ObjectiveAnxiety is thought to influence the development and maintenance of eating disorders (EDs). However, little is known about how, specifically, anxiety influences ED symptoms and vice versa. Network analysis identifies how symptoms within and across disorders are interconnected. In a network, central nodes (i.e., symptoms) have the strongest relations to other nodes and are thought to maintain psychopathology. Bridge nodes are symptoms in one diagnostic cluster that are strongly connected to symptoms in another diagnostic cluster and are thought to explain comorbidity. We identified central and bridge nodes in a network of ED symptoms and trait anxiety features. MethodWe estimated a regularized partial correlation network in patients with mixed EDs (N=296). ED symptoms were assessed with the Eating Disorder Examination-Questionnaire. Trait anxiety was assessed with the Trait subscale of the State-Trait Anxiety Inventory. Items to include in the network were selected with a statistical algorithm to ensure that all nodes represented unique constructs. Central and bridge nodes were identified with empirical calculations. ResultsCentral ED nodes were dietary restraint, as well as overvaluation of and dissatisfaction with shape and weight. The central trait anxiety node was low feelings of satisfaction. The strongest ED bridge node was avoidance of social eating. The strongest trait anxiety bridge node was low self-confidence. DiscussionAvoidance of social eating and low self-esteem may be routes through which EDs and trait anxiety are linked.
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Univ Wisconsin, Dept Psychiat, Madison, WI 53706 USAUniv Wisconsin, Dept Psychiat, Madison, WI 53706 USA
Schaumberg, Katherine
Zerwas, Stephanie
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Univ N Carolina, Dept Psychiat, Chapel Hill, NC 27515 USAUniv Wisconsin, Dept Psychiat, Madison, WI 53706 USA
Zerwas, Stephanie
Goodman, Erica
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Univ N Carolina, Dept Psychiat, Chapel Hill, NC 27515 USA
Univ North Dakota, Dept Psychol, Grand Forks, ND 58202 USAUniv Wisconsin, Dept Psychiat, Madison, WI 53706 USA
Goodman, Erica
Yilmaz, Zeynep
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Univ N Carolina, Dept Psychiat, Chapel Hill, NC 27515 USAUniv Wisconsin, Dept Psychiat, Madison, WI 53706 USA
Yilmaz, Zeynep
Bulik, Cynthia M.
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Univ N Carolina, Dept Psychiat, Chapel Hill, NC 27515 USA
Univ N Carolina, Dept Nutr, Chapel Hill, NC 27515 USA
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, SwedenUniv Wisconsin, Dept Psychiat, Madison, WI 53706 USA
Bulik, Cynthia M.
Micali, Nadia
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Univ Geneva, Dept Psychiat, Fac Med, Geneva, Switzerland
Icahn Sch Med Mt Sinai, Dept Psychiat, New York, NY 10029 USA
UCL, Inst Child Hlth, London, EnglandUniv Wisconsin, Dept Psychiat, Madison, WI 53706 USA