A network approach can improve eating disorder conceptualization and treatment

Levinson, Cheri A.; Cusack, Claire E.; Brown, Mackenzie; Smith, April R.

doi:10.1038/s44159-022-00062-y

Cited by 26 publications

(26 citation statements)

References 169 publications

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“…A promising approach to examining these associations is network analysis (Levinson et al, 2022; Monteleone & Cascino, 2021). Although prior network studies analyzing ED symptoms have focused on links with anxiety and depressive symptoms (Levinson et al, 2017; Smith, Mason, et al, 2018), few studies have done so on Latin‐American populations, particularly in non‐clinical and college samples (Tavolacci et al, 2020), where ED symptoms (Smink et al, 2012) and SRB are prevalent (Pillay, 2021).…”

Section: Introductionmentioning

confidence: 99%

Examining associations between symptoms of eating disorders and symptoms of anxiety, depression, suicidal ideation, and perceived family functioning in university students: A brief report

Murga

Cabezas

Chinchilla

et al. 2022

Intl J Eating Disorders

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Objective We examined the relationships between eating disorders symptoms (EDs), suicidal ideation, depressive and anxiety symptoms, and perceived family functioning in a sample of university students aged 18–25 years (N = 397). Method Assessment of symptoms was carried out with the Eating Disorder Diagnostic Scale, Beck Anxiety Inventory and Beck Depression Inventory, among others. We explored the associations between the domains using network analysis. Results We found that physical anxiety symptoms, followed by cognitive and physical depressive symptoms showed the greatest centrality in the current network. Perceived family functioning was negatively related to eating disorder symptoms. Discussion We provide evidence regarding the relevant role of anxiety and depression symptoms in the presentation of ED symptoms in university students. These findings provide new insights to improve preventive interventions to timely reduce symptoms and risk factors associated with EDs. Public significance Using a network approach, we found specific associations between physical anxiety symptoms, cognitive and physical depressive symptoms, eating disorders symptoms, suicidal ideation and perceived family functioning in university students. These variables can be potential targets to develop evidence‐based preventive strategies in this population. A better understanding of these complex associations and the role of family variables could enhance the effectiveness of interventions in both clinical and educational settings.

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Section: Introductionmentioning

confidence: 99%

Examining associations between symptoms of eating disorders and symptoms of anxiety, depression, suicidal ideation, and perceived family functioning in university students: A brief report

Murga

Cabezas

Chinchilla

et al. 2022

Intl J Eating Disorders

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“…However, ED treatment providers may be under-resourced and unprepared to appropriately address co-occurring mental health concerns. Due to the complex entanglement of co-occurring disorders and EDs, other psychiatric disorders may interfere with remission of eating disorder symptomatology and negatively impact long-term healing if left untreated [ 62 ]. Overall, these factors contribute to treatment inaccessibility, avoidance of healthcare, and distrust of medical systems, which can become further entrenched by experiences in treatment that are more likely to be culturally incompatible, retraumatizing, and ill-suited for individuals within these populations.…”

Section: Systemic Oppression and Barriers To Carementioning

confidence: 99%

“…Although the authors acknowledge that “consensus regarding criteria for SE-AN remains elusive” [ 1 , p. 2], they go on to describe “terminal” AN as a “subcategory of SE-AN” which constitutes a “distinct condition” [ 5 , p. 2]. However, the lack of clinical consensus around characterizing “SE-AN” itself [ 62 , 65 , 66 calls into question the claim that this category of ED or subcategories within it can be used to meaningfully assess predictable medical decline or mortality. Current definitions of SE-AN range from a minimum of 3 years to a minimum of 10 years of illness duration [ 67 ] and vary in whether they require previous “unsuccessful” treatment attempts and low body mass index (BMI) as qualifying criteria [ 68 ].…”

Section: Shifting Characteristics and Discretionary Applicationmentioning

confidence: 99%

Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of “terminal” anorexia nervosa

Sharpe¹,

Adams²,

Smith³

et al. 2023

J Eat Disord

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Informed by our lived experiences with eating disorders, our work providing direct support to communities underserved by existing healthcare structures, and our commitment to social justice, we are deeply troubled by several aspects of the proposed characteristics for “terminal” anorexia nervosa outlined by Gaudiani et al. in Journal of Eating Disorders (10:23, 2022). We have identified two substantial areas of concern in the proposed characteristics provided by Gaudiani et al. and the subsequent publication by Yager et al. (10:123, 2022). First, the original article and the subsequent publication fail to adequately address the widespread inaccessibility of eating disorder treatment, the lack of parameters for what constitutes “high quality care”, and the prevalence of trauma experienced in treatment settings for those who do access treatment. Second, the characteristics proposed for “terminal” anorexia nervosa are constructed largely based on subjective and inconsistent valuations of suffering which build on and contribute to harmful and inaccurate eating disorder stereotypes. Overall, we believe these proposed characteristics in their current form stand to detract from, rather than assist, the ability of patients and providers to make informed, compassionate, and patient-centered decisions about safety and autonomy both for individuals with enduring eating disorders and for individuals with more recently diagnosed eating disorders.

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“…EDs are heterogeneous and are usually associated with physical and mental health morbidity and elevated mortality, which vary according to the diagnosis, duration, and frequency of certain specific behaviors [ 2 , 3 , 4 ]. Comorbidities with other psychiatric diseases are high [ 5 ] since up to 95% of EDs subjects have at least one additional psychiatric illness [ 6 ]. EDs are prevalent among females and young adults, with a female-to-male ratio ranging from 3:1 to 8:1 [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The pathogenesis of EDs ensues from a pattern of genetic, psychosocial, biological, and environmental risk factors [ 9 , 10 ], and its complexity is often increased by the shift from one to another eating disorder diagnosis [ 6 , 11 ] (typically within the first 5 years of illness), suggesting an overlapping pathogenesis of this type of disorder [ 12 ]. In particular, it has been demonstrated that EDs share common neurobiological abnormalities, such as dysregulation of the serotonergic system [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

SLC6A4 DNA Methylation Levels and Serum Kynurenine/Tryptophan Ratio in Eating Disorders: A Possible Link with Psychopathological Traits?

et al. 2023

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Background: The incidence of eating disorders (EDs), serious mental and physical conditions characterized by a disturbance in eating or eating-related behaviors, has increased steadily. The present study aims to develop insights into the pathophysiology of EDs, spanning over biochemical, epigenetic, psychopathological, and clinical data. In particular, we focused our attention on the relationship between (i) DNA methylation profiles at promoter-associated CpG sites of the SCL6A4 gene, (ii) serum kynurenine/tryptophan levels and ratio (Kyn/Trp), and (iii) psychopathological traits in a cohort of ED patients. Among these, 45 patients were affected by restricting anorexia nervosa (AN0), 21 by purging AN (AN1), 21 by bulimia (BN), 31 by binge eating disorders (BED), 23 by unspecified feeding or eating disorders (UFED), and finally 14 by other specified eating disorders (OSFED) were compared to 34 healthy controls (CTRs). Results: Kyn level was higher in BED, UFED, and OSFED compared to CTRs (p ≤ 0.001). On the other hand, AN0, AN1, and BN patients showed significatively lower Kyn levels compared to the other three ED groups but were closed to CTRs. Trp was significantly higher in AN0, AN1, and BN in comparison to other ED groups. Moreover, AN1 and BN showed more relevant Trp levels than CTRs (p <0.001). BED patients showed a lower Trp as compared with CTRs (p ≤ 0.001). In addition, Kyn/Trp ratio was lower in the AN1 subtype but higher in BED, UFED, and OSFED patients than in CTRs (p ≤ 0.001). SCL6A4 DNA methylation level at CpG5 was lower in AN0 compared to BED (p = 0.021), and the CpG6 methylation was also significantly lower in AN0 in comparison to CTRs (p = 0.025). The mean methylation levels of the six CpGs analyzed were lower only in the AN0 subgroup compared to CTRs (p = 0.008). Relevant psychological trait EDI-3 subscales were correlated with biochemical and epigenetic data. Conclusions: These findings underline the complexity of psychological and pathophysiological components of EDs.

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A network approach can improve eating disorder conceptualization and treatment

Cited by 26 publications

References 169 publications

Examining associations between symptoms of eating disorders and symptoms of anxiety, depression, suicidal ideation, and perceived family functioning in university students: A brief report

Examining associations between symptoms of eating disorders and symptoms of anxiety, depression, suicidal ideation, and perceived family functioning in university students: A brief report

Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of “terminal” anorexia nervosa

SLC6A4 DNA Methylation Levels and Serum Kynurenine/Tryptophan Ratio in Eating Disorders: A Possible Link with Psychopathological Traits?

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