Illness pathways between eating disorder and post‐traumatic stress disorder symptoms: Understanding comorbidity with network analysis

Abstract

Eating disorders (EDs) and post-traumatic stress disorder (PTSD) are highly comorbid. However, specific mechanisms by which PTSD-ED comorbidity is maintained are unknown. The current study constructed two PTSD-ED comorbidity networks (25 EDs and 17 PTSD symptoms) in two samples: a clinical (N = 158 individuals with an ED diagnosis) and a nonclinical sample (N = 300 college students). Glasso networks were constructed to identify (1) pathways between disorders (bridge symptoms) and (2) core symptoms. Three illness pathways emerged: between binge eating and irritability, between desire for a flat stomach and disturbing dreams, and between concentration problems and weight and shape-related concentration problems. Our findings suggest that pathways between binge eating and irritability, body dissatisfaction and trauma reminders, and concentration difficulties may be the mechanisms by which comorbidity is maintained. Interventions disrupting these pathways and targeting core and bridge symptoms may be more efficient than traditional treatment approaches.

Re‐conceptualization of anorexia nervosa psychopathology: A network analysis study in adolescents with short duration of the illness

“…Indeed, the assessed post‐traumatic stress symptoms do not refer to a traumatic event but reflect current subjective general distress. These findings are in line with those of Vanzhula et al () who included in their network more symptoms specific of the PTSD syndrome and found connecting pathways between ED and PTSD symptoms such as those between binge eating and irritability or between body dissatisfaction and trauma reminders or concentration difficulties. Moreover, our findings reveal that PTSD symptoms are connected to ED core symptoms through depression symptoms and emotion dysregulation, as in the study of Vanzhula et al (), and are highly connected with obsessive–compulsive symptoms.…”

“…In line with the above cited study in adult patients with AN including the broadest spectrum of symptoms in the network (Solmi et al, ), we hypothesize that anxiety and depressive symptoms, in addition to ED core symptoms, play a pivotal role in the psychopathological network of children/adolescents with AN. In accordance with the only study assessing the comorbidity between PTSD at the first occurrence and AN (Vanzhula et al, ), we expect emotion dysregulation may represent a pathway connecting PTSD and AN core symptoms. However, given the evidence that symptoms are expressed differently in childhood and adolescence compared to adulthood (Bravender et al, ), some differences are expected in terms of the identification of ED core symptoms in young patients with AN, such as the reduced centrality of body dissatisfaction due to the deny of body image value, which seems to be common in adolescents (Lock, La Via, & American Academy of Child and Adolescent Psychiatry [AACAP] Committee on Quality Issues [CQI], ).…”

“…The main objective of this study was to identify core psychopathological variables of hospitalized adolescents suffering from AN at the onset of their illness. In comparison to previous researches (Levinson et al, 2018; Vanzhula et al, ), we included in our NA a broader group of symptoms in order to get a better comprehension of psychopathological variables promoting psychiatric comorbidity in the early phase of AN. We therefore assessed the complex relationships between general psychiatric symptoms (anxiety and depressive symptoms, post‐traumatic stress symptoms and obsessive–compulsive symptoms) and ED core symptoms and we found that depressive symptoms and personal alienation were the nodes with the highest centrality in the network and, thus, the core variables maintaining the psychopathology structure.…”

“…Recent studies also demonstrated the centrality of general psychiatric symptoms (anxiety and depressive symptoms, interpersonal problems, and ineffectiveness) together with ED core symptoms (drive to thinness and interoceptive awareness) in adult patients suffering from an ED (either AN, bulimia nervosa [BN], or binge‐eating disorder) or AN (Elliott, Jones, & Schmidt, ; Solmi et al, ; Solmi, Collantoni, Meneguzzo, Tenconi, & Favaro, ). Furthermore, network analyses were performed in order to assess comorbidity with anxious and depressive symptoms in people with BN (Levinson et al, ), comorbidity between EDs and social anxiety symptoms (Levinson et al, ), and comorbidity between post‐traumatic stress disorder and ED symptoms (Vanzhula, Calebs, Fewell, & Levinson, ). These researches showed that sensitivity to physical sensations (Levinson et al, ), others watching you drink and eating in public (Levinson et al, 2018), binge eating and feeling irritable (Vanzhula et al, ) were, respectively, the connecting symptoms between the evaluated disorders.…”

“…Furthermore, network analyses were performed in order to assess comorbidity with anxious and depressive symptoms in people with BN (Levinson et al, ), comorbidity between EDs and social anxiety symptoms (Levinson et al, ), and comorbidity between post‐traumatic stress disorder and ED symptoms (Vanzhula, Calebs, Fewell, & Levinson, ). These researches showed that sensitivity to physical sensations (Levinson et al, ), others watching you drink and eating in public (Levinson et al, 2018), binge eating and feeling irritable (Vanzhula et al, ) were, respectively, the connecting symptoms between the evaluated disorders. The latter two studies used the bridge symptoms function, which identifies symptoms connecting general psychiatric symptoms and ED specific symptoms through an empiric method rather than by selecting these symptoms visually or through the strongest correlation coefficients.…”