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 journalArticlepeer-review

    160 Citations (Scopus)


    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
    Issue number3
    Publication statusPublished - 1 Apr 2017


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