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Johnson-Munguia S, Bottera AR, Vanzhula I, Forbush KT, Gould SR, Negi S, Thomeczek ML, L’Insalata AM, Like EE, Sharma AR, Morgan RW, Rasheed S. Understanding community provider practices in diagnosing and treating atypical anorexia nervosa: A mixed methods study. Int J Eat Disord 2024; 57:892-902. [PMID: 38239071 PMCID: PMC11018496 DOI: 10.1002/eat.24125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions. METHOD A variety of providers (N = 141; 96.4% female) completed an online survey pertaining to diagnostic and treatment practices with atypical AN. Descriptive statistics were computed to characterize provider-based practices and Fisher's exact tests were used to test for differences in diagnostic practices by professional discipline. Thematic analysis was used to examine open-ended questions. RESULTS Most (63.97%) providers diagnosed atypical AN in the absence of any weight loss if other AN criteria were met, but doctoral-level psychologists and medical professionals were less likely to do so compared to nutritional or other mental health professionals. Most providers found weight gain was only sometimes necessary for atypical AN recovery. Qualitative responses revealed providers found atypical AN to be a stigmatizing label that was not taken seriously. Providers preferred to use an individualized approach focused on behaviors, rather than weight when diagnosing and treating atypical AN. DISCUSSION Lack of diagnostic clarity and concrete treatment guidelines for atypical AN may result in substantial deviations from the DSM-5-TR criteria in real-world practice. Clinically useful diagnostic definitions for restrictive eating disorders and evidence-based treatment guidelines for TW and/or other relevant recovery metrics are needed. PUBLIC SIGNIFICANCE The current study found variability in how community providers diagnose and determine target recovery weight for atypical anorexia nervosa (atypical AN). Many providers viewed the diagnosis of atypical AN as stigmatizing and preferred to focus on behaviors, rather than weight. This study underscores the importance of creating a clinically useful diagnostic definition and guidelines for recovery for atypical AN backed by empirical evidence that providers may implement in practice.
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Vanzhula I, Hagan K, Duck SA, Pan I, Wang EY, Steinglass J, Attia E, Wildes JE, Guarda AS, Schreyer C. Eating disorder symptom non-endorsers in hospitalised patients with anorexia nervosa: Who are they? Eur Eat Disord Rev 2024. [PMID: 38528330 DOI: 10.1002/erv.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Impaired insight and illness denial are common in anorexia nervosa (AN). Missing an AN diagnosis may delay treatment and negatively impact outcomes. METHOD The current retrospective study examined the prevalence and characteristics of AN symptom non-endorsement (i.e., scoring within the normal range on the Eating Disorder Examination Questionnaire [EDE-Q] or the Eating Disorder Examination [EDE] interview) in three independent samples of hospitalised patients with AN (N1 = 154; N2 = 300; N3 = 194). A qualitative chart review of a subsample of non-endorsers (N4 = 32) extracted reports of disordered eating behaviours observed by the treatment team. RESULTS The prevalence of non-endorsement ranged from 11% to 34% across sites. Non-endorsers were more likely to be diagnosed with AN restricting type (AN-R) and reported fewer symptoms of co-occurring psychopathology than endorsers. Groups benefitted equally from treatment. The qualitative chart review indicated that objective symptoms of AN were recorded by staff in over 90% of non-endorsers. CONCLUSIONS Eating disorder symptom assessments using the EDE-Q or EDE may miss symptomatology in up to a third of individuals hospitalised with AN. This study highlights the potential utility of multi-modal assessment including patient interviews, collateral informants, and behavioural observation to circumvent non-endorsement.
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Affiliation(s)
- Irina Vanzhula
- University of Kansas, LifeSpan Institute, Lawrence, Kansas, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelsey Hagan
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Sarah Ann Duck
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Isabella Pan
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin Y Wang
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Jennifer E Wildes
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago Medicine, Chicago, Illinois, USA
| | - Angela S Guarda
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen Schreyer
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Levinson CA, Osborn K, Hooper M, Vanzhula I, Ralph-Nearman C. Evidence-Based Assessments for Transdiagnostic Eating Disorder Symptoms: Guidelines for Current Use and Future Directions. Assessment 2024; 31:145-167. [PMID: 37997290 DOI: 10.1177/10731911231201150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Eating disorders are severe and often chronic mental illnesses that are associated with high impairment and mortality rates. Recent estimates suggest that eating disorder prevalence rates are on the rise, indicating an increased need for accurate assessment and detection. The current review provides an overview of transdiagnostic eating disorder assessments, including interview, self-report, health and primary care screeners, and technology-based and objective assessments. We focused on assessments that are transdiagnostic in nature and exhibit high impact in the field. We provide recommendations for how these assessments should be used in research and clinical settings. We also discuss considerations that are crucial for assessment, including the use of a categorical versus dimensional diagnostic framework, assessment of eating disorders in related fields (i.e., anxiety and depression), and measurement-based care for eating disorders. Finally, we provide suggestions for future research, including the need for more research on short transdiagnostic screeners for use in health care settings, standardized assessments for ecological momentary assessment, development of state-based assessment of eating disorder symptoms, and consideration of assessment across multiple timescales.
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Affiliation(s)
| | - Kimberly Osborn
- University of Louisville, KY, USA
- Oklahoma State University, Stillwater, USA
| | - Madison Hooper
- University of Louisville, KY, USA
- Vanderbilt University, Nashville, TN, USA
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Vanzhula I, Duck SA, Pletch A, Guarda AS, Schreyer C. Greater dietary variety is associated with lower food anxiety at discharge from intensive eating disorder treatment. Int J Eat Disord 2023. [PMID: 36951232 DOI: 10.1002/eat.23940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Food anxiety and limited dietary variety often persist after intensive treatment for eating disorders (EDs) and may contribute to relapse. Prior studies demonstrate decreased meal-related anxiety with residential or inpatient treatment, but less is known about changes in dietary variety and anxiety associated with specific foods. The current study assessed change in food anxiety and dietary variety in inpatients with EDs (anorexia nervosa and bulimia nervosa) in relation to discharge outcomes from meal-based behavioral treatment. METHOD Patients (N = 128) admitted to a specialized, hospital-based behavioral treatment program completed measures of food anxiety, dietary variety, and ED symptoms at admission and discharge. Demographic and clinical data were abstracted from electronic medical records. A novel network community analysis identified three food anxiety groups: fruit-veg, animal-based, and carb-based foods. RESULTS High-energy density combination foods were most anxiety-provoking and most avoided. Food anxiety decreased, and dietary variety increased from admission to discharge. Reduction in food anxiety was associated with lower ED symptom scores and higher normative eating self-efficacy at discharge. For animal-based foods, increased dietary variety was associated with lower food anxiety at discharge. Neither variety nor anxiety was associated with weight restoration. DISCUSSION Findings highlight the importance of broadening dietary variety and targeting food anxiety during the nutritional rehabilitation and weight restoration phase of ED treatment. Increasing dietary variety may contribute to reduced food anxiety, which, in turn, may increase normative eating self-efficacy. These results may help inform nutritional guidelines for meal-based treatment programs. PUBLIC SIGNIFICANCE Consuming a greater variety of foods during meal-based intensive treatment may help alleviate food anxiety in patients with eating disorders.
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Affiliation(s)
- Irina Vanzhula
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Ann Duck
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allisyn Pletch
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angela S Guarda
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen Schreyer
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Levinson CA, Hunt RA, Keshishian AC, Brown ML, Vanzhula I, Christian C, Brosof LC, Williams BM. Correction to: Using individual networks to identify treatment targets for eating disorder treatment: a proof-of-concept study and initial data. J Eat Disord 2022; 10:99. [PMID: 35818061 PMCID: PMC9275135 DOI: 10.1186/s40337-022-00626-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA.
| | - Rowan A Hunt
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA
| | - Ani C Keshishian
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA
| | - Mackenzie L Brown
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA
| | - Irina Vanzhula
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA
| | - Caroline Christian
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA
| | - Brenna M Williams
- Department of Psychological and Brain Sciences, Life Sciences Building, University of Louisville, Louisville, KY, 40292, USA
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Sala M, Vanzhula I, Roos CR, Levinson CA. Mindfulness and Eating Disorders: A Network Analysis. Behav Ther 2022; 53:224-239. [PMID: 35227400 DOI: 10.1016/j.beth.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/27/2022]
Abstract
Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.
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Affiliation(s)
- Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University
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Levinson CA, Hunt RA, Keshishian AC, Brown ML, Vanzhula I, Christian C, Brosof LC, Williams BM. Using individual networks to identify treatment targets for eating disorder treatment: a proof-of-concept study and initial data. J Eat Disord 2021; 9:147. [PMID: 34736538 PMCID: PMC8567590 DOI: 10.1186/s40337-021-00504-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/23/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are severe mental illnesses, with high morbidity, mortality, and societal burden. EDs are extremely heterogenous, and only 50% of patients currently respond to first-line treatments. Personalized and effective treatments for EDs are drastically needed. METHODS The current study (N = 34 participants with an ED diagnosis collected throughout the United States) aimed to investigate best methods informing how to select personalized treatment targets utilizing idiographic network analysis, which could then be used for evidence based personalized treatment development. We present initial data collected via experience sampling (i.e., ecological momentary assessment) over the course of 15 days, 5 times a day (75 total measurement points) that were used to select treatment targets for a personalized treatment for EDs. RESULTS Overall, we found that treatment targets were highly variable, with less than 50% of individuals endorsing central symptoms related to weight and shape, consistent with current treatment response rates for treatments designed to target those symptoms. We also found that different aspects of selection methods (e.g., number of items, type of centrality measure) impacted treatment target selection. CONCLUSIONS We discuss implications of these data, how to use idiographic network analysis to personalize treatment, and identify areas that need future research. TRIAL REGISTRATION Clinicaltrials.gov, NCT04183894. Registered 3 December 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04183894 . NCT04183894 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.
| | - Rowan A Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Ani C Keshishian
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Mackenzie L Brown
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Irina Vanzhula
- 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
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Brenna M Williams
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
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Levinson CA, Christian C, Ram SS, Vanzhula I, Brosof LC, Michelson LP, Williams BM. Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders. J Affect Disord 2020; 276:585-591. [PMID: 32794449 DOI: 10.1016/j.jad.2020.07.075] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/15/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few evidence-based treatments for eating disorders (EDs) exist. Imaginal exposure therapy is a key component of effective treatment for anxiety disorders and post-traumatic stress disorder. However, imaginal exposure has not been systematically tested as a treatment for EDs. The current study aimed to develop and test online imaginal exposure as a treatment for EDs. METHODS The current study tested a four-week trial of online imaginal exposure for EDs (N = 229 participants with EDs recruited globally). Participants completed diagnostic interviews and four sessions of weekly online imaginal exposure, in which they wrote about and imagined a core ED fear (identified with a therapist). Participants completed measures of ED symptoms and fears (i.e., fear of weight gain, food) at pre-imaginal exposure, post-imaginal exposure, and six-month follow-up. Participants were recruited and participated in the protocol from November 2016 to October 2018. RESULTS All primary outcomes (ED symptoms, ED fears) significantly decreased at study completion and six-month follow-up with medium-to-large effect sizes. State anxiety across the exposure and follow-ups significantly decreased, specifically from initial sessions to follow-up. Worry, but not depression, significantly decreased. LIMITATIONS This study was an open case trial and did not include a control condition. CONCLUSIONS Significant decreases in ED symptoms and fears occurred during the course of imaginal exposure treatment. Online imaginal exposure is a feasible treatment for EDs and is associated with decreases in core ED symptomatology, which are comparable in magnitude to decreases seen from other evidence-based treatments. A future randomized-controlled trial is needed. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier NCT03712748.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States.
| | - Caroline Christian
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Shruti Shankar Ram
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Irina Vanzhula
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Lisa P Michelson
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Brenna M Williams
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
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Brosof LC, Egbert AH, Reilly EE, Wonderlich JA, Karam A, Vanzhula I, Steward T, Levinson CA. Intolerance of uncertainty moderates the relationship between high personal standards but not evaluative concerns perfectionism and eating disorder symptoms cross-sectionally and prospectively. Eat Behav 2019; 35:101340. [PMID: 31731235 DOI: 10.1016/j.eatbeh.2019.101340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
Two dimensions of perfectionism related to eating disorder (ED) symptoms are evaluative concerns and high standards. Evaluative concerns are consistently linked with ED symptoms, whereas there are conflicting results regarding high standards and ED symptoms. High standards are unrelated to ED symptoms in some studies and are linked to higher ED symptoms in others. Intolerance of uncertainty (IU) may influence the relation between high standards and ED symptoms; individuals elevated in both IU and high standards may find it distressing to be uncertain about future situations for fear of not living up to high expectations and use ED behaviors to cope with such uncertainty. In the current study (N = 216), we explored whether IU moderates the relationships between high standards and evaluative concerns and ED symptoms, both cross-sectionally and prospectively across two weeks. IU significantly moderated high standards and ED symptoms both cross-sectionally and across time while accounting for baseline ED symptoms, but did not moderate the relationship between evaluative concerns and ED symptoms. Higher standards were associated with greater ED symptoms in individuals higher, but not lower in IU. These findings suggest high standards may only contribute to ED symptoms when individuals are also high in IU.
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Affiliation(s)
- Leigh C Brosof
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA.
| | - Amy H Egbert
- Loyola University Chicago, Department of Psychology, Chicago, IL, USA
| | - Erin E Reilly
- University of California, San Diego, Department of Psychiatry, San Diego, CA, USA(2); Hofstra University, Department of Psychology, Hempstead, NY, USA(1)
| | | | - Anna Karam
- Washington University in St. Louis, Department of Psychological and Brain Sciences, USA
| | - Irina Vanzhula
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA
| | - Trevor Steward
- Bellvitge University Hospital-IDIBELL, Department of Psychiatry, Barcelona, Spain; School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA
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Levinson CA, Vanzhula I, Brosof LC. Longitudinal and personalized networks of eating disorder cognitions and behaviors: Targets for precision intervention a proof of concept study. Int J Eat Disord 2018; 51:1233-1243. [PMID: 30291641 DOI: 10.1002/eat.22952] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite the high mortality and significant societal and personal costs associated with eating disorders (EDs) there are few evidence-based treatments. Part of the difficulty developing and implementing evidence-based treatments in EDs is due to the extremely high heterogeneity (e.g., variability in treatment outcome, symptom presentation etc) present. METHODS To begin to identify specific symptom heterogeneity within persons, the current study used novel within and between group and intra-individual network analyses to create longitudinal and within-person networks of ED cognitions and behaviors (N = 66 individuals diagnosed with an ED). This article provides a proof of concept study for how to use between and within-person network analyses both for the EDs and other forms of psychopathology. RESULTS We found that cognitions focused on desiring thinness played a likely maintaining role in ED pathology, across network type and across time. Furthermore, we showed that three individuals with the same diagnosis (anorexia nervosa) differed in which symptoms maintained the disorder. We use these participants to exemplify how to use intra-individual network analysis to personalize treatment focused on the primary maintaining symptoms. Finally, we found that amount of time (e.g., 4 hr vs. simultaneously) impacts how symptoms maintain each other. CONCLUSIONS These findings have implications for the development of novel personalized evidence-based treatments for EDs, as well as implications for how the field understands how psychopathology maintains itself. These data represent a first-step towards using intra-individual network analyses in the ED field, as well as for hypotheses generation in future research.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Irina Vanzhula
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
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Levinson CA, Brosof LC, Vanzhula I, Christian C, Jones P, Rodebaugh TL, Langer JK, White EK, Warren C, Weeks JW, Menatti A, Lim MH, Fernandez KC. Social anxiety and eating disorder comorbidity and underlying vulnerabilities: Using network analysis to conceptualize comorbidity. Int J Eat Disord 2018; 51:693-709. [PMID: 30102777 DOI: 10.1002/eat.22890] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/06/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Eating disorders (EDs) and social anxiety disorder (SAD) are highly co-occurring. This comorbidity is extremely relevant, given that individuals with comorbid ED-SAD are less likely to seek and/or benefit from ED treatment. METHOD We used network analysis to conceptualize ED-SAD comorbidity in a sample of 2,215 participants with a primary diagnosis of ED, SAD, or no known diagnosis. We used novel network analyses methods to select symptoms for our models, identify potential illness pathways (i.e., bridge symptoms) between disorders and underlying vulnerabilities (e.g., perfectionism, social appearance anxiety), and to compare across sample types (e.g., clinical vs. nonclinical). We also tested several novel network analyses methods aimed at the following methodological concerns: (a) topological concerns (i.e., which items should be included in NA models), (b) how to use empirical indices to quantify bridge symptoms and (c) what differences in networks across samples mean. RESULTS We found that difficulty with drinking beverages and eating in public were bridge symptoms between ED and SAD. We also found that feeling nervous about one's appearance was a bridge symptom. CONCLUSIONS We identified public eating and drinking as bridge symptoms between EDs and SAD. Future research is needed to test if interventions focused on public eating and drinking might decrease symptoms of both EDs and SAD. Researchers can use this study (code provided) as an exemplar for how to use network analysis, as well as to use network analysis to conceptualize ED comorbidity and compare network structure and density across samples.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, 40292
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, 40292
| | - Irina Vanzhula
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, 40292
| | - Caroline Christian
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, 40292
| | - Payton Jones
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Julia K Langer
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Emily K White
- Neurological Institute Cleveland Clinic, Cleveland, Ohio
| | - Cortney Warren
- Department of Psychology, University of Nevada, Reno, Nevada
| | - Justin W Weeks
- Department of Psychology, Ohio University, Columbus, Ohio
| | - Andrew Menatti
- Department of Psychology, Ohio University, Columbus, Ohio
| | - Michelle H Lim
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Katya C Fernandez
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
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