Feeling imperfect and imperfectly feeling: A network analysis on perfectionism, interoceptive sensibility, and eating symptomatology in anorexia nervosa

Abstract

Objective In recent years, the network analysis (NA) methodology has been applied to identify the central features of the psychopathology of anorexia nervosa (AN) and specific connections to previously recognized vulnerabilities. However, an NA investigating both multidimensional perfectionism and interoceptive sensibility in connection to eating symptomatology is currently missing. Method A total of 260 individuals (139 patients with AN, 121 healthy control individuals) completed the Frost Multidimensional Perfectionism Scale, the Multidimensional Assessment of Interoceptive Awareness and the Eating Disorders Inventory‐2. Using state‐of‐the‐art techniques, we estimated a main network with data from all participants and then compared the two separated networks. We checked the variables for empirical overlap through goldbricker, combined as suggested and implemented the empirical measure of the bridge nodes. Results Ineffectiveness and need for control over self and body (resulting from combining Asceticism and Drive for Thinness) were the most central nodes, whereas perfectionistic evaluative concerns (resulting from combining Doubts about Actions and Concern over Mistakes) and mistrust in body sensations were the bridge nodes. No significant differences between the patient and control networks emerged. Conclusions Perfectionistic evaluative concerns and mistrust in body sensations could be key components in the relationships among perfectionism, interoceptive sensibility and eating symptomatology.

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

“…In line with the application to other mental disorders, various research goals can be identified among the existing literature about network approaches to EDs, namely: validation of the transdiagnostic model of eating disorders by comparing network characteristics across ED diagnoses (DuBois et al, 2017; Forrest et al, 2018; Goldschmidt et al, 2018; Mares et al, 2021; Monteleone, Tzischinsky, et al, 2022; Solmi et al, 2018; Solmi et al, 2019); estimation of the symptom network of EDs and identification of the core symptoms (Beauchamp et al, 2021; Forbush et al, 2016; Forrest et al, 2018; Forrest, Perkins, et al, 2019; Rodgers et al, 2018; Wang et al, 2019); identification and interaction with nonspecific ED symptoms (i.e., the external field) like general psychiatric symptoms, personality traits and other clinical variables (Monteleone, Mereu, et al, 2019; Solmi et al, 2018; Solmi et al, 2019), embodiment dimensions (Cascino et al, 2019), childhood maltreatment (Liebman et al, 2021; Monteleone, Cascino, et al, 2019; Monteleone, Tzischinsky, et al, 2022; Rodgers et al, 2019), mentalizing and empathy (Monteleone et al, 2020), vulnerability factors (Vervaet et al, 2021), suicidal thoughts and behaviors (Smith et al, 2020), perfectionism and interoceptive sensibility (Martini et al, 2021), affective and metacognitive symptoms (Aloi et al, 2021; Wong et al, 2021), interoceptive awareness (Brown et al, 2020), sleep disturbance (Ralph-Nearman et al, 2021), well-being domains (de Vos et al, 2021), inflexible and biased social interpretations, socioemotional functioning (Bronstein et al, 2022); assessment of psychiatric comorbidities such as depression and anxiety (Bronstein et al, 2022; Elliott et al, 2020; Kenny et al, 2021; Levinson et al, 2017; Sahlan, Williams, et al, 2021; Smith et al, 2019), posttraumatic stress disorder (Liebman et al, 2021; Vanzhula et al, 2019), social anxiety disorder (Levinson et al, 2018a; Sahlan, Keshishian, et al, 2021), obsessive-compulsive disorder (Giles et al, 2022; Kinkel-Ram et al, 2021; Meier et al, 2020; Vanzhula et al, 2021), trait anxiety disorder (Forrest, Sarfan, et al, 2019), autism spectrum disorder (Kerr-Gaffney et al, 2020), borderline personality disorder (De Paoli et al, 2020), and alcohol misuse (Cusack et al, 2021); comparison of estimated network structures among clinical and nonclinical (Vanzhula et al, 2019),...…”

“…identification and interaction with nonspecific ED symptoms (i.e., the external field) like general psychiatric symptoms, personality traits and other clinical variables (Monteleone, Mereu, et al, 2019; Solmi et al, 2018; Solmi et al, 2019), embodiment dimensions (Cascino et al, 2019), childhood maltreatment (Liebman et al, 2021; Monteleone, Cascino, et al, 2019; Monteleone, Tzischinsky, et al, 2022; Rodgers et al, 2019), mentalizing and empathy (Monteleone et al, 2020), vulnerability factors (Vervaet et al, 2021), suicidal thoughts and behaviors (Smith et al, 2020), perfectionism and interoceptive sensibility (Martini et al, 2021), affective and metacognitive symptoms (Aloi et al, 2021; Wong et al, 2021), interoceptive awareness (Brown et al, 2020), sleep disturbance (Ralph-Nearman et al, 2021), well-being domains (de Vos et al, 2021), inflexible and biased social interpretations, socioemotional functioning (Bronstein et al, 2022);…”

“…Similarly, Smith et al (2020) used the FGL to estimate and compare distinct networks from samples corresponding to either of the following groups: outpatients without ED diagnosis, outpatients with a lifetime attempt of suicide, and people with a current ED diagnosis. Martini et al (2021) employed FGL to compare a sample of AN patients with a control group. Finally, (Forrest, Perkins, et al, 2019) jointly estimated and compared the network structures of two nonclinical samples of men with and without core ED symptoms.…”

“…Only one study (Forbush et al, 2016) was found to employ nonregularized methods, such as association and concentration graphs, and only one (Rodgers et al, 2019) produced a directed Bayesian network. The parallel estimation of symptom networks on different subsamples was achieved in few cases through the FGL technique (Forrest, Perkins, et al, 2019; Martini et al, 2021; Schlegl et al, 2021; Smith et al, 2020). Finally, different studies based on panel data were also found to employ mlVAR to estimate between-subject networks and graphicalVAR to estimate temporal and contemporaneous networks (Levinson et al, 2021; Levinson et al, 2018; Levinson et al, 2020).…”

“…A. validation of the transdiagnostic model of eating disorders by comparing network characteristics across ED diagnoses (DuBois et al, 2017;Forrest et al, 2018;Goldschmidt et al, 2018;Mares et al, 2021;Monteleone, Tzischinsky, et al, 2022;Solmi et al, 2018;Solmi et al, 2019); B. estimation of the symptom network of EDs and identification of the core symptoms (Beauchamp et al, 2021;Forbush et al, 2016;Forrest et al, 2018;Forrest, Perkins, et al, 2019;Rodgers et al, 2018;Wang et al, 2019); C. identification and interaction with nonspecific ED symptoms (i.e., the external field) like general psychiatric symptoms, personality traits and other clinical variables (Monteleone, Mereu, et al, 2019;Solmi et al, 2018;Solmi et al, 2019), embodiment dimensions (Cascino et al, 2019), childhood maltreatment (Liebman et al, 2021;Monteleone, Tzischinsky, et al, 2022;Rodgers et al, 2019), mentalizing and empathy (Monteleone et al, 2020), vulnerability factors (Vervaet et al, 2021), suicidal thoughts and behaviors (Smith et al, 2020), perfectionism and interoceptive sensibility (Martini et al, 2021), affective and metacognitive symptoms (Aloi et al, 2021;Wong et al, 2021), interoceptive awareness (Brown et al, 2020), sleep disturbance (Ralph-Nearman et al, 2021), well-being domains (de Vos et al, 2021, inflexible and biased social interpretations, socioemotional functioning (Bronstein et al, 2022); D. assessment of psychiatric comorbidities such as depression and anxiety (Bronstein et al, 2022;Elliott et al, 2020;…”