A Network Analysis of Eating Disorder, PTSD, Major Depression, State-trait Anxiety, and Quality of Life Measures in Eating Disorder Patients Treated in Residential Care

Overview

Journal Eur Eat Disord Rev

Publisher Wiley

Specialty Nutritional Sciences

Date 2024 Sep 18

PMID 39289909

Authors

Timothy D Brewerton

Maren C G Kopland

Ismael Gavidia

Giulia Suro

Molly M Perlman

Affiliations

Soon will be listed here.

Abstract

Background: The network approach in the eating disorder (ED) field has confirmed important links between EDs and posttraumatic stress disorder (PTSD) symptoms. However, studies including comorbid symptoms are scarce, which limits our understanding of potentially important connections. We hypothesised that anxiety, depression and poor quality of life (QOL) would provide a more complete picture of central, maintaining factors.

Methods: Network analysis using R was performed in 2178 adult ED patients (91% female) admitted to residential treatment. Assessments included the ED Examination Questionnaire (EDEQ), the Eating Disorders Inventory (EDI-2), the PTSD Checklist for DSM-5 (PTSD clusters (PCL-5)), the Patient Health Questionnaire (PHQ-9), the Spielberger State-Trait Anxiety Scale (STAI), and the ED QOL Scale (EDQOL), which measure symptoms of EDs, PTSD, major depression, state-trait anxiety, and QOL, respectively.

Results: EDI-2 ineffectiveness showed the highest centrality (expected influence) followed by EDI-2 interoceptive awareness, STAI state anxiety, EDEQ shape concern, EDQOL psychological subscale, and PTSD cluster D (hyperarousal) symptoms. Eating Disorder Quality of Life psychological and physical-cognitive subscales and PHQ-9 major depressive, STAI state anxiety and PCL-5 PTSD cluster E (negative alterations in mood and cognition) symptoms showed the highest bridge expected influence, suggesting their interactive role in maintaining ED-PTSD comorbidity.

Conclusions: This is the first network analysis of the interaction between ED and PTSD symptoms to include the comorbid measures of depression, anxiety, and QOL in a large clinical sample of ED patients. Our results indicate that several symptom clusters are likely to maintain ED-PTSD comorbidity and may be important targets of integrated treatment.

Citing Articles

A network analysis of eating disorder, PTSD, major depression, state-trait anxiety, and quality of life measures in eating disorder patients treated in residential care.

Brewerton T, Kopland M, Gavidia I, Suro G, Perlman M Eur Eat Disord Rev. 2024; 33(1):148-162.

PMID: 39289909 PMC: 11617816. DOI: 10.1002/erv.3136.

References

Monteleone A, Tzischinsky O, Cascino G, Alon S, Pellegrino F, Ruzzi V . The connection between childhood maltreatment and eating disorder psychopathology: a network analysis study in people with bulimia nervosa and with binge eating disorder. Eat Weight Disord. 2021; 27(1):253-261. PMC: 8860810. DOI: 10.1007/s40519-021-01169-6. View

Paivio S, McCulloch C . Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse Negl. 2004; 28(3):339-54. DOI: 10.1016/j.chiabu.2003.11.018. View

Inniss D, Steiger H, Bruce K . Threshold and subthreshold post-traumatic stress disorder in bulimic patients: prevalences and clinical correlates. Eat Weight Disord. 2011; 16(1):e30-6. DOI: 10.1007/BF03327518. View

Scioli-Salter E, Johnides B, Mitchell K, Smith B, Resick P, Rasmusson A . Depression and dissociation as predictors of physical health symptoms among female rape survivors with posttraumatic stress disorder. Psychol Trauma. 2016; 8(5):585-91. PMC: 4982768. DOI: 10.1037/tra0000135. View

Berke D, Macdonald A, Poole G, Portnoy G, McSheffrey S, Creech S . Optimizing trauma-informed intervention for intimate partner violence in veterans: The role of alexithymia. Behav Res Ther. 2017; 97:222-229. DOI: 10.1016/j.brat.2017.08.007. View

Leenaerts N, Jongen D, Ceccarini J, Van Oudenhove L, Vrieze E . The neurobiological reward system and binge eating: A critical systematic review of neuroimaging studies. Int J Eat Disord. 2022; 55(11):1421-1458. DOI: 10.1002/eat.23776. View

Hittner J, May K, Silver N . A Monte Carlo evaluation of tests for comparing dependent correlations. J Gen Psychol. 2003; 130(2):149-68. DOI: 10.1080/00221300309601282. View

Kaye W, Bailer U . Understanding the neural circuitry of appetitive regulation in eating disorders. Biol Psychiatry. 2011; 70(8):704-705. PMC: 5954823. DOI: 10.1016/j.biopsych.2011.08.018. View

Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S . Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord. 2022; 10(1):132. PMC: 9442924. DOI: 10.1186/s40337-022-00654-2. View

10.

Mitchell K, Scioli E, Galovski T, Belfer P, Cooper Z . Posttraumatic stress disorder and eating disorders: maintaining mechanisms and treatment targets. Eat Disord. 2021; 29(3):292-306. DOI: 10.1080/10640266.2020.1869369. View

11.

Bryant R, Creamer M, ODonnell M, Forbes D, McFarlane A, Silove D . Acute and Chronic Posttraumatic Stress Symptoms in the Emergence of Posttraumatic Stress Disorder: A Network Analysis. JAMA Psychiatry. 2016; 74(2):135-142. DOI: 10.1001/jamapsychiatry.2016.3470. View

12.

Mitchell K, Mazzeo S . Mediators of the association between abuse and disordered eating in undergraduate men. Eat Behav. 2005; 6(4):318-27. DOI: 10.1016/j.eatbeh.2005.03.004. View

13.

McNally R, Heeren A, Robinaugh D . A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse. Eur J Psychotraumatol. 2017; 8(sup3):1341276. PMC: 5632780. DOI: 10.1080/20008198.2017.1341276. View

14.

Brewerton T, Kopland M, Gavidia I, Suro G, Perlman M . A network analysis of eating disorder, PTSD, major depression, state-trait anxiety, and quality of life measures in eating disorder patients treated in residential care. Eur Eat Disord Rev. 2024; 33(1):148-162. PMC: 11617816. DOI: 10.1002/erv.3136. View

15.

Bos F, Snippe E, de Vos S, Hartmann J, Simons C, van der Krieke L . Can We Jump from Cross-Sectional to Dynamic Interpretations of Networks? Implications for the Network Perspective in Psychiatry. Psychother Psychosom. 2017; 86(3):175-177. PMC: 5516409. DOI: 10.1159/000453583. View

16.

Molendijk M, Hoek H, Brewerton T, Elzinga B . Childhood maltreatment and eating disorder pathology: a systematic review and dose-response meta-analysis. Psychol Med. 2017; 47(8):1402-1416. DOI: 10.1017/S0033291716003561. View

17.

McNally R . Network Analysis of Psychopathology: Controversies and Challenges. Annu Rev Clin Psychol. 2020; 17:31-53. DOI: 10.1146/annurev-clinpsy-081219-092850. View

18.

Rice A, Lavender J, Shank L, Neyland M, Markos B, Repke H . Associations among alexithymia, disordered eating, and depressive symptoms in treatment-seeking adolescent military dependents at risk for adult binge-eating disorder and obesity. Eat Weight Disord. 2022; 27(8):3083-3093. PMC: 9805474. DOI: 10.1007/s40519-022-01429-z. View

19.

Huston J, Grillo A, Iverson K, Mitchell K . Associations between disordered eating and intimate partner violence mediated by depression and posttraumatic stress disorder symptoms in a female veteran sample. Gen Hosp Psychiatry. 2019; 58:77-82. DOI: 10.1016/j.genhosppsych.2019.03.007. View

20.

Jones P, Williams D, McNally R . Sampling Variability Is Not Nonreplication: A Bayesian Reanalysis of Forbes, Wright, Markon, and Krueger. Multivariate Behav Res. 2020; 56(2):249-255. DOI: 10.1080/00273171.2020.1797460. View