A systematic review of network analysis studies in eating disorders: Is time to broaden the core psychopathology to non specific symptoms

Abstract

Objective Network theory considers mental disorders as the product of symptom interaction. A growing number of studies employing this methodology has been conducted in eating disorders (EDs). We aimed to review those studies to provide evidence and limitations for a novel conceptualisation of EDs. Methods According to PRISMA guidelines and PICOS criteria, studies eligible for inclusion were those employing network analysis in people with a clinically defined diagnosis of ED. Twenty‐five studies were included and were analysed in relation to diagnosis, comorbidity, and treatment outcome. Results Despite the central role of overvaluation of body shape and weight and cognitive restraint across ED diagnoses, ineffectiveness, interoceptive awareness and affective problems appear central symptoms. Ineffectiveness and interoceptive awareness emerge as bridge symptoms promoting comorbidity in people with anorexia nervosa and in mixed ED samples. Although few studies assessed treatment outcome, there is evidence supporting the predictive role of central network nodes. Conclusions Ineffectiveness, interoceptive ability and affective problems may be included in the core ED psychopathology, in addition to ED‐specific symptoms. Network analysis is a promising method to reconceptualize comorbidity. Future studies are recommended to include general psychopathology in ED networks, to assess connections with the external field and clinical meaning of network connectivity.

Irrational Beliefs and Their Role in Specific and Non-Specific Eating Disorder Symptomatology and Cognitive Reappraisal in Eating Disorders

“…Targeting these dysfunctional thoughts could help reducing ED-specific core symptoms and ED-related psychopathology and would be beneficial for cognitive change. In line with the promising method to reconceptualize ED that is network analysis [10], our results support to broaden the core psychopathology to non-ED-specific cognitive symptoms. Including additional psychological cognitive features in the assessment of EDs might yield incremental data to better evaluate and treat the complex interplay characterizing ED psychopathology.…”

“…The irrational belief of negative global evaluations was found instead to be the most significant predictor of non-specific ED general psychological maladjustment, which includes aspects pertaining to perfectionism, self-esteem, inefficacy, and interpersonal difficulties. Feelings of inefficacy in particular have been hypothesized to play a core role in clinical models of Eds, and they have been empirically supported, using network analysis procedures, to reach centrality among nodes of the network of symptoms of ED patients [10,48]. ED patients commonly present low self-esteem, low self-efficacy, and beliefs of incompetence [31,[49][50][51][52] linked with ED symptomatology even when considering confounding depressive symptoms [53].…”

“…While cognitive features such as preoccupations regarding food, weight, and shape have been widely investigated in EDs, only a few studies examine other cognitively oriented conceptualization of maladaptive cognitions beyond strictly ED-related themes in this population [6][7][8][9]. Broadening the cognitive targets in EDs may help to better represent different aspects of the cognitive processes associated with the ED psychopathology, which include related general psychopathology, in addition to ED-specific symptomatology [10]. Non-specific ED symptoms such as low self-esteem, reduced interoceptive awareness, and affective problems have been recently discovered to have a central role in EDs in studies using network analysis, a promising method to reconceptualize EDs [10].…”

“…Broadening the cognitive targets in EDs may help to better represent different aspects of the cognitive processes associated with the ED psychopathology, which include related general psychopathology, in addition to ED-specific symptomatology [10]. Non-specific ED symptoms such as low self-esteem, reduced interoceptive awareness, and affective problems have been recently discovered to have a central role in EDs in studies using network analysis, a promising method to reconceptualize EDs [10].…”

Change in eating‐disorder psychopathology network structure in patients with anorexia nervosa treated with intensive cognitive behavior therapy

“…Most previous studies using the network approach in psychopathology have assessed the patterns between specific symptoms of eating disorders via cross-sectional study designs, as revealed by a recent review (Monteleone & Cascino, 2021). In particular, two studies evaluated longitudinal networks of eating disorder symptoms, the first assessing participants at risk of eating disorder onset (Levinson, Vanzhula, Smith, & Stice, 2020), and the second evaluating participants with self-reported anorexia nervosa symptoms; the latter was designed to examine the trajectory of symptom change associated with the use of a digital guided self-help intervention to augment treatment as usual (Monteleone et al, 2020).…”