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A comparative network analysis of eating disorder psychopathology and co-occurring depression and anxiety symptoms before and after treatment

Published online by Cambridge University Press:  15 April 2018

Kathryn E. Smith Open the ORCID record for Kathryn E. Smith [Opens in a new window] ,
Tyler B. Mason ,
Ross D. Crosby ,
Li Cao ,
Rachel C. Leonard ,
Chad T. Wetterneck ,
Brad E. R. Smith ,
Nicholas R. Farrell ,
Bradley C. Riemann  and
Stephen A. Wonderlich
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Kathryn E. Smith*
Affiliation:
Neuropsychiatric Research Institute, Fargo, North Dakota, USA Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
Tyler B. Mason
Affiliation:
Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
Ross D. Crosby
Affiliation:
Neuropsychiatric Research Institute, Fargo, North Dakota, USA Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
Li Cao
Affiliation:
Neuropsychiatric Research Institute, Fargo, North Dakota, USA
Rachel C. Leonard
Affiliation:
Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
Chad T. Wetterneck
Affiliation:
Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
Brad E. R. Smith
Affiliation:
Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
Nicholas R. Farrell
Affiliation:
Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
Bradley C. Riemann
Affiliation:
Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
Stephen A. Wonderlich
Affiliation:
Neuropsychiatric Research Institute, 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
Affiliation:
Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
*
Author for correspondence: Kathryn E. Smith, E-mail: [email protected]
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Abstract

Background

Network analysis is an emerging approach in the study of psychopathology, yet few applications have been seen in eating disorders (EDs). Furthermore, little research exists regarding changes in network strength after interventions. Therefore the present study examined the network structures of ED and co-occurring depression and anxiety symptoms before and after treatment for EDs.

Method

Participants from residential or partial hospital ED treatment programs (N = 446) completed assessments upon admission and discharge. Networks were estimated using regularized Graphical Gaussian Models using 38 items from the Eating Disorders Examination-Questionnaire, Quick Inventory of Depressive Symptomatology, and State-Trait Anxiety Inventory.

Results

ED symptoms with high centrality indices included a desire to lose weight, guilt about eating, shape overvaluation, and wanting an empty stomach, while restlessness, self-esteem, lack of energy, and feeling overwhelmed bridged ED to depression and anxiety symptoms. Comparisons between admission and discharge networks indicated the global network strength did not change significantly, though symptom severity decreased. Participants with denser networks at admission evidenced less change in ED symptomatology during treatment.

Conclusions

Findings suggest that symptoms related to shape and weight concerns and guilt are central ED symptoms, while physical symptoms, self-esteem, and feeling overwhelmed are links that may underlie comorbidities in EDs. Results provided some support for the validity of network approaches, in that admission networks conveyed prognostic information. However, the lack of correspondence between symptom reduction and change in network strength indicates that future research is needed to examine network dynamics in the context of intervention and relapse prevention.

Keywords

Anxietyclassificationdepressioneating disordersnetwork analysistreatment
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 2 , January 2019 , pp. 314 - 324
Copyright
Copyright © Cambridge University Press 2018 

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