The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis

Cheri A. Levinson, Stephanie Zerwas, Benjamin Calebs, Kelsie Forbush, Hans Kordy, Hunna Watson, Sara Hofmeier, Michele Levine, Ross D. Crosby, Christine Peat, Cristin D. Runfola, Benjamin Zimmer, Markus Moesner, Marsha D. Marcus, Cynthia M. Bulik

    Research output: Contribution to journalArticle

    35 Citations (Scopus)

    Abstract

    Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive- behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms.

    Original languageEnglish
    Pages (from-to)340-354
    Number of pages15
    JournalJournal of Abnormal Psychology
    Volume126
    Issue number3
    DOIs
    Publication statusPublished - 1 Apr 2017

    Fingerprint

    Bulimia Nervosa
    Anxiety
    Depression
    Psychopathology
    Bulimia
    Diagnostic and Statistical Manual of Mental Disorders
    Weight Gain
    Fear
    Network Analysis
    Implosive Therapy
    Feeding Behavior
    Appetite
    Research
    Emotions

    Cite this

    Levinson, C. A., Zerwas, S., Calebs, B., Forbush, K., Kordy, H., Watson, H., ... Bulik, C. M. (2017). The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. Journal of Abnormal Psychology, 126(3), 340-354. https://doi.org/10.1037/abn0000254
    Levinson, Cheri A. ; Zerwas, Stephanie ; Calebs, Benjamin ; Forbush, Kelsie ; Kordy, Hans ; Watson, Hunna ; Hofmeier, Sara ; Levine, Michele ; Crosby, Ross D. ; Peat, Christine ; Runfola, Cristin D. ; Zimmer, Benjamin ; Moesner, Markus ; Marcus, Marsha D. ; Bulik, Cynthia M. / The core symptoms of bulimia nervosa, anxiety, and depression : A network analysis. In: Journal of Abnormal Psychology. 2017 ; Vol. 126, No. 3. pp. 340-354.
    @article{9c2c97831d704c16bd87da942b23302c,
    title = "The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis",
    abstract = "Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive- behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms.",
    keywords = "Anxiety, Bulimia nervosa, Depression, Network analysis",
    author = "Levinson, {Cheri A.} and Stephanie Zerwas and Benjamin Calebs and Kelsie Forbush and Hans Kordy and Hunna Watson and Sara Hofmeier and Michele Levine and Crosby, {Ross D.} and Christine Peat and Runfola, {Cristin D.} and Benjamin Zimmer and Markus Moesner and Marcus, {Marsha D.} and Bulik, {Cynthia M.}",
    year = "2017",
    month = "4",
    day = "1",
    doi = "10.1037/abn0000254",
    language = "English",
    volume = "126",
    pages = "340--354",
    journal = "Journal of Abnormal Psychology",
    issn = "0021-843X",
    publisher = "American Psychological Association",
    number = "3",

    }

    Levinson, CA, Zerwas, S, Calebs, B, Forbush, K, Kordy, H, Watson, H, Hofmeier, S, Levine, M, Crosby, RD, Peat, C, Runfola, CD, Zimmer, B, Moesner, M, Marcus, MD & Bulik, CM 2017, 'The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis' Journal of Abnormal Psychology, vol. 126, no. 3, pp. 340-354. https://doi.org/10.1037/abn0000254

    The core symptoms of bulimia nervosa, anxiety, and depression : A network analysis. / Levinson, Cheri A.; Zerwas, Stephanie; Calebs, Benjamin; Forbush, Kelsie; Kordy, Hans; Watson, Hunna; Hofmeier, Sara; Levine, Michele; Crosby, Ross D.; Peat, Christine; Runfola, Cristin D.; Zimmer, Benjamin; Moesner, Markus; Marcus, Marsha D.; Bulik, Cynthia M.

    In: Journal of Abnormal Psychology, Vol. 126, No. 3, 01.04.2017, p. 340-354.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - The core symptoms of bulimia nervosa, anxiety, and depression

    T2 - A network analysis

    AU - Levinson, Cheri A.

    AU - Zerwas, Stephanie

    AU - Calebs, Benjamin

    AU - Forbush, Kelsie

    AU - Kordy, Hans

    AU - Watson, Hunna

    AU - Hofmeier, Sara

    AU - Levine, Michele

    AU - Crosby, Ross D.

    AU - Peat, Christine

    AU - Runfola, Cristin D.

    AU - Zimmer, Benjamin

    AU - Moesner, Markus

    AU - Marcus, Marsha D.

    AU - Bulik, Cynthia M.

    PY - 2017/4/1

    Y1 - 2017/4/1

    N2 - Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive- behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms.

    AB - Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive- behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms.

    KW - Anxiety

    KW - Bulimia nervosa

    KW - Depression

    KW - Network analysis

    UR - http://www.scopus.com/inward/record.url?scp=85014585786&partnerID=8YFLogxK

    U2 - 10.1037/abn0000254

    DO - 10.1037/abn0000254

    M3 - Article

    VL - 126

    SP - 340

    EP - 354

    JO - Journal of Abnormal Psychology

    JF - Journal of Abnormal Psychology

    SN - 0021-843X

    IS - 3

    ER -