Network analysis of specific psychopathology and psychiatric symptoms in patients with eating disorders

Network analysis of psychiatric symptoms describes reciprocal relationships of individual symptoms, beyond categorical diagnoses. Those with eating disorders (EDs) frequently have complex patterns of comorbid symptoms and the transdiagnostic theory includes shared common core features across diagnoses. We aim to test whether general psychiatric symptoms comprise components of these transdiagnostic features.

Network analysis was applied on 2068 patients with EDs (955 anorexia nervosa [AN], 813 bulimia nervosa [BN], and 300 binge-eating disorder [BED]). All patients underwent clinical interviews and some self-reported questionnaires, such as the Symptom Check-List 90 (SCL-90) to measure psychiatric symptoms, the Eating Disorder Inventory (EDI) to measure ED-specific symptoms, and the Tridimensional Personality Questionnaire (TPQ) for personality traits.

Across EDs and within each ED, SCL-90 scores of depression, anxiety and interpersonal sensitivity, EDI ineffectiveness, interoceptive awareness, interpersonal distrust, and drive for thinness had high centrality. Notably, body mass index (BMI) and EDI bulimia played a central role when considering the whole group, whereas they did not in individual EDs.

The shared centrality of identified nodes in both individual and merged groups supported the transdiagnostic theory of EDs (diagnoses share core ED features), with a central role of BMI. Moreover, the most central nodes were general psychiatric symptoms, interpersonal domain, and self-efficacy. These findings suggest that-in addition to ED-core symptoms and BMI-depressive and anxiety symptoms, interpersonal sensitivity and ineffectiveness may be important targets to provide effective treatments across AN, BN, and BED.