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Delaquis CP, Godart N, Barry C, Ringuenet D, Maria AS, Nicolas I, Berthoz S. Perfectionism, self-esteem, and affective symptoms in anorexia nervosa subtypes: A network analysis of French inpatients. J Clin Psychol 2024. [PMID: 38646977 DOI: 10.1002/jclp.23698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Previous studies have highlighted the relevance of perfectionism, self-esteem, and anxio-depressive symptoms in anorexia nervosa (AN). However, the relationships between these factors and cardinal eating disorders (ED) symptoms remain unclear, particularly in AN subtypes. This study aimed to examine their interconnections using network analysis. METHOD The sample included n = 338 inpatients with AN who completed the Eating Disorder Examination Questionnaire, Frost Multidimensional Perfectionism Scale, Rosenberg Self-Esteem Scale, and Hospital Anxiety and Depression Scale. Using network analysis, we estimated three networks: full sample, AN-restrictive (AN-R) and AN-binge/purging (AN-BP) subtypes. We estimated central and bridge symptoms using expected influence and conducted an exploratory network comparison test to compare AN subtypes. RESULTS Overvaluation of Weight and Shape, Concern over Mistakes, and Personal Standards were consistently central in all networks. The most central bridge symptoms across all networks were Concern over Mistakes and Self-Esteem. Concern over Mistakes bridged perfectionism and ED symptoms, while Self-Esteem was highly connected to all symptom clusters. Anxiety was significantly more central in the AN-R network compared to the AN-BP network. CONCLUSIONS The present study contributes to a growing body of network studies suggesting that nodes related to perfectionism are just as central as cardinal ED symptoms, indicating the relevance of perfectionism in ED pathology. The high bridge centrality of self-esteem suggests that it may be an important link between perfectionism, mood, and ED symptoms. Future research should investigate the efficacy of targeting multiple psychological factors in the treatment of AN, as well as their potential transdiagnostic relevance.
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Affiliation(s)
| | - Nathalie Godart
- Fondation Santé des Etudiants de France, Paris, France
- CESP, Inserm, Université Paris Saclay, Villejuif, France
- UFR Simone Veil-Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Caroline Barry
- CESP, Inserm, Université Paris Saclay, Villejuif, France
| | - Damien Ringuenet
- CESP, Inserm, Université Paris Saclay, Villejuif, France
- Unité de Traitement des Troubles des Conduites Alimentaires, Département de Psychiatrie et d'Addictologie, Hôpital Paul Brousse, Villejuif, France
| | | | - Isabelle Nicolas
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Sylvie Berthoz
- INCIA CNRS UMR 5287, Univ. Bordeaux, Bordeaux, France
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
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Kopland MCG, Vrabel K, Slof-Op 't Landt M, Hoffart A, Johnson SU, Giltay EJ. Breaking the cycle: Identifying key symptom pathways of eating disorders and the influence of childhood maltreatment. Int J Eat Disord 2024; 57:316-326. [PMID: 38006259 DOI: 10.1002/eat.24097] [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: 05/31/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Most network analyses on central symptoms in eating disorders (EDs) have been cross-sectional. Longitudinal within-person analyses of therapy processes are scarce. Our aim was to investigate central change processes in therapy in a transdiagnostic sample, considering the influence of childhood maltreatment. METHOD We employed dynamic time warping analyses to identify clusters of symptoms that tended to change similarly across therapy on a within-person level. Symptoms were measured by a 28-item Eating Disorder Examination Questionnaire (EDE-Q). Furthermore, we examined the temporal direction of symptom change to identify symptoms that tended to precede and predict other symptoms. Finally, we estimated two directed, temporal networks in patients with and without a history of childhood maltreatment. RESULTS Our analysis included 122 ED patients (mean age = 30.9, SD = 9.7; illness duration = 14.2 years, SD = 8.9; prior treatment = 5.6 years, SD = 5.1). The initial network revealed three robust clusters of symptoms over time: (1) ED behavior, (2) inhibition, and (3) cognitions and feelings about body and weight. Overvaluation of shape had the highest out-strength preceding and predicting other symptoms. Dissatisfaction with weight preceded and predicted other symptoms in the maltreatment network. The non-maltreatment network showed a similar structure to the transdiagnostic network. CONCLUSION Targeting and monitoring feelings and cognitions related to shape may be crucial for achieving lasting symptom improvement in a transdiagnostic sample. Furthermore, our findings highlight the need for further investigation into the different processes driving EDs based on maltreatment status. PUBLIC SIGNIFICANCE There is limited understanding of the processes that occur for patients with eating disorders between admission and discharge in therapy, especially for patients with a history of childhood maltreatment. Our analyses suggest that changes in cognitions regarding shape precede and predict changes in cognitions about weight. Different processes may be driving the eating disorder according to maltreatment status, which might further illuminate the riddle of dropout and relapse in therapy for patients with a history of childhood maltreatment. These findings suggest the need for further investigation into the specific dynamics occurring during therapy for individuals with a history of childhood maltreatment.
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Affiliation(s)
- Maren C G Kopland
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - KariAnne Vrabel
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Margarita Slof-Op 't Landt
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - Asle Hoffart
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Sverre Urnes Johnson
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Health Campus The Hague, Leiden University, Leiden, The Netherlands
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Gilmartin T, Dipnall JF, Gurvich C, Sharp G. Identifying overcontrol and undercontrol personality types among young people using the five factor model, and the relationship with disordered eating behaviour, anxiety and depression. J Eat Disord 2024; 12:16. [PMID: 38267972 PMCID: PMC10809654 DOI: 10.1186/s40337-024-00967-4] [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: 09/22/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Overcontrol and undercontrol personality types have been associated with an increase in eating pathology, depression and anxiety. The aim of the research was to explore whether latent overcontrol and undercontrol personality types could be identified using cluster analysis of the facets of the five factor model (FFM). We further aimed to understand how these personality types were associated with eating pathology, depressed mood and anxiety. METHODS A total of 561 participants (394 women and 167 men), aged 16-30 years in Australia completed a survey designed to assess disordered eating, FFM personality traits, anxiety, depression and stress. A systematic four-step process using hierarchical, k-means, and random forest cluster analyses were used to identify a meaningful 3-cluster solution. RESULTS The results revealed a cluster solution that represented overcontrol, undercontrol and resilient personality types, and highlighted facets of the FFM that were associated with each type. Both overcontrol and undercontrol personality types were associated with increased clinical symptoms compared to the resilient types. CONCLUSIONS It was concluded that FFM facets may potentially be more meaningful than broad domains in identifying personality types, and that both overcontrol and undercontrol personality types are likely associated with increased clinical symptoms.
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Affiliation(s)
- Tanya Gilmartin
- Department of Neuroscience, Monash University and the Alfred Hospital, Melbourne, Australia.
| | - Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
| | - Caroline Gurvich
- Department of Psychiatry, HER CENTRE Australia, Central Clinical School, Monash University, Melbourne, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University and the Alfred Hospital, Melbourne, Australia
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Wu R, Guang Z, Wang Y, Xue B, Zhang A, Dawa Y, Guo C, Tong X, Wang S, Lu C. Eating disorders symptoms and depressive symptoms in Chinese Tibetan University students: a network analysis. BMC Psychiatry 2023; 23:957. [PMID: 38129774 PMCID: PMC10734136 DOI: 10.1186/s12888-023-05452-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Depression is being increasingly acknowledged as a global public health concern, and following this trend, attention towards eating disorders (EDs) has surged within China's national consciousness. EDs symptoms frequently coexist with various mental health conditions, including depression. However, research focusing on EDs symptoms and depressive symptoms among Tibetan students in China remains scant. This study employs network analysis to estimate the relational network between EDs and depressive symptoms. METHODS Tibetan (n = 2,582) and Han (n = 1,743) students from two universities in the Xizang Autonomous Region, China, completed the Eating Attitude Test-26 (EAT-26) and the Patient Health Questionnaire-9 (PHQ-9). We estimated the network structure of EDs symptoms and depressive symptoms, identified central and bridge symptoms, and examined whether network characteristics differed by gender and ethnic. RESULTS The core symptoms identified within this study were Calorie_awareness, Desire_to_thin and Fatigue. Conversely, bridge symptoms included Appetite, Suicide, Anhedonia, Guilty, Body_fat_awareness, and Food_preoccupation. The study also revealed no significant gender differences within the network model. However, disparities among ethnic groups were observed within the network structure. CONCLUSIONS Our study examined the correlation between EDs symptoms and depressive symptoms in Tibetan college students. Focusing on the individual's quest for the perfect body shape and some Tibetan students' appetite problems - potentially stemming from transitioning to a new university environment, adapting to the school canteen's diet, or being away from their hometown - could aid in the prevention and management of EDs and depression symptoms. It could reduce the incidence of complications by helping students maintain good physical and mental health. Concurrently, our research provides insights into the relatively higher levels of depression triggered by the unique plateau environment.
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Affiliation(s)
- Ruipeng Wu
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, People's Republic of China
| | - Zixuan Guang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Yingting Wang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Bei Xue
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Ailing Zhang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Yundan Dawa
- Department of Tibetan Medicine, University of Tibetan Medicine(UTC), 850000, Lhasa, People's Republic of China
| | - Chenghui Guo
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Xiaopeng Tong
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Shaokang Wang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China.
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, People's Republic of China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 510080, Guangzhou, People's Republic of China.
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Hatoum AH, Burton AL, Berry SL, Abbott MJ. Psychometric properties of self-report measures of eating disorder cognitions: a systematic review. J Eat Disord 2023; 11:233. [PMID: 38124134 PMCID: PMC10734145 DOI: 10.1186/s40337-023-00947-0] [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: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Although eating disorder (ED) models display some differences in theory and treatment approach, cognitive-behavioural, schema-focused, and disorder-specific models all highlight the fundamental nature of cognitions as key factors in ED development and maintenance processes. As such, it is vital that ED cognitions continue to be assessed and monitored as therapeutic targets and treatment outcomes as well as being examined as constructs in empirical research. This review aimed to systematically identify and evaluate the psychometric properties of existing self-report measures of ED cognitions. METHODS A systematic review protocol was registered using the international prospective register of systematic reviews (PROSPERO; CRD42023440840). Included studies described the development, validation and/or the psychometric evaluation of a measure (or subscale) that was specifically developed to solely assess ED cognitions (that is thoughts, expectations, assumptions, or beliefs), in English-speaking, adult populations. The search was conducted using three electronic databases: PsycINFO, MedLine, and Embase. Two independent reviewers conducted screening, selection and evaluation of the psychometric properties of relevant measures using a standardised, well-established quality appraisal tool. RESULTS Of the initial search of 7581 potential studies, 59 met inclusion criteria and described the psychometric evaluation of 31 measures (or subscales) of ED cognitions. The findings from the current review indicate that of the included measures, none currently meet all nine criteria of adequate psychometric properties. The Eating Beliefs Questionnaire (EBQ; and EBQ-18), and the Eating Disorder Inventory Body Dissatisfaction subscale (EDI [BD]) currently possess the most evidence supporting their validity, reliability, and clinical utility. CONCLUSIONS The findings of the current systematic review provide guidance for future researchers to focus efforts on improving evidence for the validity, reliability and utility of self-report measures of ED cognitions. Overall, the present study has provided a detailed and systematic evaluation to support researchers and clinicians in future selection of measures of ED cognitions dependent on the specific aims of their research and treatment.
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Affiliation(s)
- Amaani H Hatoum
- School of Psychology, The University of Sydney, Level 2, 94 Mallet Street, Camperdown, Sydney, NSW, 2006, Australia.
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Amy L Burton
- School of Psychology, The University of Sydney, Level 2, 94 Mallet Street, Camperdown, Sydney, NSW, 2006, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sophie L Berry
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Level 2, 94 Mallet Street, Camperdown, Sydney, NSW, 2006, Australia
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Eisenstadt BE, Murchison GR, Soulliard ZA, Gordon AR. Body Image and High-Risk Weight and Shape Control Behaviors Among Transgender and Nonbinary Young Adults: The Role of Sexual Assault. LGBT Health 2023; 10:586-594. [PMID: 37410994 PMCID: PMC10712357 DOI: 10.1089/lgbt.2022.0324] [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] [Indexed: 07/08/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) populations experience disproportionate rates of sexual assault. Despite evidence from cisgender samples linking sexual assault exposure to body image concerns and disordered eating behaviors, such as weight and shape control behaviors (WSCBs), little is known about these relationships in TNB people. The purpose of this study was to assess associations among past-year sexual assault exposure, body areas satisfaction, body weight esteem, and high-risk WSCBs in a sample of TNB young adults. Methods: A sample of 714 participants completed a cross-sectional online survey. Multivariable linear and logistic models were fit to determine associations between constructs of interest. Natural effects mediation analyses assessed for potential mediation of the relationship between sexual assault and WSCBs by body areas satisfaction and body weight esteem. Analyses were stratified by three gender identity categories. Results: Past-year sexual assault exposure was associated with significantly decreased body areas satisfaction, but only for nonbinary participants. No significant association was found between sexual assault and body weight esteem. Sexual assault was associated with significantly increased risk for WSCBs across gender identity categories. No mediation of these relationships by body areas satisfaction and body weight esteem was observed. Conclusion: Findings support clinical consideration of WSCBs in TNB survivors of sexual assault. Results suggest that multiple factors, including body image and sexual assault, may contribute separately to disordered eating behaviors in TNB young adults.
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Affiliation(s)
- Benjamin E. Eisenstadt
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Gabriel R. Murchison
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Klapsas M, Hindle A. Patients' Pre and Post-Bariatric Surgery Experience of Dieting Behaviours: Implications for Early Intervention. Obes Surg 2023; 33:2702-2710. [PMID: 37468701 DOI: 10.1007/s11695-023-06689-x] [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: 11/01/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Bariatric surgery works, in part, by surgically changing signals of hunger and satiety to achieve weight loss. Not all patients experience optimal outcomes. One potential explanation is that post-surgery dieting may subvert the ability to identify physiological cues of hunger and fullness. Dieting behaviours (e.g. restriction/cognitive restraint) are correlated with disordered eating, and disordered eating implicated in poor outcomes. This study examines the experience of dieting after bariatric surgery. METHOD Seventeen adult participants who had undertaken bariatric surgery and residing in Australia participated in semi-structured interviews. Surgeries occurred in 2021 (n = 8), 2020 (n = 4), 2019 (n = 2), and one participant each had surgery in 2014, 2009, and 2004. Thematic analysis elicited themes related to post-operative dieting. RESULTS All participants reported chronic pre-surgery dieting. Lifestyle change was the overarching post-surgical theme comprising (i) flexibility (e.g. allowing food, intuitive eating), and (ii) control, comprising surgery control (e.g. set portions, surgery instilled control) and dieting control (e.g. discipline, restriction/restraint). Descriptions of lifestyle change often mirrored pre-surgery descriptions of dieting. CONCLUSION Post-surgery lifestyle change appears to encompass a tension between flexible/adaptive approaches to eating and the need to maintain control. Control may emerge as practices that mirror pre-surgery dieting with the potential to interfere with adaptive eating behaviours or promote disordered eating. Dieting behaviours may be a precursor to the development of disordered eating. Health care practitioners should regularly assess dieting behaviour post-surgery to enable early intervention where warranted. Future research should consider how post-surgery re-emerging dieting may be identified and measured to aid in intervention.
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Affiliation(s)
- Margaret Klapsas
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Annemarie Hindle
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia.
- Department of Psychology, Counselling and Therapy, La Trobe University, 133 McKoy Street, Wodonga, VIC, 3689, Australia.
- Centre for Eating, Weight, and Body Image, Suite 215, 100 Victoria Parade, East Melbourne, VIC, 3002, Australia.
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Gilmartin TL, Gurvich C, Dipnall JF, Sharp G. Dimensional personality pathology and disordered eating in young adults: measuring the DSM-5 alternative model using the PID-5. Front Psychol 2023; 14:1113142. [PMID: 37434891 PMCID: PMC10330766 DOI: 10.3389/fpsyg.2023.1113142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction The Personality Inventory for DSM-5 (PID-5) is a self-report measure of personality pathology designed to measure pathological personality traits outlined in the DSM-5 alternative model of personality disorders. Within the extensive literature exploring the relationship between personality and disordered eating, there are few that explore the relationship between the PID-5 and disordered eating behaviours in a non-clinical sample of males and females: restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building. Methods An online survey assessed disordered eating, PID-5 traits and general psychopathology and was completed by 394 female and 167 male participants aged 16-30. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the PID-5 scales, body dissatisfaction and age predicted behaviour. Results The results indicated that each of the six disordered behaviours were associated with a unique pattern of maladaptive personality traits. The statistical models differed between males and females indicating possible differences in how dimensional personality pathology and disordered eating relate. Discussion It was concluded that understanding disordered eating behaviour in the context of personality pathology may assist formulating potentially risky behaviour.
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Affiliation(s)
- Tanya Louise Gilmartin
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Joanna F. Dipnall
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Centre for Innovation in Mental and Physical Health and Clinical Treatment, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Gemma Sharp
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Delaquis CP, Godart NT, Fatséas M, Berthoz S. Cognitive and Interpersonal Factors in Adolescent Inpatients with Anorexia Nervosa: A Network Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040730. [PMID: 37189979 DOI: 10.3390/children10040730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
The cognitive-interpersonal model of anorexia nervosa (AN) posits that cognitive and interpersonal traits contribute to the development and maintenance of AN. We investigated cognitive and interpersonal factors put forward by the model in a sample of 145 adolescent inpatients with AN using network analysis. Our main outcomes included core eating disorder symptoms, cognitive style, socio-affective factors, and mood symptoms. We estimated a cross-sectional network using graphical LASSO. Core and bridge symptoms were identified using strength centrality. Goldbricker was used to reduce topological overlap. The node with the highest strength centrality was Concern over Mistakes, followed by Eating Preoccupation, Social Fear, and Overvaluation of Weight and Shape. The nodes with the highest bridge strength were Concern over Mistakes, Doubt about Actions, Overvaluation of Weight and Shape, and Depression. Notably, both performance on a cognitive flexibility task and BMI were not connected to any other nodes and were subsequently removed from the final network. We provide partial support for the cognitive-interpersonal model while also supporting certain premises put forward by the transdiagnostic cognitive-behavioral model. The high centrality of Concern over Mistakes and Social Fear supports the theory that both cognitive and interpersonal difficulties contribute to AN, particularly in adolescence.
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Affiliation(s)
| | - Nathalie T Godart
- Fondation Santé des Etudiants de France, 75014 Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay, 94805 Villejuif, France
- UFR Simone Veil-Santé, Université Versailles Saint-Quentin-en-Yvelines, 78047 Montigny-le-Bretonneux, France
| | - Melina Fatséas
- INCIA CNRS UMR 5287, Université de Bordeaux, 33000 Bordeaux, France
- Department of Addictology, CHU Bordeaux, 33000 Bordeaux, France
| | - Sylvie Berthoz
- INCIA CNRS UMR 5287, Université de Bordeaux, 33000 Bordeaux, France
- Department of Psychiatry, Institut Mutualiste Montsouris, 75014 Paris, France
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Liu S, Zhang D, Tian Y, Xu B, Wu X. Gender differences in symptom structure of adolescent problematic internet use: A network analysis. Child Adolesc Psychiatry Ment Health 2023; 17:49. [PMID: 37029403 PMCID: PMC10082539 DOI: 10.1186/s13034-023-00590-2] [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: 01/22/2023] [Accepted: 03/15/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Gender differences in problematic Internet use (PIU) have long been discussed. However, whether and how female and male adolescents differ in central symptoms and symptom associations are not fully understood. METHODS As a national survey in the Chinese mainland, 4884 adolescents (51.6% females; Mage = 13.83 ± 2.41) participated in the present study. This study applies network analysis to identify central symptoms of PIU networks in female and male adolescents and compares whether and how global and local connectivity of PIU networks differ by gender. RESULTS Female and male network structures of PIU were different and global strength was stronger in males than females, indicating a higher risk of chronicity of PIU among male adolescents. Specifically, "Reluctant to turn off Internet" exerted the largest effect on both genders. "Increase time online to achieve satisfaction" and "Feel depressed once not online for a while" were particularly critical to female and male adolescents, respectively. Moreover, females scored higher centralities in social withdrawal symptoms and males did so in interpersonal conflicts owing to PIU. CONCLUSIONS These findings provide novel insights into gender differential risks and features of adolescent PIU. Differences in the core symptoms of PIU suggest that gender-specific interventions focusing on core symptoms might effectively relieve PIU and maximize treatment effects.
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Affiliation(s)
- Sihan Liu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Beijing Normal University, No.19, Xinjiekouwai St, Haidian District, Beijing, China
| | - Di Zhang
- Education and Counseling Center of Psychological Health, Ocean University of China, Qingdao, Shandong, China
| | - Yuxin Tian
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Boya Xu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Beijing Normal University, No.19, Xinjiekouwai St, Haidian District, Beijing, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Beijing Normal University, No.19, Xinjiekouwai St, Haidian District, Beijing, China.
- School of Applied Psychology, Beijing Normal University at Zhuhai, Zhuhai, Guangdong, China.
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Finch JE, Xu Z, Girdler S, Baker JH. Network analysis of eating disorder symptoms in women in perimenopause and early postmenopause. Menopause 2023; 30:275-282. [PMID: 36728103 PMCID: PMC9974533 DOI: 10.1097/gme.0000000000002141] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are often stereotyped as disorders of adolescence and young adulthood; however, they can occur at any age. Prevalence of EDs at midlife are approximately 3.5% and specific symptoms at midlife can have prevalences as high as 29.3%. Studies also inconsistently suggest that EDs and related symptoms may be more prevalent in midlife aged women during perimenopause compared with midlife aged women at pre-menopause. To date few studies have examined the structure of and associations between ED symptoms in women specifically during perimenopause and early postmenopause. Thus, the purpose of the current study is to investigate the structure of ED symptoms specifically during perimenopause and early postmenopause. METHODS Participants included 36 participants (45-61 y old) in a larger clinical trial who completed the Eating Disorder Examination Questionnaire (EDE-Q) at a baseline study visit. Network analysis statistical models were used to examine the structure of and associations between ED symptoms assessed via the EDE-Q. RESULTS Shape dissatisfaction and weight dissatisfaction were the top 2 central symptoms in the network. CONCLUSIONS Results corroborate previous studies and indicate that, similar to young adult samples, dissatisfaction with body image is a core feature of ED pathology across the lifespan.
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Affiliation(s)
- Jody E. Finch
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA 30302-5010, USA
| | - Ziqian Xu
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27515, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA
| | - Jessica H. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA
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12
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Phillipou A, McGorry P, Killackey E, Maguire S. Eating disorders in young people. Australas Psychiatry 2023:10398562231159514. [PMID: 36853994 DOI: 10.1177/10398562231159514] [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] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Eating disorders (EDs) have their onset most frequently in adolescence and young adulthood. Treatment for EDs lack efficacy, and we have made little progress in improving outcomes for patients over the course of the last several decades. As with other mental health conditions, early intervention may greatly improve outcomes, yet, little research exists in this area. CONCLUSIONS More effective evidence-based treatments are sorely needed for EDs, particularly for early stages of the illness to minimise the potential harms of treatment and long-standing illness. Treatment service models would also benefit from taking an approach that ensures continuation of care from adolescence to young adulthood.
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Affiliation(s)
- Andrea Phillipou
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,188668Orygen, Melbourne, VIC, Australia.,Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia.,and Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,188668and Orygen, Melbourne, VIC, Australia
| | - Eóin Killackey
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,188668and Orygen, Melbourne, VIC, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, 4334The University of Sydney, Sydney, NSW, Australia
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13
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Gilmartin T, Gurvich C, Dipnall JF, Sharp G. One size does not fit all: Exploring how the five-factor model facets predict disordered eating behaviours among adolescent and young adult males and females. Br J Psychol 2023; 114:132-158. [PMID: 36183174 PMCID: PMC10092835 DOI: 10.1111/bjop.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
There is a wealth of research that has highlighted the relationship between personality and eating disorders. It has been suggested that understanding how subclinical disordered eating behaviours are uniquely associated with personality can help to improve the conceptualization of individuals with eating disorders. This study aimed to explore how the facets of the Five-Factor Model (FFM) predicted restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building among males and females. An online survey assessing disordered eating behaviours, FFM and general psychopathology was completed by 394 females and 167 males aged between 16 and 30 years. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the FFM facets, body dissatisfaction and age predicted behaviour. The results indicated that each of the six disordered behaviours were predicted by a unique pattern of thinking, feeling and behaving. Considerable differences between males and females were found for each path model, suggesting differences between males and females in the personality traits that drive disordered eating behaviours. It was concluded that it is important to take personality into account when treating males and females who engage in disordered eating behaviours.
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Affiliation(s)
- Tanya Gilmartin
- Monash Alfred Psychiatry Research Centre, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Gemma Sharp
- Monash Alfred Psychiatry Research Centre, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
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14
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Anaya C, Culbert KM, Klump KL. Binge Eating Risk During Midlife and the Menopausal Transition: Sensitivity to Ovarian Hormones as Potential Mechanisms of Risk. Curr Psychiatry Rep 2023; 25:45-52. [PMID: 36565385 PMCID: PMC9974637 DOI: 10.1007/s11920-022-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Recent research suggests that binge eating may be more prevalent among women in midlife than previously believed. The menopausal transition, an important developmental stage during midlife, is characterized by substantial fluctuations and eventual decreases in ovarian hormones that may contribute to increased risk. This narrative review summarizes findings from studies of binge eating during midlife and menopause and discusses the potential role of ovarian hormones in binge eating risk. RECENT FINDINGS Studies are few in number and findings are mixed, with only some studies showing increased binge eating during midlife and the menopausal transition. Sensitivity to ovarian hormones, potentially through gene x hormone interactions, may influence who experiences increased binge eating risk and could help explain mixed findings in the field. Future studies of hormone sensitivity and gene x hormone interactions are needed to further elucidate midlife and menopausal risk for binge eating in women.
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Affiliation(s)
- Carolina Anaya
- Department of Psychology, Michigan State University, MI, 48824-1116, East Lansing, USA
| | - Kristen M Culbert
- Department of Psychology, Michigan State University, MI, 48824-1116, East Lansing, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, MI, 48824-1116, East Lansing, USA.
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15
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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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16
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Schultz A, Maurer L, Alexandrowicz RW. Strengths and weaknesses of the German translation of the Inflexible Eating Questionnaire and of eating disorder assessment in general. Front Psychol 2022; 13:1002463. [PMID: 36600707 PMCID: PMC9806356 DOI: 10.3389/fpsyg.2022.1002463] [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: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The present article introduces the German translation of the Inflexible Eating Questionnaire (IEQ-G), performs a psychometric evaluation, and explores the relationship of Inflexible Eating to the subscales of the Eating Disorder Examination-Questionnaire (EDE-Q) and Obsessive-Compulsive (OC) symptoms. Methods The cross-sectional study was carried out in the German-speaking area. A paper and pencil survey was completed by 612 females and 442 males of the general population. Results SEM analyses showed that the IEQ-G allows for calculating a total score and invariance tests were mostly promising. As a side result, the original 4-factorial structure of the EDE-Q could not be replicated, but a 3 dimensional solution proved convincing. From a psychometric point of view, the IEQ-G outperformed the EDE-Q. On a latent level, Inflexible Eating was remarkably strong related to OC-symptoms and the EDE-Q subscales. Discussion The detail analyses revealed that Eating Disorder assessment in general lacks subgroup-specific aspects, for instance, regarding gender or dietary preferences, important for early diagnosis and screening of ED. The IEQ-G proved applicable in a German speaking adult population and recommends itself for cross-cultural studies.
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17
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Schmidt M, Taube CO, Heinrich T, Vocks S, Hartmann AS. Body image disturbance and associated eating disorder and body dysmorphic disorder pathology in gay and heterosexual men: A systematic analyses of cognitive, affective, behavioral und perceptual aspects. PLoS One 2022; 17:e0278558. [PMID: 36472982 PMCID: PMC9725123 DOI: 10.1371/journal.pone.0278558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study contributes to the quantitatively large, yet narrow in scope research on body image in gay men by assessing whether gay and heterosexual men systematically differ on various dimensions of body image disturbance and associated pathology, i.e., eating disorder and body dysmorphic disorder symptoms. Moreover, we examined the influence of general everyday discrimination experiences and involvement with the gay community on body image. METHOD N = 216 men (n = 112 gay men, n = 104 heterosexual men) participated in an online survey measuring the discrepancy between self-rated current and ideal body fat/ muscularity; drive for leanness, muscularity, and thinness; body satisfaction; body-related avoidance and checking; appearance fixing; overall body image disturbance; eating disorder and body dysmorphic disorder pathology; general everyday discrimination experiences; and involvement with the gay community. RESULTS Gay men showed a greater discrepancy between self-rated current and ideal body fat; higher drive for thinness, body-related avoidance, appearance fixing, overall body image disturbance, eating disorder and body dysmorphic disorder pathology; and lower body appreciation than heterosexual men (all p ≤ .05). Contrary to expectation, everyday discrimination experiences were more strongly associated with body image disturbance and eating disorder/ body dysmorphic disorder pathology in heterosexual men than in gay men (all p ≤ .05). Gay community involvement was not associated with any body image disturbance-, ED-, or BDD aspect in gay men (all p ≥ .20). DISCUSSION The results suggest greater body image disturbance in gay men than in heterosexual men regarding cognitions, emotions, behaviors, and perception as well as higher eating disorder and body dysmorphic disorder pathology. The results also suggest the dilemma of a thin, yet muscular body ideal in gay men. Surprisingly, discrimination experiences and involvement with the gay community did not explain differences in body image disturbance. Gay men may have become resilient to discrimination over time, and body ideals might differ across gay sub-communities.
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Affiliation(s)
- Michaela Schmidt
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
- * E-mail:
| | - Christoph O. Taube
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Thomas Heinrich
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Andrea S. Hartmann
- Department of Psychology, Unit of Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
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18
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Eating disorder psychopathology dimensions based on individual co-occurrence patterns of symptoms over time: a dynamic time warp analysis in a large naturalistic patient cohort. Eat Weight Disord 2022; 27:3649-3663. [PMID: 36469226 DOI: 10.1007/s40519-022-01504-5] [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: 05/17/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Most of the network approaches in eating disorders found the highest degree of centrality for symptoms related to weight and shape concerns. However, longitudinal analyses are scarce and may increase our insight of the complex characteristics and dynamics over time. In the current study, an alternative non-linear method to perform longitudinal network analyses, the dynamic time warp approach, was used to examine whether robust dimensions of eating disorder psychopathology symptoms could be found based on the individual dynamic interplay of eating disorder symptoms co-occurrence patterns in time. METHODS The study sample included a naturalistic cohort of patients (N = 255) with all eating disorder subtypes who were assessed with the eating disorder examination questionnaire (EDE-Q) at a minimum of four times during treatment. Dynamic time warp analyses yielded distance matrices within each individual patient, which were subsequently aggregated into symptom networks and dimensions at the group level. RESULTS Aggregation of the individual distance matrices at the group level yielded four robust symptom dimensions: 1. restraint/rules, 2. secret eating/fasting, 3. worries/preoccupation, and 4. weight and shape concern. The items 'fear of weight gain' and 'guilt' were bridge symptoms between the dimensions 1, 3 and 4. CONCLUSION Dynamic time warp could capture the within-person dynamics of eating disorder symptoms. Sumscores of the four dimensions could be used to follow patients over time. This approach could be applied in the future to visualize eating disorder symptom dynamics and signal the central symptoms within an individual and groups of patients. LEVEL OF EVIDENCE Level III: evidence obtained from well-designed cohort or case-control analytic studies. .
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19
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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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20
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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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21
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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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22
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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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23
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Ryan O, Hamaker EL. Time to Intervene: A Continuous-Time Approach to Network Analysis and Centrality. PSYCHOMETRIKA 2022; 87:214-252. [PMID: 34165691 PMCID: PMC9021117 DOI: 10.1007/s11336-021-09767-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 05/08/2023]
Abstract
Network analysis of ESM data has become popular in clinical psychology. In this approach, discrete-time (DT) vector auto-regressive (VAR) models define the network structure with centrality measures used to identify intervention targets. However, VAR models suffer from time-interval dependency. Continuous-time (CT) models have been suggested as an alternative but require a conceptual shift, implying that DT-VAR parameters reflect total rather than direct effects. In this paper, we propose and illustrate a CT network approach using CT-VAR models. We define a new network representation and develop centrality measures which inform intervention targeting. This methodology is illustrated with an ESM dataset.
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Affiliation(s)
- Oisín Ryan
- Utrecht University, Padualaan 14, 3584 CH,, Utrecht, The Netherlands.
| | - Ellen L Hamaker
- Utrecht University, Padualaan 14, 3584 CH,, Utrecht, The Netherlands
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24
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Liu S, Xu B, Zhang D, Tian Y, Wu X. Core symptoms and symptom relationships of problematic internet use across early, middle, and late adolescence: A network analysis. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2021.107090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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25
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Schreuder MJ, Wigman JTW, Groen RN, Weinans E, Wichers M, Hartman CA. Anticipating the direction of symptom progression using critical slowing down: a proof-of-concept study. BMC Psychiatry 2022; 22:49. [PMID: 35062917 PMCID: PMC8781362 DOI: 10.1186/s12888-022-03686-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND As complex dynamic systems approach a transition, their dynamics change. This process, called critical slowing down (CSD), may precede transitions in psychopathology as well. This study investigated whether CSD may also indicate the direction of future symptom transitions, i.e., whether they involve an increase or decrease in symptoms. METHODS In study 1, a patient with a history of major depression monitored their mental states ten times a day for almost eight months. Study 2 used data from the TRAILS TRANS-ID study, where 122 young adults at increased risk of psychopathology (mean age 23.64±0.67 years, 56.6% males) monitored their mental states daily for six consecutive months. Symptom transitions were inferred from semi-structured diagnostic interviews. In both studies, CSD direction was estimated using moving-window principal component analyses. RESULTS In study 1, CSD was directed towards an increase in negative mental states. In study 2, the CSD direction matched the direction of symptom shifts in 34 individuals. The accuracy of the indicator was higher in subsets of individuals with larger absolute symptom transitions. The indicator's accuracy exceeded chance levels in sensitivity analyses (accuracy 22.92% vs. 11.76%, z=-2.04, P=.02) but not in main analyses (accuracy 27.87% vs. 20.63%, z=-1.32, P=.09). CONCLUSIONS The CSD direction may predict whether upcoming symptom transitions involve remission or worsening. However, this may only hold for specific individuals, namely those with large symptom transitions. Future research is needed to replicate these findings and to delineate for whom CSD reliably forecasts the direction of impending symptom transitions.
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Affiliation(s)
- Marieke J Schreuder
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Internal Postal Code: CC72, Triade Building Entrance 24, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands.
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Internal Postal Code: CC72, Triade Building Entrance 24, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands
| | - Robin N Groen
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Internal Postal Code: CC72, Triade Building Entrance 24, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands
| | - Els Weinans
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Internal Postal Code: CC72, Triade Building Entrance 24, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Internal Postal Code: CC72, Triade Building Entrance 24, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands
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Poovey K, Ahlich E, Attaway S, Rancourt D. General versus hunger/satiety-specific interoceptive sensibility in predicting disordered eating. Appetite 2022; 171:105930. [PMID: 35033582 DOI: 10.1016/j.appet.2022.105930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/14/2021] [Accepted: 01/11/2022] [Indexed: 12/21/2022]
Abstract
Dysfunctional interoceptive processing of hunger and satiety cues is particularly relevant to disordered eating behaviors. However, researchers often rely on general measures of interoceptive sensibility (IS1; self-reported experience of internal bodily cues) which conflate interoceptive processes across biological systems (e.g., gastric, cardiac) when assessing the role of interoception in disordered eating. Participants (N = 213; 50% female, age M = 20.77 years) were recruited from a large southeastern university for this online study and completed the Intuitive Eating Scale-2 (hunger/satiety-specific), the Multidimensional Assessment of Interoceptive Awareness-2 (general), and the Eating Disorder Inventory Interoceptive Awareness Subscale (general) as measures of IS. The Eating Pathology Symptoms Inventory was used to assess disordered eating attitudes and behaviors. Controlling for sex and body mass index, hunger/satiety-specific IS was associated with binge eating, purging, and cognitive restraint over and above general IS measures and emerged as the dominant predictor of each. Hunger/satiety-specific IS did not predict restricting behavior. Dysfunctional processing of hunger and satiety cues may be a particularly important risk factor to target in screenings and interventions for disordered eating. Findings highlight the importance of careful selection of IS measures in research and targeting hunger/satiety-specific IS in clinical interventions for disordered eating.
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Affiliation(s)
- Kendall Poovey
- Department of Psychology, University of South Florida, 4204 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Erica Ahlich
- Department of Psychology, University of South Florida, 4204 E Fowler Ave, Tampa, FL, 33620, USA
| | - Sarah Attaway
- Department of Psychology, University of South Florida, 4204 E Fowler Ave, Tampa, FL, 33620, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, 4204 E Fowler Ave, Tampa, FL, 33620, USA
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Symptom Clusters and Key Symptoms Among Midlife Perimenopausal and Postmenopausal Women With and Without Metabolic Syndrome. Nurs Res 2022; 71:E28-E38. [PMID: 35759720 PMCID: PMC9237449 DOI: 10.1097/nnr.0000000000000591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Midlife perimenopausal and postmenopausal women with metabolic syndrome experience multiple symptoms concurrently. OBJECTIVE The study objectives were to examine the relationship among symptoms through network visualization and identify and compare symptom clusters and key symptoms across symptom occurrence and symptom severity dimensions in midlife perimenopausal and postmenopausal women with and without metabolic syndrome. METHODS Cross-sectional data from the Study of Women's Health Across the Nation (Visit 5) were used for analysis. A machine-learning-based network analysis and the Walktrap algorithm were used to fulfill the study objectives. RESULTS The number and types of symptom clusters differed between the groups. Midlife perimenopausal and postmenopausal women with metabolic syndrome experienced the psychological/somatic/genital cluster (key symptom: frequent mood change), the sleep/urinary cluster (sleep disturbance), and the vasomotor cluster (cold sweat) in the symptom occurrence dimension and the psychological/somatic/sexual cluster (anxiety), the sleep/urinary cluster (sleep disturbance), and the vasomotor/genital cluster (night sweat) in the symptom severity dimension. In contrast, midlife perimenopausal and postmenopausal women without metabolic syndrome experienced the psychological cluster (anxiety), the sleep/somatic/genitourinary cluster (sleep disturbance), and the vasomotor cluster (night sweat) in the symptom occurrence dimension and the psychological/somatic cluster (anxiety), the sleep/urinary cluster (sleep disturbance), the vasomotor cluster (night sweat), and the sexual/genital cluster (vaginal dryness) in the symptom severity dimension. DISCUSSION The study findings may serve as a knowledge basis for effective assessment and management of symptom clusters and key symptoms in clinical settings and provide directions for future development of targeted symptom management interventions.
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Rezeppa TL, Roberts SR, Maheux AJ, Choukas-Bradley S, Salk RH, Thoma BC. Psychosocial correlates of body esteem and disordered eating among sexual minority adolescent girls. Body Image 2021; 39:184-193. [PMID: 34487999 PMCID: PMC8643346 DOI: 10.1016/j.bodyim.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 11/19/2022]
Abstract
The present study examined whether body esteem mediates the associations between psychosocial factors, including peer victimization and parent-adolescent relationship quality, and multiple categories of disordered eating (DE) within a diverse sample of adolescent sexual minority (SM) girls. Participants were 528 girls, aged 14-18 years, recruited as part of a larger online study on LGBTQ + adolescent health. Participants anonymously completed self-report measures of parent-adolescent relationship quality, sexual orientation-based victimization, body esteem, and DE behaviors, including binge eating, purging, and caloric restriction. Parent-adolescent relationship quality was positively associated with SM adolescent girls' body esteem, and some aspects of body esteem subsequently mediated the associations between parent-adolescent relationship quality and DE behaviors. Experiences of sexual orientation-related victimization were also positively related to endorsement of caloric restriction. However, no significant indirect effects were observed between sexual orientation-related victimization and DE via body esteem. These results suggest parents could influence their SM daughters' DE behaviors via body esteem, and SM girls may be engaging in caloric restriction if they experience victimization, regardless of their body esteem.
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Affiliation(s)
- Taylor L Rezeppa
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, United States.
| | - Savannah R Roberts
- Department of Psychological and Brain Sciences, University of Delaware, United States
| | - Anne J Maheux
- Department of Psychological and Brain Sciences, University of Delaware, United States
| | | | - Rachel H Salk
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
| | - Brian C Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
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Hilbert A, Herpertz S, Zipfel S, Tuschen-Caffier B, Friederich HC, Mayr A, de Zwaan M. Psychopathological Networks in Cognitive-Behavioral Treatments for Binge-Eating Disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:379-385. [PMID: 32694245 DOI: 10.1159/000509458] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Network approaches to psychopathology posit that mental disorders emerge from interrelated symptoms, and thus connectivity among symptoms are assumed to negatively predict the treatment response and decrease with efficacious treatment. OBJECTIVE This study uniquely sought to elucidate the network structure, its change, and its predictive value in cognitive-behavioral therapy (CBT) for binge-eating disorder (BED). METHODS In a multicenter randomized trial of face-to-face and Internet-based guided self-help CBT, 178 individuals with full syndrome and subsyndromal BED, eating disorder and general psychopathology, and body mass index (BMI) were subjected to Gaussian Graphical Network and Exploratory Graph Analyses before and after treatment and at 6-month follow-up. RESULTS At pretreatment, 3 network communities of: eating disorder psychopathology; general psychopathology; and restraint and BMI were identified, with the latter community included in the first thereafter. Eating disorder-related impairment and self-esteem were the most central symptoms, while BMI and binge eating had the lowest centrality. Network connectivity significantly increased from pre- to posttreatment, with the greatest increases in strength centrality found in binge eating and shape concern, but it did not predict remission from binge eating. CONCLUSIONS With decreasing symptom severity, CBT resulted in a greater integration and connectivity of the psychopathology network in BED, suggesting an increased patient understanding of relations between binge eating and other symptoms. Network connectivity was not a negative prognostic indicator of treatment outcome. These results indicate a need for further research on the predictive value of network variables in the explanation of therapeutic change for patients with BED.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany,
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University, Bochum, Germany
| | - Stephan Zipfel
- Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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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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31
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Wong VZ, Christian C, Hunt RA, Levinson CA. Network investigation of eating disorder symptoms and positive and negative affect in a clinical eating disorder sample. Int J Eat Disord 2021; 54:1202-1212. [PMID: 33819357 DOI: 10.1002/eat.23511] [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: 10/28/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Growing literature suggests that emotions influence the maintenance of eating disorder (ED) symptoms. However, most research has studied the relationship between ED symptoms and affect broadly (i.e., negative affect [NA], positive affect [PA]), rather than examining models comprised of multiple specific affective states (e.g., upset, proud). METHOD The current study (N = 196 individuals with EDs) used network analysis to examine the most interconnected (i.e., central) NA and PA states in EDs and test the complex associations between specific NA, PA, and ED symptoms. We estimated two networks: one with affective states only and another with affective states and ED symptoms. RESULTS Feeling distressed, afraid, attentive, and determined were the most central symptoms in the affect-only network. ED symptoms related to overvaluation of weight and shape, including affect-based ED symptoms (i.e., guilt about eating), were central in the network of affect and ED symptoms. Guilt about eating and shame were central bridge symptoms across affect and ED symptom clusters, meaning that they were each strongly connected across clusters, and may represent important pathways among affect and ED symptoms. DISCUSSION Limitations include the cross-sectional and between-person nature of these analyses, from which we cannot derive causal or within-persons processes. Clinical interventions that target central and bridge symptoms (e.g., fear, shame) may disrupt the reinforcing cycle of NA in EDs that may contribute to ED behaviors. Future research should examine relationships among affective states and ED symptoms in longitudinal and intraindividual network models to develop more effective treatments for EDs.
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Affiliation(s)
- Valerie Z Wong
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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32
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Roberts SR, Salk RH, Thoma BC, Romito M, Levine MD, Choukas-Bradley S. Disparities in disordered eating between gender minority and cisgender adolescents. Int J Eat Disord 2021; 54:1135-1146. [PMID: 33638569 DOI: 10.1002/eat.23494] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Adolescence is a developmental period of increased risk for disordered eating. Gender minority adolescents (GMAs), or those whose gender identity does not align with their sex assigned at birth, may experience body image concerns related to unique gender-related stressors. GMAs may use disordered eating to affirm a feminine, masculine, or nonbinary gender identity. However, little is known about differences in disordered eating between GMAs and cisgender adolescents. Therefore, this study had two primary goals: (a) to compare disordered eating between GMAs and cisgender adolescents by examining the role of gender identity and sex assigned at birth; and (b) within GMAs, to examine associations between gender identity congruence and disordered eating. METHOD A large U.S. sample of GMAs and cisgender adolescents (n = 1,191 GMAs; 919 cisgender; Mage = 15.93 years) reported their disordered eating on an anonymous online survey. RESULTS A MANOVA revealed a significant interaction between gender identity and sex assigned at birth. Follow-up ANOVAs demonstrated that purging, caloric restriction, excessive exercise, and muscle building differed as a function of gender identity and sex assigned at birth. Among GMAs, a multiple multivariate regression model demonstrated that disordered eating was lower among participants who reported greater gender identity congruence. DISCUSSION GMAs should not be considered a homogenous group, as differences in gender identity may lead to the internalization of different appearance ideals and disparate eating disorder symptomatology. Results suggest that clinicians working with GMAs consider the unique body image concerns that could accompany a specific gender identity.
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Affiliation(s)
- Savannah R Roberts
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel H Salk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian C Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Madelaine Romito
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sophia Choukas-Bradley
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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de Vos JA, Radstaak M, Bohlmeijer ET, Westerhof GJ. The psychometric network structure of mental health in eating disorder patients. EUROPEAN EATING DISORDERS REVIEW 2021; 29:559-574. [PMID: 33949742 PMCID: PMC8252750 DOI: 10.1002/erv.2832] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Psychometric network analysis has led to new possibilities to assess the structure and dynamics of psychiatric disorders. The current study focuses on mental health networks in patients with anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating disorders (EDs). METHOD Network analyses were applied with five mental health domains (emotional, psychological and social well-being, and general and specific psychopathology) among 905 ED patients. Also, networks of 36 underlying symptoms related to the domains were estimated. The network stability, structure and (bridge) centrality of the nodes were assessed for the total group and each ED type. Network differences between the ED types were also examined. RESULTS ED psychopathology was only weakly connected with the well-being domains. Psychological well-being was the most central node in the domain network. The most central nodes in the symptom network were feeling depressed, feeling worthless, purpose in life and self-acceptance. Bridge symptoms between well-being and psychopathology were self-acceptance, environmental mastery, interested in life and feeling depressed. There were no network differences between the ED types in both the domain and symptom networks. CONCLUSIONS This study shows novel associations between well-being and psychopathology in ED patients. Central domains and their underlying symptoms may be especially important to consider in treatment for promoting mental health in ED patients.
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Affiliation(s)
- Jan Alexander de Vos
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
- Stichting Human ConcernCentrum voor eetstoornissenAmsterdamThe Netherlands
| | - Mirjam Radstaak
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
| | - Ernst T. Bohlmeijer
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
| | - Gerben J. Westerhof
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
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Romero-Mesa J, Peláez-Fernández MA, Extremera N. Emotional intelligence and eating disorders: a systematic review. Eat Weight Disord 2021; 26:1287-1301. [PMID: 32734465 DOI: 10.1007/s40519-020-00968-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/17/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prior research indicates that deficits in emotional abilities are key predictors of the onset and maintenance of eating disorders (ED). As a relatively new emotion-related construct, emotional intelligence (EI) comprises a set of basic emotional abilities. Preliminary research suggests that deficits in EI are linked with disordered eating and other impulsive behaviours. Also, previous research reveals that emotional and socio-cognitive abilities, as well as ED symptomatology, varies across lifespan development. However, while the findings suggest promising results for the development of potential effective treatments for emotional deficits and disordered eating, it is difficult to summarise the relationship between EI and ED due to the diversity of theoretical approaches and variety of EI and ED measures. OBJECTIVE Our study, therefore, aimed to systematically review the current evidence on EI and ED in both the general and clinical populations and across different developmental stages. METHODS The databases examined were Medline, PsycInfo and Scopus, and 15 eligible articles were identified. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. RESULTS All the studies reviewed indicated negative associations between EI and the dimensions of ED. Additionally, several mechanisms involved, namely adaptability, stress tolerance and emotional regulation were highlighted. CONCLUSION The systematic review suggests promising but challenging preliminary evidence of the associations between EI and the dimensions of ED across diverse stages of development. In addition, future research, practical implications and limitations are discussed. LEVEL OF EVIDENCE I Systematic review.
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Affiliation(s)
- Juana Romero-Mesa
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain
| | - María Angeles Peláez-Fernández
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain.
| | - Natalio Extremera
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain
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Emotion Dysregulation within the CBT-E Model of Eating Disorders: A Narrative Review. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10225-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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36
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Hunt RA, Levinson CA, Peiper NC. Leveraging general risk surveillance to reduce suicide in early adolescents: Associations between suicidality, disordered eating, and other developmental risk factors. Suicide Life Threat Behav 2021; 51:247-254. [PMID: 33876496 DOI: 10.1111/sltb.12700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Suicide is a leading cause of death in early adolescents (i.e., children ages 11-14), underscoring the need for a more complex understanding of suicidality in youth. Syndemics framework posits that the overlap of multiple maladaptive behaviors (or risk factors) produces worse health outcomes compared to each behavior alone. The use of this framework in preventing suicide necessitates that identification of developmental risk factors that occur in tandem to suicide (e.g., disordered eating behaviors and substance use) may be important for intervening on those at greatest risk of suicide. METHOD The present study uses latent class analysis (LCA) to evaluate the relationship between suicidality and disordered eating behaviors in early adolescence, and associations with other developmental risk factors in an epidemiological sample of middle school students (N = 3,811). RESULTS Lifetime prevalence ranged from 6.8% to 18.2% for suicidality, and 5.3%-48.7% for disordered eating behavior. Our final model identified six independent classes, and each class had differential associations with several additional developmental risk factors. CONCLUSION By pinpointing specific classes of individuals who may be at risk for multiple developmental risk factors, our results have important implications for public health intervention and prevention efforts for a wide range of adolescent risk behaviors, including suicidality.
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Affiliation(s)
- Rowan A Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Nicholas C Peiper
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA.,Louisville Center, Pacific Institute for Research and Evaluation, Louisville, KY, USA
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Vaňousová N, Brown TA, Sellbom M. Criterion and Incremental Validity of the MMPI-3 Eating Concerns Scale in a University Sample. J Clin Psychol Med Settings 2021; 29:34-43. [PMID: 33782843 DOI: 10.1007/s10880-021-09772-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/24/2022]
Abstract
The purpose of the current study was to evaluate the validity of scores on the Eating Concerns (EAT) scale on the recently released Minnesota Multiphasic Personality Inventory-3 (MMPI-3), which aims to assess for problematic eating behaviours. It was hypothesised that the EAT scale scores would be correlated with binge eating, purging, restrictive eating, weight and body shape concerns. Participants were 396 university students, who completed a series of well-validated eating disorder measures. The EAT scale scores evidenced moderate to large correlations with many symptom dimensions of EDs, including binge eating, purging, restrictive eating and weight and shape concern, thus, supporting the hypotheses and showing evidence for criterion validity. Hierarchical regression analyses also revealed incremental validity for the EAT scale above and beyond other MMPI-3 Specific Problems scale scores. Overall, scores on the new MMPI-3 EAT scale were associated with positive support for validity in a university population and seem promising as a good screening measure for eating pathology.
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Affiliation(s)
- Nela Vaňousová
- Department of Psychology, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Tiffany A Brown
- Department of Psychology, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Martin Sellbom
- Department of Psychology, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Dreier MJ, Coniglio K, Selby EA. Mapping features of pathological exercise using hierarchical-dimensional modeling. Int J Eat Disord 2021; 54:422-432. [PMID: 33185893 DOI: 10.1002/eat.23406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Pathological exercise is common among those with eating disorders and has typically been characterized as excessive, compulsive, or compensatory in nature. Little is known about how pathological exercise is associated with other eating disorder behaviors or personality traits, or whether these associations differ between men and women. METHOD We used hierarchical dimensional modeling in three samples, including college women (N = 205), women with eating psychopathology (N = 268), and college men (N = 235), to examine latent associations between pathological exercise and eating disorder psychopathology, namely compulsivity, emotion regulation, and body dissatisfaction. RESULTS Using Goldberg's (2006) "bass-ackwards" method, we identified separate 10-factor solutions (women) or an 11-factor solution (men). A distinct muscle building factor arose in the three-factor solution for men, and it also notably arose in the six- and eight-factor solutions for community and college women, respectively, highlighting an important understudied motivation factor in both healthy and pathological exercise. Each solution accounted for 64.8% (college women), 51.9% (women with eating psychopathology), and 43.9% (college men) of the variance in excessive exercise, respectively. DISCUSSION Findings indicate that pathological exercise is associated with different psychological traits (e.g., poor emotion regulation, compulsivity) across populations, and such differences may necessitate unique treatment approaches tailored accordingly.
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Affiliation(s)
- Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Edward A Selby
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
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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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Levinson CA, Cash E, Welch K, Epskamp S, Hunt RA, Williams BM, Keshishian AC, Spoor SP. Personalized networks of eating disorder symptoms predicting eating disorder outcomes and remission. Int J Eat Disord 2020; 53:2086-2094. [PMID: 33179347 PMCID: PMC7864225 DOI: 10.1002/eat.23398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022]
Abstract
Enhanced cognitive-behavioral therapy (CBT-E) is one of the primary evidence-based treatments for adults with eating disorders (EDs). However, up to 50% of individuals do not respond to CBT-E, likely because of the high heterogeneity present even within similar diagnoses. This high heterogeneity, especially in regard to presenting pathology, makes it difficult to develop a treatment based "on averages" and for clinicians to accurately pinpoint which symptoms should be targeted in treatment. As such, new models based at both the group, and individual level, are needed to more accurately refine targets for personalized evidence-based treatments that can lead to full remission. The current study (Expected N = 120 anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa) will build both group and individual longitudinal models of ED behaviors, cognitions, affect, and physiology. We will collect data for 30 days utilizing a mobile application to assess behaviors, cognition, and affect and a sensor wristband that assesses physiology (heart rate, acceleration). We will also collect outcome data at 1- and 6-month follow-ups to assess ED outcomes and remission status. These data will allow for identification of "on average" and "individual" targets that maintain ED pathology and test if these targets predict outcomes, including ED remission.
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Affiliation(s)
- Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Elizabeth Cash
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Karla Welch
- Department of Engineering, University of Louisville, Louisville, Kentucky
| | - Sacha Epskamp
- Department of Psychological Methods and Psychometrics, University of Amsterdam, Amsterdam, The Netherlands
| | - Rowan A. Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Brenna M. Williams
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Ani C. Keshishian
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Samantha P. Spoor
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
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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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Brown TA, Vanzhula IA, Reilly EE, Levinson CA, Berner LA, Krueger A, Lavender JM, Kaye WH, Wierenga CE. Body mistrust bridges interoceptive awareness and eating disorder symptoms. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:445-456. [PMID: 32202809 DOI: 10.1037/abn0000516] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Interoceptive awareness (IA), or the awareness of internal body states, is known to be impaired in individuals with eating disorders (EDs); however, little is understood about how IA and ED symptoms are connected. Network analysis is a statistical approach useful for examining how symptoms interrelate and how comorbidities may be maintained. The present study used network analysis to (1) test central symptoms within an IA-ED network, (2) identify symptoms that may bridge the association between IA and ED symptoms, and (3) explore whether central and bridge symptoms predict ED remission at discharge from intensive treatment. A regularized partial correlation network was estimated in a sample of 428 adolescent (n = 187) and adult (n = 241) ED patients in a partial hospital program. IA was assessed using items from the Multidimensional Assessment of Interoceptive Awareness, and ED symptoms were assessed using items from the Eating Disorder Examination-Questionnaire. Central symptoms within the network were strong desire to lose weight, feeling guilty, and listening for information from the body about emotional state. The most central symptom bridging IA and ED symptoms was (not) feeling safe in one's body. Of the central symptoms, greater desire to lose weight predicted lower likelihood of remission at treatment discharge. Bridge symptoms did not significantly predict remission. Body mistrust may be a mechanism by which associations between IA and EDs are maintained. Findings suggest targeting central and bridge symptoms may be helpful to improve IA and ED symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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