A comparative network analysis of eating disorder psychopathology and co-occurring depression and anxiety symptoms before and after treatment
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Background: Network analysis is an emerging approach in the study of psychopathology, yet few applications have been seen in eating disorders (EDs). Furthermore, little research exists regarding changes in network strength after interventions. Therefore the present study examined the network structures of ED and co-occurring depression and anxiety symptoms before and after treatment for EDs. Method: Participants from residential or partial hospital ED treatment programs ( N = 446) completed assessments upon admission and discharge. Networks were estimated using regularized Graphical Gaussian Models using 38 items from the Eating Disorders Examination-Questionnaire, Quick Inventory of Depressive Symptomatology, and State-Trait Anxiety Inventory. Results: ED symptoms with high centrality indices included a desire to lose weight, guilt about eating, shape overvaluation, and wanting an empty stomach, while restlessness, self-esteem, lack of energy, and feeling overwhelmed bridged ED to depression and anxiety symptoms. Comparisons between admission and discharge networks indicated the global network strength did not change significantly, though symptom severity decreased. Participants with denser networks at admission evidenced less change in ED symptomatology during treatment. Conclusions: Findings suggest that symptoms related to shape and weight concerns and guilt are central ED symptoms, while physical symptoms, self-esteem, and feeling overwhelmed are links that may underlie comorbidities in EDs. Results provided some support for the validity of network approaches, in that admission networks conveyed prognostic information. However, the lack of correspondence between symptom reduction and change in network strength indicates that future research is needed to examine network dynamics in the context of intervention and relapse prevention.
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Improvement in one set of symptoms often results in the resolution of or improvement in related symptoms of other disorders.
“It is well known that improvement in one set of symptoms often results in the resolution of or improvement in related symptoms of other disorders, which exist in a network with each other (see #10 in Figure 1) (147, 236–238).”
From The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines (2023) · cites this paper as [237]
The Treatment Outcome and Network Analysis section describes links among eating-disorder, depression, and anxiety symptoms and proposes that targeting those links may reduce psychopathology (page unavailable). But the Discussion reports that symptom improvement did not correspond to changes in network connectivity and says the causal influence of connected symptoms remains unclear. The paper therefore does not establish that improvement in one disorder’s symptoms often causes improvement or resolution of another’s. (LLM, conf=0.86)
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- Authors
- Smith, K. E., Mason, T. B., Crosby, R. D., Cao, L., Leonard, R. C., Wetterneck, C. T., Smith, B. E. R., Farrell, N. R., Riemann, B. C., Wonderlich, S. A., & Moessner, M.
- Affiliations
- University of North Dakota (US)
- University of Southern California (US)
- Neuropsychiatric Research Institute (US)
- University Hospital Heidelberg (DE)
- Corresponding author
- Smith, Kathryn E.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-04-15
- Volume
- 49
- Issue
- 2
- Pages
- 314-324
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC6310232
- OpenAlex
- W2800157145
- Cited by
- 101
- References
- 50
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 21 · 2023: 20 · 2022: 19 · 2021: 13 · 2020: 5 · 2019: 7
- FWCI
- 7.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (T32MH082761)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- eating disorders, depression, anxiety, symptom networks, network centrality, comorbidities, residential treatment, partial hospitalization, treatment outcomes, weight concern, self-esteem, network dynamics, relapse prevention
- MeSH terms
- Adolescent, Adult, Anxiety, Feeding and Eating Disorders, Depression, Female, Humans, Male, Middle Aged, Models, Statistical, Outcome Assessment, Health Care, Young Adult
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