The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis.

Abstract

Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a DSM-IV diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive-behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms.

Fear of food prospectively predicts drive for thinness in an eating disorder sample recently discharged from intensive treatment

“…Relatedly, feared concerns of eating, such as fearing that eating will make one gain weight or not eating because of fear of judgment, could be focused on using imaginal or in-vivo exposures, in which the patient imagines they are gaining weight or are being judged because of weight gain. Our findings fit with other research suggesting that fears of weight gain (and therefore related fears of food) may be a primary driver behind eating disorder symptomatology (Levinson et al, 2017; Murray, Loeb, & Le Grange, 2016) and suggest fear of food may be an avenue to target drive for thinness.…”

Using network analysis to identify central eating disorder symptoms among men

“…For instance, shape overvaluation and desiring weight loss were among the most central symptoms in the current study, and either or both of these symptoms have emerged as central in several other studies (Forrest et al, 2018;Levinson, Zerwas, et al, 2017;Wang et al, in press). For instance, shape overvaluation and desiring weight loss were among the most central symptoms in the current study, and either or both of these symptoms have emerged as central in several other studies (Forrest et al, 2018;Levinson, Zerwas, et al, 2017;Wang et al, in press).…”

Network analysis: An innovative framework for understanding eating disorder psychopathology

“…In a sample of mixed ED diagnoses, Forbush and colleagues identified items that reflected shape and weight overvaluation and body‐checking as central symptoms in the network structure of eating psychopathology, while feeling the need to exercise every day and items related to dietary restraint were identified as “key players” such that removal of these items disrupted the network structure (Forbush et al, ). In another network analysis examining bridges between ED symptoms and mood and anxiety symptoms among adults with bulimia nervosa, fear of weight gain and overvaluation of shape and weight emerged as central symptoms, and sensitivity to physical sensations were symptoms that bridged ED to depression and anxiety symptoms (Levinson et al, ). Most recently, DuBois and colleagues () found that shape and weight overvaluation were central symptoms within the network of individuals with EDs, and the connectivity of the global network structure was stronger among those with higher levels of overvaluation.…”