Eating disorder and social anxiety symptoms in Iranian preadolescents: a network analysis

Abstract

Purpose Network studies of eating disorder (ED) symptoms have identified central and bridge symptoms in Western samples, yet few network models of ED symptoms have been tested in non-Western samples, especially among preadolescents. The current study tested a network model of ED symptoms in Iranian preadolescents (ages 9 to 13), as well as a model of co-occurring social anxiety disorder (SAD) and ED symptoms. Method Preadolescent boys (n = 405) and girls (n = 325) completed the Children Eating Attitudes Test-20 and Social Anxiety Scale for Children. We estimated two network models (ED and ED/SAD networks) and identified central and bridge symptoms, as well as tested if these models differed by sex. Results We found that discomfort eating sweets were the most central symptoms in ED networks. Concern over being judged was central in networks including both ED and SAD symptoms. Additionally, concern over being judged was the strongest bridge symptoms. Networks did not differ by sex. Conclusion Future research is needed to test if interventions focused on bridge symptoms (i.e., concern over being judged) as primary intervention points target comorbid ED-SAD pathology in preadolescents at risk for ED and SAD. Level of evidence Level III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.

Network-based methods for psychometric data of eating disorders: A systematic review

“…assessment of psychiatric comorbidities such as depression and anxiety [ 33 , 44 , 53 , 56 , 75 , 79 ], posttraumatic stress disorder [ 60 , 82 ], social anxiety disorder [ 76 , 99 ], obsessive- compulsive disorder [ 49 , 55 , 63 , 83 ], trait anxiety disorder [ 48 ], autism spectrum disorder [ 54 ], borderline personality disorder [ 41 ], and alcohol misuse [ 40 ];…”

“…After all, the fact that EDs are much more common in women than in men is broadly known and documented [ 102 ], with reasons usually attributed to social pressure [ 103 ], adolescent turbulence, poor body concept, and role confusion [ 104 ]. Just one study involved only male participants [ 47 ], while few other papers reported a more heterogeneous (mostly nonclinical) sample with male participants within the range of 40–60% [ 33 , 53 , 55 , 60 , 71 , 75 , 76 ].…”

“…Remarkably, many studies reported no differences in network structure nor in global strength with regards to different ED diagnoses [ 42 , 50 , 61 ], age [ 34 , 35 , 75 ], and sex [ 75 , 76 ].…”

Network-Based Methods for Psychometric Data of Eating Disorders: A Systematic Review

“…Remarkably, many studies reported no differences in network structure nor in global strength with regards to different ED diagnoses (de Vos et al, 2021;Goldschmidt et al, 2018;Mares et al, 2021), age (Brown et al, 2020;Calugi et al, 2020;Sahlan, Williams, et al, 2021), and sex (Sahlan, Keshishian, et al, 2021;Sahlan, Williams, et al, 2021).…”

“…After all, the fact that EDs are much more common in women than in men is broadly known and documented (Striegel-Moore et al, 2009), with reasons usually attributed to social pressure (Whiteman, 2016), adolescent turbulence, poor body concept, and role confusion (Hsu, 1989). Just one study involved only male participants (Forrest, Perkins, et al, 2019), while few other papers reported a more heterogeneous (mostly nonclinical) sample with male participants within the range of 40-60% (Bronstein et al, 2022;Kenny et al, 2021;Kinkel-Ram et al, 2021;Liebman et al, 2021;Perko et al, 2019;Sahlan, Keshishian, et al, 2021;Sahlan, Williams, et al, 2021).…”