Examination-Questionnaire (EDE-Q), Rosenberg Self-Esteem Scale (RSES) and Beck Depression Inventory, Second Edition (BDI-II). We computed six Glasso networks and identified central and bridge symptoms. RESULTS Central disordered eating nodes in most models were a desire to lose weight and discomfort when seeing one's own body. Central self-esteem and depression nodes were feeling useless and self-dislike, respectively. Feeling like a failure was the most common bridge symptom between disordered eating and depression symptoms. With exception of a few differences in some edges, networks did not significantly differ in structure. DISCUSSION Desire to lose weight was the most central node in the networks, which is consistent with sociocultural theories of disordered eating development, as well as prior network models from Western-culture samples. Feeling like a failure was the most central bridge symptom between depression and disordered eating, suggesting that very low self-esteem may be a shared correlate or risk factor for disordered eating and depression in Iranian adolescents and young adults.
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Affiliation(s)
- Reza N. Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Brenna M. Williams
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | | | | | | | - Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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29
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Levinson CA, Williams BM. Eating disorder fear networks: Identification of central eating disorder fears. Int J Eat Disord 2020; 53:1960-1973. [PMID: 32918319 DOI: 10.1002/eat.23382] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Eating-related fear and anxiety are hallmark symptoms of eating disorders (EDs). However, it is still unclear which fears are most important (e.g., food, weight gain), which has practical implications, given treatments for eating-related fear necessitate modifications based on the specific fear driving ED pathology. For example, exposure treatments should be optimized based on specific fears that maintain pathology. The current study (N = 1,622 combined clinical ED and undergraduate sample) begins to answer questions on the precise nature of ED fears and how they operate with other ED symptoms. METHOD We used network analysis to create two models of ED fears and symptoms. The first model consisted of ED fears only (e.g., fears of food, fears of weight gain) to identify which fear is most central. The second model consisted of ED fears and ED symptoms to detect how ED fears operate with ED symptoms. RESULTS We found fear of disliking how one's body feels due to weight gain, disliking eating in social situations, feeling tense around food, fear of judgment due to weight gain, and food anxiety were the most central ED fears. We also identified several bridge symptoms between ED fears and symptoms. Finally, we found that the most central ED fears predicted excessive exercise at two-month follow-up. DISCUSSION These data support the idea that consequences (i.e., judgment) associated with fears of weight gain and interoceptive fears are the most central ED fears. These data have implications for the future development of precision interventions targeted to address ED-related fear.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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30
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Levinson CA, Williams BM, Christian C. What are the emotions underlying feeling fat and fear of weight gain? J Affect Disord 2020; 277:146-152. [PMID: 32828001 DOI: 10.1016/j.jad.2020.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/29/2020] [Accepted: 08/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Eating disorders (EDs) are most always accompanied by cognitive-affective comorbidities, such as anxiety and depression. In addition to these common comorbidities, EDs are unique in that they are characterized by affective symptoms centered on body image and weight. Two of these primary, yet understudied, affective symptoms are feelings of fatness and fears of weight gain, which are theorized to be maintaining symptoms of EDs and are highly common in those with EDs. Despite the importance of these symptoms, there is no research characterizing which cognitive-affective symptoms contribute to feelings of fatness and fears of weight gain. METHODS The current study (N=168 individuals with an ED) tested cross-sectional and prospective models of cognitive-affect variables (negative affect, guilt, shame, fear of negative evaluation, anxiety sensitivity, and depression) to identify which thoughts and emotions were uniquely associated and prospectively predicted feelings of fatness and fear of weight gain. RESULTS Depression both cross-sectionally and prospectively predicted feeling fat over and above all other forms of affect. Fears of negative evaluation and depression were uniquely associated with fears of weight gain, and shame prospectively predicted fear of weight gain. LIMITATIONS Variables were self-reported, and the sample primarily consisted of women. Fear of weight gain and feelings of fatness were assessed using single items. CONCLUSIONS This research suggests that depression may be an important intervention target when individuals with an ED report feeling fat. Additionally, treatment targeting fear of negative evaluation, depression, and shame may decrease fears of weight gain.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States.
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States
| | - Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States
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31
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Vervaet M, Puttevils L, Hoekstra RHA, Fried E, Vanderhasselt MA. Transdiagnostic vulnerability factors in eating disorders: A network analysis. EUROPEAN EATING DISORDERS REVIEW 2020; 29:86-100. [PMID: 33159404 DOI: 10.1002/erv.2805] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/02/2020] [Accepted: 10/24/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Eating disorder (ED) symptoms and transdiagnostic vulnerability characteristics play a crucial role in the aetiology and maintenance of EDs. Over the last decade, researchers have started to model complex interrelations between symptoms using network models, but the literature is limited in that it has focused solely on symptoms and investigated-specific disorders while ignoring transdiagnostic aspects of mental health. METHOD This study tackles these challenges by investigating network relations among core ED symptoms, comorbid clinical symptoms (depression and anxiety) and empirically supported vulnerability and protective mechanisms (personality traits, maladaptive cognitive schemata, perfectionism and resilience) in a sample of 2302 treatment-seeking ED patients. We estimated a regularized partial correlation network to obtain conditional dependence relations among all variables. We estimated node centrality (interconnectivity) and node predictability (the overall magnitude of symptom inter-relationships). RESULTS The findings indicate a central role of overvigilance, excessive focus on inhibiting emotions and feelings, interoceptive awareness and perfectionism. CONCLUSIONS These results suggest that excessive control of bodily aspects by dietary restraint (possibly through inhibition) and interoceptive awareness may be important constructs that warrant future research in understanding vulnerability in EDs. We provide all code and data via the Open Science Framework.
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Affiliation(s)
- Myriam Vervaet
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Louise Puttevils
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Ria H A Hoekstra
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Eiko Fried
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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32
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Spiller TR, Levi O, Neria Y, Suarez-Jimenez B, Bar-Haim Y, Lazarov A. On the validity of the centrality hypothesis in cross-sectional between-subject networks of psychopathology. BMC Med 2020; 18:297. [PMID: 33040734 PMCID: PMC7549218 DOI: 10.1186/s12916-020-01740-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the network approach to psychopathology, psychiatric disorders are considered networks of causally active symptoms (nodes), with node centrality hypothesized to reflect symptoms' causal influence within a network. Accordingly, centrality measures have been used in numerous network-based cross-sectional studies to identify specific treatment targets, based on the assumption that deactivating highly central nodes would proliferate to other nodes in the network, thereby collapsing the network structure and alleviating the overall psychopathology (i.e., the centrality hypothesis). METHODS Here, we summarize three types of evidence pertaining to the centrality hypothesis in psychopathology. First, we discuss the validity of the theoretical assumptions underlying the centrality hypothesis in psychopathology. We then summarize the methodological aspects of extant studies using centrality measures as predictors of symptom change following treatment, while delineating their main findings and several of their limitations. Finally, using a specific dataset of 710 treatment-seeking patients with posttraumatic stress disorder (PTSD) as an example, we empirically examine node centrality as a predictor of therapeutic change, replicating the approach taken by previous studies, while addressing some of their limitations. Specifically, we investigated whether three pre-treatment centrality indices (strength, predictability, and expected influence) were significantly correlated with the strength of the association between a symptom's change and the change in the severity of all other symptoms in the network from pre- to post-treatment (Δnode-Δnetwork association). Using similar analyses, we also examine the predictive validity of two simple non-causal node properties (mean symptom severity and infrequency of symptom endorsement). RESULTS Of the three centrality measures, only expected influence successfully predicted how strongly changes in nodes/symptoms were associated with change in the remainder of the nodes/symptoms. Importantly, when excluding the amnesia node, a well-documented outlier in the phenomenology of PTSD, none of the tested centrality measures predicted symptom change. Conversely, both mean symptom severity and infrequency of symptom endorsement, two standard non-network-derived indices, were found to be more predictive than expected influence and remained significantly predictive also after excluding amnesia from the network analyses. CONCLUSIONS The centrality hypothesis in its current form is ill-defined, showing no consistent supporting evidence in the context of cross-sectional, between-subject networks.
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Affiliation(s)
- Tobias R Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Ofir Levi
- Division of Mental Health, Medical Corps, Israel Defense Forces, Tel Aviv, Israel
- Social Work Department, Ruppin Academic Center, Emek Hefer, Israel
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Neria
- Departments of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Benjamin Suarez-Jimenez
- Departments of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Amit Lazarov
- Departments of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
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Ranzenhofer LM, Wilhelmy M, Hochschild A, Sanzone K, Walsh BT, Attia E. Peer mentorship as an adjunct intervention for the treatment of eating disorders: A pilot randomized trial. Int J Eat Disord 2020; 53:497-509. [PMID: 32159243 PMCID: PMC7383944 DOI: 10.1002/eat.23258] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Peer mentorship has been shown to be helpful for other mental health conditions, but it has been understudied for patients with eating disorders. The goal of the present study was to evaluate the feasibility and efficacy of peer mentorship for individuals with eating disorders by conducting a randomized controlled trial (RCT). TRIAL DESIGN Parallel three-arm pilot RCT with 1:1:1 allocation to peer mentorship, social support mentorship (active comparison intervention), and waiting list. METHOD Sixty outpatients with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) were randomly assigned to a condition. Outcome measures, including eating disorder symptoms and general psychopathology, were completed at baseline, mid-, and postintervention. RESULTS Session attendance and acceptability ratings were higher in peer mentorship than social support mentorship. More participants in social support mentorship (39%) dropped out compared to peer mentorship (5%). In intent-to-treat analysis, peer mentorship showed greater reductions in body dissatisfaction and anxiety compared with both control groups. Compared with social support mentorship, peer mentorship had greater reductions in depression. Compared with waiting list, peer mentorship had greater reduction in binge eating days/week in patients with BN/BED and restriction days/week in patients with AN. Peer mentorship did not impact body mass index or reentry into higher level of care. DISCUSSION This pilot RCT provides preliminary evidence that peer mentorship is effective for some cognitive and behavioral symptoms of eating disorders as an adjunct to outpatient treatment. Additional studies are needed to evaluate the efficacy of peer mentorship in absence of treatment.
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Affiliation(s)
- Lisa M. Ranzenhofer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Mylene Wilhelmy
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Annabella Hochschild
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Kaitlin Sanzone
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
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34
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Calugi S, Sartirana M, Misconel A, Boglioli C, Dalle Grave R. Eating disorder psychopathology in adults and adolescents with anorexia nervosa: A network approach. Int J Eat Disord 2020; 53:420-431. [PMID: 32314382 DOI: 10.1002/eat.23270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess and compare eating disorder feature networks in adult and adolescent patients with anorexia nervosa. METHODS Patients seeking treatment for anorexia nervosa in inpatient and outpatient settings were consecutively recruited from January 2008 to September 2019. Body mass index was measured, and each patient completed the Eating Disorder Examination Questionnaire. RESULTS The sample comprised 547 adolescent and 724 adult patients with anorexia nervosa. Network analysis showed that in both adults and adolescents, the most central and highly interconnected nodes in the network were related to shape overvaluation and desiring weight loss. The network comparison test identified similar global strength and network invariance, confirming the similarity of the two network structures. DISCUSSION The network structures in adult and adolescent patients with anorexia nervosa are similar, and lend weight to the cognitive behavioral theory that overvaluation of shape and weight is the core feature of anorexia nervosa psychopathology.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | | - Arianna Misconel
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Camilla Boglioli
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Schaumberg K, Wonderlich S, Crosby R, Peterson C, Le Grange D, Mitchell JE, Crow S, Joiner T, Bardone-Cone AM. Impulsivity and anxiety-related dimensions in adults with bulimic-spectrum disorders differentially relate to eating disordered behaviors. Eat Behav 2020; 37:101382. [PMID: 32247895 PMCID: PMC7259439 DOI: 10.1016/j.eatbeh.2020.101382] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
While facets of both anxiety and impulsivity appear central to the development and maintenance of bulimia nervosa (BN), specific BN behaviors may be propagated by differing profiles of risk. The current study examined associations between dimensions of anxiety and impulsivity and BN symptoms (binge eating, vomiting, laxative misuse, driven exercise), both in terms of the presence of such behaviors and their frequency. Two hundred and four women (Mage = 25.7 years) who met DSM-IV criteria for full or subthreshold BN completed self-report measures of perfectionism (Frost Multidimensional Perfectionism Scale), anxiety (Spielberger Trait Anxiety Inventory), impulsivity (Barratt Impulsiveness Scale-11; Impulsive Behavior Scale), eating disordered behaviors (Eating Disorder Examination - Questionnaire), and associated psychiatric symptoms (Michigan Assessment Screening Test/Alcohol-Drug; Maudsley Obsessive-Compulsive Inventory). Factor analysis revealed multidimensional impulsive and anxiety-related traits (5 anxiety-related factors; 7 impulsivity-related factors). In zero-sensitive regression models, different facets of impulsivity evidenced association with the presence of binge eating (risk taking), laxative misuse (impulsive spending), and fasting (difficulty concentrating), along with the frequency of vomiting (long-term planning difficulties). In contrast, anxiety-related dimensions were only associated with driven exercise (high standards) and fasting (concern over mistakes, high standards, parental expectations). Overall, impulsive and anxiety-related factors and symptoms showed distinct associations with specific eating disorder behaviors, even among those with the same diagnosis.
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Affiliation(s)
| | | | - Ross Crosby
- Biobehavioral Research Institute, Sanford Health
| | | | - Daniel Le Grange
- University of California, San Francisco,The University of Chicago
| | | | - Scott Crow
- University of Minnesota, Department of Psychiatry
| | | | - Anna M. Bardone-Cone
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience
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Wasil AR, Venturo-Conerly KE, Shinde S, Patel V, Jones PJ. Applying network analysis to understand depression and substance use in Indian adolescents. J Affect Disord 2020; 265:278-286. [PMID: 32090752 DOI: 10.1016/j.jad.2020.01.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/14/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Network analysis has been used to better understand relationships between depressive symptoms. Existing work has rarely examined networks of adolescents or individuals in non-western countries. METHODS We used data from 13,035 adolescents (52.5% male; Mage=13.8) from Bihar, a low-resource state in India. Depression was measured using the Patient Health Questionnaire-9, and substance use was measured using a questionnaire adapted from the World Health Organization. We modeled a network of depressive symptoms and a network examining connections between depressive symptoms and substance use. RESULTS The most commonly reported depressive symptoms were sleep problems, poor appetite, and low energy. In the depression network, feeling like a failure and sad mood were the most central symptoms, and somatic symptoms clustered together. To our surprise, depressive symptoms were only weakly associated with substance use. LIMITATIONS Our study uses cross-sectional data, which are not sufficient to draw causal inferences about the relationships between symptoms. Additionally, we used an exploratory data-driven approach, and we did not pose a priori hypotheses about the relationships between symptoms. DISCUSSION Our findings suggest that feelings like a failure and sad mood are highly central symptoms in Indian adolescents; future research may examine if these symptoms are strong targets for intervention. Sad mood has commonly been identified as a central symptom of depression in western samples, while feeling like a failure has not. We offer avenues for future research, illustrating how network analysis may enhance our ability to understand, prevent, and treat psychopathology in LMICs.
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Affiliation(s)
- Akash R Wasil
- Department of Psychology, Harvard University, United States; Department of Psychology, University of Pennsylvania, United States
| | | | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, United States; Sangath, Goa, India
| | - Payton J Jones
- Department of Psychology, Harvard University, United States
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Perko VL, Forbush KT, Siew CSQ, Tregarthen JP. Application of network analysis to investigate sex differences in interactive systems of eating-disorder psychopathology. Int J Eat Disord 2019; 52:1343-1352. [PMID: 31608479 DOI: 10.1002/eat.23170] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Victoria L Perko
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Cynthia S Q Siew
- Department of Psychology, National University of Singapore, Singapore
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Monteleone AM, Mereu A, Cascino G, Criscuolo M, Castiglioni MC, Pellegrino F, Patriciello G, Ruzzi V, Monteleone P, Vicari S, Zanna V. Re-conceptualization of anorexia nervosa psychopathology: A network analysis study in adolescents with short duration of the illness. Int J Eat Disord 2019; 52:1263-1273. [PMID: 31313374 DOI: 10.1002/eat.23137] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research evidence suggests the need to identify treatments based on a more precise characterization of psychopathology and psychiatric comorbidity in anorexia nervosa. Network analysis provides a new method to conceptualize psychopathology. We use this approach to investigate the relationships between eating disorder and general psychiatric symptoms in adolescents with anorexia nervosa. METHODS Four-hundred and five adolescents with anorexia nervosa and illness duration less than 3 years were consecutively recruited from those admitted to inpatient treatment. They completed the following questionnaires: the Eating Disorder Inventory-3, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Youth Self Report. A network analysis was conducted, including eating psychopathology measures, anxiety and depressive symptoms, and obsessive-compulsive and post-traumatic stress problems. We employ a novel approach, the bridge function, to identify symptom clusters. RESULTS Depression symptoms and personal alienation were the nodes with the highest centrality in the network, followed by asceticism, post-traumatic stress problems, drive to thinness, low self-esteem, and anxiety physical symptoms. Three symptom clusters (relative to eating disorder psychopathology, self-esteem problems, and internalizing difficulties) were identified. Depression symptoms, personal alienation, low self-esteem, and interoceptive deficits showed the highest bridge centrality. Besides eating disorder core symptoms, negative affect and internalizing symptoms seem to contribute to anorexia nervosa psychopathology independently from illness duration effects. DISCUSSION These findings suggest that anorexia nervosa is characterized by a broad psychopathological spectrum rather than the mere eating disorder core symptoms, confirm the need to re-conceptualize psychiatric comorbidity in this disorder, and provide intriguing diagnostic and therapeutic implications.
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Affiliation(s)
| | - Alberta Mereu
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Michela Criscuolo
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Maria Chiara Castiglioni
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Stefano Vicari
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Valeria Zanna
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
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Castro D, Ferreira F, de Castro I, Rodrigues AR, Correia M, Ribeiro J, Ferreira TB. The Differential Role of Central and Bridge Symptoms in Deactivating Psychopathological Networks. Front Psychol 2019; 10:2448. [PMID: 31827450 PMCID: PMC6849493 DOI: 10.3389/fpsyg.2019.02448] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022] Open
Abstract
The network model of psychopathology suggests that central and bridge symptoms represent promising treatment targets because they may accelerate the deactivation of the network of interactions between the symptoms of mental disorders. However, the evidence confirming this hypothesis is scarce. This study re-analyzed a convenience sample of 51 cross-sectional psychopathological networks published in previous studies addressing diverse mental disorders or clinically relevant problems. In order to address the hypothesis that central and bridge symptoms are valuable treatment targets, this study simulated five distinct attack conditions on the psychopathological networks by deactivating symptoms based on two characteristics of central symptoms (degree and strength), two characteristics of bridge symptoms (overlap and bridgeness), and at random. The differential impact of the characteristics of these symptoms was assessed in terms of the magnitude and the extent of the attack required to achieve a maximum impact on the number of components, average path length, and connectivity. Only moderate evidence was obtained to sustain the hypothesis that central and bridge symptoms constitute preferential treatment targets. The results suggest that the degree, strength, and bridgeness attack conditions are more effective than the random attack condition only in increasing the number of components of the psychopathological networks. The degree attack condition seemed to perform better than the strength, bridgeness, and overlap attack conditions. Overlapping symptoms evidenced limited impact on the psychopathological networks. The need to address the basic mechanisms underlying the structure and dynamics of psychopathological networks through the expansion of the current methodological framework and its consolidation in more robust theories is stressed.
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Affiliation(s)
- Daniel Castro
- Department of Social and Behavioural Sciences, University Institute of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Filipa Ferreira
- Department of Social and Behavioural Sciences, University Institute of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Inês de Castro
- Department of Social and Behavioural Sciences, University Institute of Maia, Maia, Portugal
| | - Ana Rita Rodrigues
- Department of Social and Behavioural Sciences, University Institute of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Marta Correia
- Department of Social and Behavioural Sciences, University Institute of Maia, Maia, Portugal
| | - Josefina Ribeiro
- Department of Social and Behavioural Sciences, University Institute of Maia, Maia, Portugal
| | - Tiago Bento Ferreira
- Department of Social and Behavioural Sciences, University Institute of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
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Forrest LN, Perkins NM, Lavender JM, Smith AR. Using network analysis to identify central eating disorder symptoms among men. Int J Eat Disord 2019; 52:871-884. [PMID: 31228298 DOI: 10.1002/eat.23123] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
| | | | - Jason M Lavender
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio
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Fusar‐Poli P, Solmi M, Brondino N, Davies C, Chae C, Politi P, Borgwardt S, Lawrie SM, Parnas J, McGuire P. Transdiagnostic psychiatry: a systematic review. World Psychiatry 2019; 18:192-207. [PMID: 31059629 PMCID: PMC6502428 DOI: 10.1002/wps.20631] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the "transdiagnostic" approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self-defining transdiagnostic research meets such high expectations. A multi-step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word "transdiagnostic" in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical "TRANSD"iagnostic recommendations are proposed here to guide future research in this field.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Neuroscience Department, Psychiatry UnitUniversity of PaduaPaduaItaly
| | - Natascia Brondino
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Chungil Chae
- Applied Cognitive Science Lab, Department of Information Science and TechnologyPennsylvania State University, University ParkPAUSA
| | - Pierluigi Politi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | | | | | - Josef Parnas
- Center for Subjectivity ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Philip McGuire
- OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,National Institute for Health Research Maudsley Biomedical Research CentreSouth London and Maudsley NHS Foundation TrustLondonUK
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Forrest LN, Sarfan LD, Ortiz SN, Brown TA, Smith AR. Bridging eating disorder symptoms and trait anxiety in patients with eating disorders: A network approach. Int J Eat Disord 2019; 52:701-711. [PMID: 30900758 DOI: 10.1002/eat.23070] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Anxiety is thought to influence the development and maintenance of eating disorders (EDs). However, little is known about how, specifically, anxiety influences ED symptoms and vice versa. Network analysis identifies how symptoms within and across disorders are interconnected. In a network, central nodes (i.e., symptoms) have the strongest relations to other nodes and are thought to maintain psychopathology. Bridge nodes are symptoms in one diagnostic cluster that are strongly connected to symptoms in another diagnostic cluster and are thought to explain comorbidity. We identified central and bridge nodes in a network of ED symptoms and trait anxiety features. METHOD We estimated a regularized partial correlation network in patients with mixed EDs (N = 296). ED symptoms were assessed with the Eating Disorder Examination-Questionnaire. Trait anxiety was assessed with the Trait subscale of the State-Trait Anxiety Inventory. Items to include in the network were selected with a statistical algorithm to ensure that all nodes represented unique constructs. Central and bridge nodes were identified with empirical calculations. RESULTS Central ED nodes were dietary restraint, as well as overvaluation of and dissatisfaction with shape and weight. The central trait anxiety node was low feelings of satisfaction. The strongest ED bridge node was avoidance of social eating. The strongest trait anxiety bridge node was low self-confidence. DISCUSSION Avoidance of social eating and low self-esteem may be routes through which EDs and trait anxiety are linked.
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Affiliation(s)
| | | | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | - Tiffany A Brown
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio
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De Giuseppe R, Di Napoli I, Porri D, Cena H. Pediatric Obesity and Eating Disorders Symptoms: The Role of the Multidisciplinary Treatment. A Systematic Review. Front Pediatr 2019; 7:123. [PMID: 31024868 PMCID: PMC6463004 DOI: 10.3389/fped.2019.00123] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/22/2022] Open
Abstract
The prevalence of obesity in children/adolescents has increased worldwide during the past 30 years, becoming a significant public health concern; prevention, and management of pediatric obesity onset is one of the most critical public health goals for both industrialized and developing countries. Pediatric obesity has been identified as a risk factor for various psychopathologies, including eating disorders (ED). Although it has been demonstrated that a comprehensive multidisciplinary treatment (MT), with small steps and practical approaches to lifestyle change, can be an effective treatment for children and adolescents with obesity, to the best of our knowledge, this is the first systematic review investigating the effect of MT on the development, progression or decrease of ED symptoms (EDS) in this target population. PubMed and Web of Science databases were searched (last search on 18 February 2019) according to a predetermined search strategy, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and Statement. Original studies published in English examining the effect of MT on pediatric overweight/obesity, paying particularly attention at the development of EDS, were eligible for inclusion. Seven hundred and forty-four records have been identified; nine articles with study quality ranging from weak to moderate have been included. MTs were heterogeneous in nature including length, number, frequency and type of sessions, parent-involvement and use of technology, besides several psychometric questionnaires were used to screen for EDS, since there are no standardized criteria. In 3 studies there was a significant decrease in external and emotional eating and in four studies a significant increase in restraint eating post MT. Two studies found a significant decrease of binge eating symptoms and other two studies showed an improvement of self-perception, weight, and shape concern. A statistical significant decrease in BMI, BMIz, BMISDS, and adjusted BMI was observed after all MTs, except one. A narrative summary of the evidences reported highlighted the positive impact of MT on the EDS. Moreover, since weight loss post MTs was not necessarily related to EDS, clinicians should also look for the presence of EDS and treat them accordingly.
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Affiliation(s)
- Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Ilaria Di Napoli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Debora Porri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
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Network Analysis as an Alternative Approach to Conceptualizing Eating Disorders: Implications for Research and Treatment. Curr Psychiatry Rep 2018; 20:67. [PMID: 30079431 DOI: 10.1007/s11920-018-0930-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Network analysis (NA) is an emerging methodology that allows for the characterization of maintaining symptoms and pathways among symptoms of mental disorders. The current paper provides background on NA and discusses the relevance of the network approach for the conceptualization of eating disorders (ED). RECENT FINDINGS We review the burgeoning literature conceptualizing ED from a network approach. Overall, these papers find that fear of weight gain and overvaluation of weight and shape are core symptoms in networks of ED pathology. We integrate literature on new advances in network methodology (e.g., within-person NA) and the clinical relevance of these approaches for the ED field (e.g., personalized ED treatment). We also provide several considerations (e.g., replicability, sample size, and node (item) selection) for researchers who are interested in using network science and recommend several emerging "best practices" for NA. Finally, we highlight novel applications of NA, specifically the ability to identify within-person maintaining symptoms, and the potential treatment implications for ED that network methods may hold. Overall, NA is a new methodology that holds significant promise for new treatment development in the ED field.
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Solmi M, Collantoni E, Meneguzzo P, Tenconi E, Favaro A. Network analysis of specific psychopathology and psychiatric symptoms in patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2018; 27:24-33. [DOI: 10.1002/erv.2633] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/05/2018] [Accepted: 07/01/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Marco Solmi
- Neuroscience Department, Psychiatry UnitUniversity of Padua Padua Italy
- Padua University Hospital Padua Italy
- Centro Neuroscienze Cognitive Padua Italy
| | - Enrico Collantoni
- Neuroscience Department, Psychiatry UnitUniversity of Padua Padua Italy
| | - Paolo Meneguzzo
- Neuroscience Department, Psychiatry UnitUniversity of Padua Padua Italy
| | - Elena Tenconi
- Neuroscience Department, Psychiatry UnitUniversity of Padua Padua Italy
- Padua University Hospital Padua Italy
- Centro Neuroscienze Cognitive Padua Italy
| | - Angela Favaro
- Neuroscience Department, Psychiatry UnitUniversity of Padua Padua Italy
- Padua University Hospital Padua Italy
- Centro Neuroscienze Cognitive Padua Italy
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