Key Points
Rationale
AN is a severe disorder with high mortality and often involves obsessions related to eating, weight and shape (American Psychiatric Association, 2013).
AN also commonly co-occurs with anxiety and depression, which are linked to poorer treatment outcomes (Fewell et al., 2017). However, the connections betweeneating disorder(ED) symptoms, anxiety, depression, and related cognitive factors are not well understood (Elliott et al., 2020).
Method
Participants completed standard self-report measures of depression, anxiety, cognitive flexibility, weight/shape concerns, and eating disorder symptoms.
A network analysis approach was used to map the connections between all variables at the symptom level. The expected influence statistic was calculated to determine the relative importance of each symptom in the network.
Sample
The sample comprised 193 (95.6% female) treatment-seeking individuals diagnosed with AN, with an average age of 26.89 years (SD = 9.45).
Statistical Measures
Network analysis was utilized to visually map the associations between symptoms at the node level. The expected influence statistic determined the relative importance of each node in the network.
Results
The network analysis showed the strongest connections were between:
Insight
The findings illustrate overlapping relationships between shape/weight obsession, disordered eating, and psychological distress in AN, highlighting the critical role these domains play together.
Surprisingly, cognitive flexibility did not connect directly to weight/shape concerns but had negative ties to eating habits and distress. This suggests that improving cognitive flexibility could help break cycles of restrictive eating and distress.
The presence of a minor direct link between eating issues and distress also indicates they likely mutually reinforce each other.
Overall, the study sheds light on how core AN symptoms and common comorbidities interrelate.
Weight/shape concerns appear central, highlighting the importance of addressing body image distortion. The patterns also underline eating behaviors and distress as key interlinked factors. Improving cognitive flexibility may be beneficial in targeting both.
Strengths
This study had several key methodological strengths:
Limitations
While the study had many strengths, some limitations should be noted:
Implications
References
Primary reference
Giles, S., Hughes, E. K., Castle, D., Jenkins, Z., Phillipou, A., Rossell, S., Urbini, G., Fuller-Tyszkiiewicz, M. & Krug, I. (2023). A new network analysis model in anorexia nervosa patients based on self‐reported eating disorder symptoms, psychological distress, and cognitive flexibility.British Journal of Clinical Psychology.https://doi.org/10.1111/bjc.12451
Other references
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.Archives of General Psychiatry, 68(7), 724–731.https://doi.org/10.1001/archgenpsychiatry.2011.74
American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.).https://doi.org/10.1176/appi.books.9780890425596
Elliott, H., Jones, P. J., & Schmidt, U. (2020). Central symptoms predict posttreatment outcomes and clinical impairment in anorexia nervosa: A network analysis.Clinical Psychological Science,8(1), 139-154.https://doi.org/10.1177/2167702619865958
Fewell, L. K., Levinson, C. A., & Stark, L. (2017). Depression, worry, and psychosocial functioning predict eating disorder treatment outcomes in a residential and partial hospitalization setting.Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity,22, 291-301.https://doi.org/10.1007/s40519-016-0357-6
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
