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A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive–behavioral model of eating-disorder symptoms

Published online by Cambridge University Press:  07 January 2020

Caroline Christian
Affiliation:
Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
Brenna M. Williams
Affiliation:
Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
Rowan A. Hunt
Affiliation:
Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
Valerie Z. Wong
Affiliation:
Department of Psychology, Yale University New Haven, CT, United States of America
Sarah E. Ernst
Affiliation:
Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
Samantha P. Spoor
Affiliation:
Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
Irina A. Vanzhula
Affiliation:
Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
Jenna P. Tregarthen
Affiliation:
Recovery Record, Inc.San Francisco, CA, United States of America
Kelsie T. Forbush
Affiliation:
Department of Psychology, University of Kansas, Lawrence, KS, United States of America
Cheri A. Levinson
Affiliation:
Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
Corresponding

Abstract

Background

In the past decade, network analysis (NA) has been applied to psychopathology to quantify complex symptom relationships. This statistical technique has demonstrated much promise, as it provides researchers the ability to identify relationships across many symptoms in one model and can identify central symptoms that may predict important clinical outcomes. However, network models are highly influenced by node selection, which could limit the generalizability of findings. The current study (N = 6850) tests a comprehensive, cognitive–behavioral model of eating-disorder symptoms using items from two, widely used measures (Eating Disorder Examination Questionnaire and Eating Pathology Symptoms Inventory).

Methods

We used NA to identify central symptoms and compared networks across the duration of illness (DOI), as chronicity is one of the only known predictors of poor outcome in eating disorders (EDs).

Results

Our results suggest that eating when not hungry and feeling fat were the most central symptoms across groups. There were no significant differences in network structure across DOI, meaning the connections between symptoms remained relatively consistent. However, differences emerged in central symptoms, such that cognitive symptoms related to overvaluation of weight/shape were central in individuals with shorter DOI, and behavioral central symptoms emerged more in medium and long DOI.

Conclusions

Our results have important implications for the treatment of individuals with enduring EDs, as they may have a different core, maintaining symptoms. Additionally, our findings highlight the importance of using comprehensive, theoretically- or empirically-derived models for NA.

Type
Original Articles
Copyright
Copyright © The Authors 2020. Published by Cambridge University Press

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References

Aardoom, J. J., Dingemans, A. E., Op't Landt, M. C. S., & Van Furth, E. F. (2012). Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eating Behaviors, 13, 305309.CrossRefGoogle Scholar
Berg, K. C., Peterson, C. B., Frazier, P., & Crow, S. J. (2012). Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: A systematic review of the literature. International Journal of Eating Disorders, 45, 428438.CrossRefGoogle ScholarPubMed
Berkman, N. D., Lohr, K. N., & Bulik, C. M. (2007). Outcomes of eating disorders: A systematic review of the literature. International Journal of Eating Disorders, 40, 293309.CrossRefGoogle ScholarPubMed
Borsboom, D., & Cramer, A. O. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91121.CrossRefGoogle ScholarPubMed
Boswell, J. F., Anderson, L. M., & Anderson, D. A. (2015). Integration of interoceptive exposure in eating disorder treatment. Clinical Psychology: Science and Practice, 22, 194210.Google Scholar
Bringmann, L. F., Elmer, T., Epskamp, S., Krause, R. W., Schoch, D., Wichers, M., … Snippe, E. (2019). What do centrality measures measure in psychological networks? The Journal of Abnormal Psychology, 128, 892903.CrossRefGoogle ScholarPubMed
Bringmann, L. F., & Eronen, M. I. (2018). Don't blame the model: Reconsidering the network approach to psychopathology. Psychological Review, 125, 606615.CrossRefGoogle Scholar
Carter, J. C., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D. B. (2004). Relapse in anorexia nervosa: A survival analysis. Psychological Medicine, 34, 671679.CrossRefGoogle ScholarPubMed
Carter, J. C., Stewart, D. A., & Fairburn, C. G. (2001). Eating disorder examination questionnaire: Norms for young adolescent girls. Behaviour Research and Therapy, 39, 625632.CrossRefGoogle ScholarPubMed
Christian, C., Perko, V. L., Vanzhula, I. A., Tregarthen, J. P., Forbush, K. T., & Levinson, C. A. (2019). Using network analysis to examine differences in eating disorder symptom structure and interconnectedness across developmental stages. Journal of Abnormal Psychology. Advance online publication.CrossRefGoogle Scholar
Cooper, Z., & Fairburn, C. (1987). The eating disorder examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders, 6, 18.3.0.CO;2-9>CrossRefGoogle Scholar
Cramer, A. O., Waldorp, L. J., Van Der Maas, H. L., & Borsboom, D. (2010). Comorbidity: A network perspective. Behavioral and Brain Sciences, 33, 137150.CrossRefGoogle ScholarPubMed
DuBois, R. H., Rodgers, R. F., Franko, D. L., Eddy, K. T., & Thomas, J. J. (2017). A network analysis investigation of the cognitive-behavioral theory of eating disorders. Behaviour Research and Therapy, 97, 213221.CrossRefGoogle ScholarPubMed
Eckert, E. D., Halmi, K. A., Marchi, P., Grove, W., & Crosby, R. (1995). Ten-year follow-up of anorexia nervosa: Clinical course and outcome. Psychological Medicine, 25, 143156.CrossRefGoogle ScholarPubMed
Elliott, H., Jones, P. J., & Schmidt, U. (2019). Central symptoms predict post-treatment outcomes and clinical impairment in anorexia nervosa: A network analysis in a randomized-controlled trial. Clinical Psychological Science. Advance online publication.CrossRefGoogle Scholar
Epskamp, S., Cramer, A. O., Waldorp, L. J., Schmittmann, V. D., & Borsboom, D. (2012). Qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48, 118.CrossRefGoogle Scholar
Epskamp, S., Maris, G. K., Waldorp, L. J., & Borsboom, D. (2016). Network psychometrics. In Irwing, P., Hughes, D., & Booth, T. (Eds.), Handbook of Psychometrics. New York: Wiley.Google Scholar
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press.Google ScholarPubMed
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363370.Google ScholarPubMed
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy, 41, 509528.CrossRefGoogle ScholarPubMed
Forbush, K. T., Siew, C. S. Q., & Vitevitch, M. S. (2016). Application of network analysis to identify interactive systems of eating disorder psychopathology. Psychological Medicine, 46, 26672677.CrossRefGoogle ScholarPubMed
Forbush, K. T., Wildes, J. E., & Hunt, T. K. (2014). Gender norms, psychometric properties and validity for the Eating Pathology Symptoms Inventory. International Journal of Eating Disorders, 47, 8591.CrossRefGoogle ScholarPubMed
Forbush, K. T., Wildes, J. E., Pollack, L. O., Dunbar, D., Luo, J., Patterson, K., … Bright, A. (2013). Development and validation of the Eating Pathology Symptoms Inventory (EPSI). Psychological Assessment 25, 859878.CrossRefGoogle Scholar
Forrest, L. N., Jones, P. J., Ortiz, S. N., & Smith, A. R. (2018). Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis. International Journal of Eating Disorders, 51, 668679.CrossRefGoogle ScholarPubMed
Goldschmidt, A. B., Crosby, R. D., Cao, L., Moessner, M., Forbush, K. T., Accurso, E. C., & Le Grange, D. (2018). Network analysis of pediatric eating disorder symptoms in a treatment-seeking, transdiagnostic sample. Journal of Abnormal Psychology, 127, 251264.CrossRefGoogle Scholar
Hallquist, M., Wright, A. G., & Molenaar, P. C. (2019). Problems with centrality measures in psychopathology symptom networks: Why network psychometrics cannot escape psychometric theory. Multivariate Behavioral Research, 12, 125.CrossRefGoogle Scholar
Hay, P., & Touyz, S. (2015). Treatment of patients with severe and enduring eating disorders. Current Opinion in Psychiatry, 28, 473477.CrossRefGoogle ScholarPubMed
Herzog, D. B., Sacks, N. R., Keller, M. B., Lavori, P. W., Von Ranson, K. B., & Gray, H. M. (1993). Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 835842.CrossRefGoogle ScholarPubMed
Jones, P. J. (2017). networktools: Tools for identifying important nodes in networks. R package, version 1.2. Retrieved from https://CRAN.R-project.org/package=networktools.Google Scholar
Keel, P. K., & Brown, T. A. (2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43, 195204.Google ScholarPubMed
Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J., & Tyson, E. (2009). Academy for eating disorders position paper: Eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42, 97103.CrossRefGoogle ScholarPubMed
Kristeller, J., Wolever, R. Q., & Sheets, V. (2014). Mindfulness-based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5, 282297.CrossRefGoogle Scholar
Levinson, C. A., Brosof, L. C., Vanzhula, I. A., Christian, C., Jones, P., Rodebaugh, T. L., … Menatti, A. (2018). Social anxiety and eating disorder comorbidity and underlying vulnerabilities: Using network analysis to conceptualize comorbidity. International Journal of Eating Disorders 51, 693709.CrossRefGoogle ScholarPubMed
Levinson, C. A., Zerwas, S., Calebs, B., Forbush, K. T., Kordy, H., Watson, H., … Runfola, C. D. (2017). The core symptoms of bulimia nervosa, anxiety and depression: A network analysis. Journal of Abnormal Psychology 126, 340354.CrossRefGoogle ScholarPubMed
Linardon, J., Phillipou, A., Castle, D., Newton, R., Harrison, P., Cistullo, L. L., … Brennan, L. (2018). Feeling fat in eating disorders: Testing the unique relationships between feeling fat and measures of disordered eating in anorexia nervosa and bulimia nervosa. Body Image 25, 163167.CrossRefGoogle ScholarPubMed
Luce, K. H., & Crowther, J. H. (1999). The reliability of the eating disorder examination – self-report questionnaire version (EDE-Q). International Journal of Eating Disorders, 25, 349351.3.0.CO;2-M>CrossRefGoogle Scholar
Major, L. (2016). The experience of feeling fat for women with an anorexia nervosa diagnosis: An interpretative phenomenological analysis. Doctoral dissertation, University of Hertfordshire, Hatfield, England. Retrieved from https://uhra.herts.ac.uk/handle/2299/17187.Google Scholar
McNally, R. J. (2016). Can network analysis transform psychopathology? Behaviour Research and Therapy, 86, 95104.CrossRefGoogle ScholarPubMed
Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2004). Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42, 551567.CrossRefGoogle ScholarPubMed
Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics, 33, 611627.Google ScholarPubMed
Norring, C. E. A., & Sohlberg, S. S. (1993). Outcome, recovery, relapse and mortality across six years in patients with clinical eating disorders. Acta Psychiatrica Scandinavica, 87, 437444.CrossRefGoogle ScholarPubMed
Olatunji, B. O., Levinson, C. A., & Calebs, B. (2018). A network analysis of eating disorder symptoms and characteristics in an inpatient sample. Psychiatry Research, 262, 270281.CrossRefGoogle Scholar
Pallister, E., & Waller, G. (2008). Anxiety in the eating disorders: Understanding the overlap. Clinical Psychology Review, 28, 366386.CrossRefGoogle ScholarPubMed
Pe, M. L., Kircanski, K., Thompson, R. J., Bringmann, L. F., Tuerlinckx, F., Mestdagh, M., … Kuppens, P. (2015). Emotion-network density in major depressive disorder. Clinical Psychological Science 3, 292300.CrossRefGoogle Scholar
Pearson, C. M., Wonderlich, S. A., & Smith, G. T. (2015). A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior. Psychological Review, 122, 516.CrossRefGoogle ScholarPubMed
Perko, V. L., Forbush, K. T., Siew, C. S. Q., & Tregarthen, J. P. (2019). Application of network analysis to investigate sex differences in interactive systems of eating-disorder psychopathology. International Journal of Eating Disorders, 52, 13431352.CrossRefGoogle ScholarPubMed
Robinson, P (2009) Severe and enduring eating disorder (SEED): Management of complex presentations of anorexia and bulimia nervosa. Chichester, UK; Malden, MA: Wiley-Blackwell.Google Scholar
Robinson, P. (2014). Severe and enduring eating disorders: Recognition and management. Advances in Psychiatric Treatment, 20, 392401.CrossRefGoogle Scholar
Rodebaugh, T. L., Tonge, N. A., Piccirillo, M. L., Fried, E., Horenstein, A., Morrison, A. S., … Blanco, C. (2018). Does centrality in a cross-sectional network suggest intervention targets for social anxiety disorder? Journal of Consulting and Clinical Psychology 86, 831844.CrossRefGoogle Scholar
Simlett, M. (2004). Relationship between feeling fat and inhibited emotional expression in women. Doctoral dissertation, University of British Columbia, Vancouver, Canada. Retrieved from https://open.library.ubc.ca/cIRcle/collections/ubctheses/831/items/1.0053754.Google Scholar
Smith, K. E., Crosby, R. D., Wonderlich, S. A., Forbush, K. T., Mason, T. B., & Moessner, M. (2018). Network analysis: An innovative framework for understanding eating disorder psychopathology. International Journal of Eating Disorders, 51, 214222.CrossRefGoogle ScholarPubMed
Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53, 985993.CrossRefGoogle ScholarPubMed
Strober, M., Freeman, R., & Morrell, W. (1997). The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse and outcome predictors over 10–15 years in a prospective study. International Journal of Eating Disorders, 22, 339360.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Treasure, J., Cardi, V., Leppanen, J., & Turton, R. (2015). New treatment approaches for severe and enduring eating disorders. Physiology and Behavior, 152, 456465.CrossRefGoogle ScholarPubMed
Tregarthen, J. P., Lock, J., & Darcy, A. M. (2015). Development of a smartphone application for eating disorder self-monitoring. International Journal of Eating Disorders, 48, 972982.CrossRefGoogle ScholarPubMed
van Borkulo, C., Boschloo, L., Borsboom, D., Penninx, B. W., Waldorp, L. J., & Schoevers, R. A. (2015). Association of symptom network structure with the course of depression. JAMA Psychiatry, 72, 12191226.CrossRefGoogle Scholar
Vanzhula, I. A., Calebs, B., Fewell, L., & Levinson, C. A. (2019). Illness pathways between eating disorder and post-traumatic stress disorder symptoms: Understanding comorbidity with network analysis. European Eating Disorders Review, 27, 147160.CrossRefGoogle ScholarPubMed
Vanzhula, I. A., Christian, C., Brosof, L. C., Jones, P., Levinson, C. A., Forbush, K. T., … Tregarthen, J. (under review). Replicability of eating disorder psychological networks in five samples: Conceptual and methodological considerations. Manuscript submitted for publication.Google Scholar
Walsh, B. T. (2013). The enigmatic persistence of anorexia nervosa. American Journal of Psychiatry, 170, 477484.CrossRefGoogle ScholarPubMed
Wang, S. B., Jones, P. J., Dreier, M., Elliott, H., & Grilo, C. M. (2018). Core psychopathology of treatment-seeking patients with binge-eating disorder: A network analysis investigation. Psychological Medicine, 49, 19231928.CrossRefGoogle ScholarPubMed
Zipfel, S., Löwe, B., Reas, D. L., Deter, H. C., & Herzog, W. (2000). Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study. The Lancet, 355, 721722.CrossRefGoogle ScholarPubMed

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A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive–behavioral model of eating-disorder symptoms
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