The relationship between individual symptom connectivity and global eating disorder symptom severity.

BACKGROUND: The network approach has emerged as a useful framework for conceptualizing and investigating psychopathology, including eating disorders. Network connectivity, that is, the density of the connections among network nodes, has been somewhat neglected despite its theoretical relevance. As predicted by network theory, symptom connectivity would be distinct but related to symptom severity and may be a useful clinical indicator of psychopathology as stronger and/or more diffuse connections among symptoms offer more avenues for symptom activation. This study aimed to investigate the relationship between moment-by-moment individual-level symptom connectivity and global levels of symptom severity in the context of eating disorder symptoms and experiences. METHODS: A sample of 58 female undergraduate college students, mean (SD) age = 20.5 (3.1) provided data on eating disorder symptoms eight times a day over the course of 10 days. Network analyses were used to calculate the eating disorder symptoms network connectivity for each participant. In addition, participants completed survey of self-report measures of eating disorder symptom severity and trait mindfulness and body image flexibility. RESULTS: Analyses revealed a moderate, positive relationship between individual network connectivity and eating disorder symptom severity. In addition, symptom connectivity predicted unique variance of symptom severity even after controlling for other clinically-relevant variables. CONCLUSIONS: Individual-level network connectivity may be an important dimension of psychopathology and further work exploring the role of network connectivity is warranted. PUBLIC SIGNIFICANCE: These findings suggest that symptom severity and the extent to which different eating disorder symptoms are connected are related but different dimensions. Investigating how these different dimensions play a role in eating disorder pathology could help to better understand and treat these disorders.

Development and validation of the Sociocultural Influences on Fear of Fat Scale (SI-FAT).

The stigmatization of larger bodies is omnipresent in Western society and may be associated with fear of fat, one of the core elements of body image and eating concerns. To date, while much work has focused on sociocultural influences towards thinness, parallel work exploring sociocultural influence on fear of fat is lacking. This study therefore aimed to develop and evaluate a measure of sociocultural influences on fear of fat (SI-FAT). Study 1 included N = 235 women, mean (SD) age = 19.75 (1.35) years; a subsample of whom provided additional data two-weeks later (n = 140). Exploratory factor analyses supported a four-factor structure with 4-item media, peer, family, and partner subscales. These subscales revealed excellent internal and test-rest reliability. In addition, support for convergent validity with body dissatisfaction, fear of fat, and rigid dietary control emerged. Study 2, among N = 317 women, 19.82 (SD = 1.5) years, further supported the factor structure and provided additional evidence of convergent validity with weight-based teasing, divergent validity with anti-fat attitudes, and incremental validity in the prediction of dietary restriction above and beyond anti-fat bias. Together, findings suggest that the SI-FAT is a useful tool for assessing sociocultural influences on fear of fat.

Behavioral symptoms of eating disorders among adopted adolescents and young adults in the United States: Findings from the Add Health survey.

OBJECTIVE: More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating-disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals. METHOD: We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self-induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis. RESULTS: Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (ps < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (ps < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms. DISCUSSION: This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.

Structural differences in eating disorder psychopathology after history of childhood abuse: Insights from a Bayesian network analysis.

Childhood abuse is frequent among individuals with eating disorders and is associated with complex clinical presentations. However, to date, the differences in the presentations of eating disorders between these groups are poorly understood. The present study employed a Bayesian network approach to model the interactive network structure of eating disorder psychopathology, and to investigate the differences in symptom importance and network structure between individuals with eating disorders with and without an experience of childhood abuse in a sample 327 treatment-seeking individuals. Among individuals with a history of childhood abuse, a specific 4-symptom pathway emerged, leading from overvaluation of shape and weight and ending in overeating (overvaluation of weight and shape → loss of control → depressed mood → overeating). Loss of control eating and depressed mood emerged as the more important driving symptoms. In contrast, the eating disorder symptom network among the group with no abuse was organized around a heightened investment in weight and shape, and resulting efforts to control or alter weight and shape through dieting and exercise behaviors. The symptoms with the highest importance in this nonabuse group were overeating and overvaluation of weight and shape. These results support the existence of a distinct eating disorder symptom network characteristic of individuals with a history of childhood trauma, and add to the hypotheses of a maltreated eco-phenotype in eating disorders. They may be also inform treatment target in abused people with eating disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A network approach to eating disorder symptomatology: Do desire for thinness and fear of gaining weight play unique roles in the network?

This study used network analyses to test the hypotheses that desire for thinness and fear of gaining weight are related but distinct constructs that play a central role in disordered eating. Data from a sample of 251 college women were used. Sparse undirected eating disorder symptom networks were calculated. Bootstrapped difference tests for edge weights and centrality indices were used to compare the position of desire for thinness and fear of gaining weight. Desire for thinness and fear of gaining weight exhibited unique patterns of associations within the network. Desire for thinness was highly connected to body dissatisfaction, thoughts about dieting, and thoughts about binge eating. Fear of gaining weight was not. Desire for thinness emerged as the most central symptom. Our findings support the distinction between fear of gaining weight and desire for thinness and their different roles within the eating disorder symptom network.

Brief report: A network analysis of self-cutting risk among late adolescent girls exposed to dating violence.

Adolescent self-directed violence (SDV) is a major public health concern. Adolescent girls exposed to dating violence (DV) are a particularly vulnerable group. Numerous studies have examined the number and type of SDV risk factors, but few examined global patterns of relationships among them. Exploring global patterns of risk is crucial to developing targeted prevention efforts. In this study we applied a network model to identify risk patterns for a common form of SDV, self-cutting, among American adolescent girls (N = 109) with history of DV. Risk factor networks were compared among girls who did/did not endorse lifetime self-cutting. Girls with a history of self-cutting (19%) had a risk factor network characterized by a higher number of associations than girls who did not (test statistic = 0.142; 95% CI = 02-.03). For these girls, the experience of one risk factor is more likely to co-occur with multiple others, thereby potentially compounding effects and unwanted consequences.

A network analysis investigation of the cognitive-behavioral theory of eating disorders.

Network analysis has recently been introduced as a clinically relevant methodology for understanding the structure of mental disorders and for evaluating cognitive behavioral models of psychopathology. The current study uses network analysis to validate the transdiagnostic model of eating disorders by examining the association between overvaluation of shape and weight and eating disorder symptoms. Eating disorder symptoms were measured among a sample of 194 treatment-seeking children, adolescents, and adults presenting to an outpatient eating disorder clinic. We created transdiagnostic and disorder-specific symptom networks and assessed symptom strength and connectivity. Congruent with the transdiagnostic model, overvaluation of weight and shape emerged among the strongest symptoms in the network, and global network connectivity was higher among individuals with high overvaluation when compared to individuals with low overvaluation. An exploratory analysis revealed that overvaluation of weight and shape was central to anorexia nervosa, bulimia nervosa, and binge eating disorder. Results highlight the associative strength of overvaluation of shape and weight with eating disorder symptoms, regardless of the specific eating disorder diagnosis. Our findings corroborate overvaluation of weight and shape as a transdiagnostic treatment target and potentially useful severity specifier for binge eating disorder.

Cognitive biases to appearance-related stimuli in body dissatisfaction: A systematic review.

Emerging literature has documented the presence of cognitive biases toward body image related stimuli among individuals with high levels of body image concerns compared to those with low levels of body image concerns. However, the robustness and nature of these cognitive biases are unclear. The aims of this study were to conduct a systematic literature search and perform a critical synthesis of studies examining the relationship between cognitive biases toward body image-related stimuli and body image concerns. Our review identified 32 studies meeting inclusion criteria. Dot-probe, Stroop, free recall, and eye-tracking were among the most frequently used paradigms. The extant literature provides robust support for the presence of attention biases toward body image-related stimuli among individuals with high levels of body dissatisfaction compared to those with lower levels of concerns. Evidence was also found for the existence of judgment biases and memory biases. Furthermore, results suggest that body image-related cognitive biases, and levels of body dissatisfaction can be manipulated. Initial evidence was also found for differential patterns of biases toward "fat" and "thin" stimuli. These findings confirm the importance of considering cognitive biases within etiological models of body image concerns and suggest that these processes might provide novel treatment targets.