Using network analysis to compare diagnosis‐specific and age‐specific symptom networks in eating disorders

Abstract

Objective: The network theory of mental disorders conceptualizes eating disorders (EDs) as networks of interacting symptoms. Network analysis studies in EDs mostly have examined transdiagnostic and/or mixed age samples. The aim of our study was to investigate similarities and differences of networks in adolescents and adults with anorexia nervosa (AN) or bulimia nervosa (BN).Method: Participants were 2,535 patients (n = 991 adults with AN, n = 821 adolescents with AN, n = 473 adults with BN, and n = 250 adolescents with BN) who completed the Eating Disorder Inventory-2. Twenty-seven items were selected. Crosssectional networks were estimated via Joint Graphical Lasso. Core symptoms were identified using strength centrality. Spearman correlations and network comparison tests (NCTs) were used to compare groups.Results: Across diagnoses and ages, feeling ineffective, desire to be thinner, worries that feelings will get out of control, guilt after overeating as well as doing things perfectly emerged as most central symptoms. There were moderate to high correlations between symptom profiles (0.62-0.97, mean: 0.78) as well as high correlations between network structures (0.83-0.93, mean: 0.87) and network strengths (0.73-0.95, mean: 0.85). Global strength significantly differed in two of the six NCTs, and 2.5-10% of edges differed between networks.Discussion: Considerable similarities in network structures and strengths across diagnoses and ages speak in favor of the transdiagnostic approach to EDs. Besides drive for thinness, ineffectiveness, emotion regulation difficulties, and perfectionism might be the most consistent factors in ED networks. These symptoms as well as their symptom connections should be especially focused in treatment regardless of age and diagnosis.

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

“…comparison of estimated network structures among clinical and nonclinical (Vanzhula et al, 2019), ethnic minority women (Perez et al, 2021), men and women (Perko et al, 2019), across developmental stages (Calugi et al, 2020; Christian et al, 2020; Schlegl et al, 2021), and across different duration of illness (Christian et al, 2021);…”

“…The JGL has been applied in the EDs research as well. Schlegl et al (2021) used the FGL with k -fold cross-validation for parameter selection to estimate four different networks, one for each of the following groups: adolescents with AN, adults with AN, adolescents with BN, and adults with BN. 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.…”

“…He identified few connections that were stronger at baseline than at discharge, namely feelings of fatness and desiring weight loss , BMI and vomiting to control shape or weight , and others whose relationship grew at discharge, namely food preoccupation and desiring weight loss , fear of losing control overeating and vomiting to control shape or weight , feelings of fatness and dissatisfaction with weight and shape . Schlegl et al (2021) reported instead the percentage of edges that were significantly different in each pair of networks which resulted to have significant invariant network structure statistics. The values found ranged from 2.56% for the adolescents with AN versus adults with AN comparison to 10% for the adolescents with AN versus adults with BN comparison.…”

Bridging of childhood obsessive‐compulsive personality disorder traits and adult eating disorder symptoms: A network analysis approach

“…Consequently, older participants may have been less reliable in recalling OCPD traits from their childhood in comparison to younger participants, which may have differentially impacted the reliability of OCPD traits. We choose to retain these participants to maintain the diverse age range of our sample given the current under-representation of older age groups in previous research (Pike et al, 2013) and on the basis of Schlegl et al's (2021) study who found no significant differences in the ED symptom network between adults and adolescents with AN and BN.…”

Psychopathological Symptoms and Well-Being in Overweight and Underweight Adolescents: A Network Analysis

“…In recent years, psychological network analyses have been performed in patients with diagnosed eating disorders including anorexia nervosa and bulimia nervosa with the aim to identify central symptoms of the eating disorder pathology. Studies including a variety of eating disorder symptoms in their network analysis found that shape and weight concerns, desiring weight loss, desire to be thinner, feeling ineffective, worries that feeling will get out of control and guilt after overeating were the most central symptoms [25][26][27]. Other studies on eating disorder patients which additionally included general psychopathology showed that depressive and anxiety symptoms, interpersonal sensitivity and personal alienation had the highest centrality in the network [28,29].…”