Identifying the Core Symptoms of Bulimia Nervosa and Associ - PowerPoint Presentation

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Identifying the Core Symptoms of Bulimia Nervosa and Associated Anxiety and Depression

Cheri Levinson, Stephanie Zerwas, Benjamin CALEBS, Kelsie Forbush, Hunna Watson, Hans Kordy, Sara Hofmeier, Michele Levine, Benjamin Zimmer, Markus MOESSNER, Christine Peat, Cristin Runfola, Marsha Marcus, Cynthia BulikSlide2

What is at the CORE OF BULIMIA NERVOSA?

Bulimia nervosa (BN) is characterized by symptoms of:binge eating and compensatory behavioroverevaluation of weight and shapeBN symptoms often co-occur with symptoms of anxiety and depressionWhich specific BN symptoms maintain BN psychopathology? How are these symptoms associated with symptoms of depression and anxiety?Fairburn, Cooper, &

Shafran, 2003; Palister & Waller, 2008Slide3

Models of Psychopathology

Latent variable theory often used to describe why mental disorders develop & persistSymptoms arise from a common causeBN is the

cause that leads to each of these common symptoms.

Bollen, 2002; Borsboom et al., 2016; Clark & Watson, 1991; Eaton, 2015; Haslam, Holland, & Kuppens, 2012BN

Fear of weight gain

Binge eating

Purging

Avoidance of foodSlide4

Network Theory

Network theory proposes that symptoms of disorders cause each otherSymptoms are part of a dynamic network which can produce, sustain, and underlie mental disorders These interact with each other to strengthen (or weaken) the disorder

Borsboom & Cramer, 2010; Borsboom & Cramer, 2013;

Kendler, Zachar, & Craver, 2011Fear of Weight Gain

Avoidance of food

Purging

Binge eatingSlide5

What can network analysis teach us?

Determine the symptoms that are central to the BN psychopathology network Examine how symptoms of comorbid disorders interact with symptoms of BNSlide6

Clinical Utility

Reducing core symptoms in treatment should theoretically also decrease related symptomsFocus interventions to target: core symptoms−symptoms play a crucial role in the networkcomorbid symptoms that link between multiple disorders

Hayes, Yasinski, Barnes, &

Bockting, 2015Slide7

Current study

Examined: A network of BN symptoms:Which symptoms are most central (i.e. core symptoms)? The networks of BN, depression, and anxiety symptoms:

Which depression and anxiety symptoms are most strongly related to BN symptoms?Slide8

Participants

196 patients recruited for a clinical trialAll patients had DSM-IV diagnosis of BNPrimarily female (n = 187; 95.4%)European American (n = 165; 84.2%)Majority had comorbid depression and/or anxiety (n = 136; 69.4%)Slide9

Measures

Eating Disorder ExaminationBinge eating, restriction, fears of fatnessShort Evaluation of Eating DisordersVomiting, purging, excessive exerciseBeck Anxiety InventoryScared, dizzinessBeck Depression Inventory-IISad, fatigue, self-dislikeBauer et al., 2005; Beck, Steer, & Brown, 1996; Fairburn & Cooper, 1993; Steer & Beck, 1997Slide10

Network analyses

Partial Correlation Networks (Glasso Estimator)Explains how symptoms relate while also considering the impact of all other symptomsBridge SymptomsSymptoms that link adjacent symptoms together and are theorized to be pathways that could causally connect symptoms or behaviorsCentrality MeasuresBetweenness – number of times symptom is passed throughCloseness

– closeness to other symptoms in the networkStrength – having many connections to other symptomsSlide11

Bulimia Nervosa Psychopathology Network

BN NetworkSlide12

**

weight preoccupation

**

**

**

Higher peaks on right side indicate higher centrality

**highest centrality items

BETWEENESS

CLOSENESS

STRENGTH

**

weight dissatisfaction

**

lose weight

**

fear weight gainSlide13

BN AND anxiety Network

Bulimia Nervosa

&

Anxiety NetworkSlide14

Higher peaks on right side indicate higher centrality

**highest centrality items

**

****

**

**

**

**

weight preoccupation

**

unsteady

**

terrified

**

shape dissatisfaction

**

fear weight gain

**

lose control

**

choking

**

avoid eating

BETWEENESS CLOSENESS STRENGTHSlide15

BN and depression network

Bulimia Nervosa

&

Depression NetworkSlide16

Higher peaks on right side indicate higher centrality

**highest centrality items

**

****

**

**

BETWEENESS CLOSENESS STRENGTH

**

weight preoccupation

**

fear weight gain

**sad

**irritable

**concentrateSlide17

CONCLUSIONS

Core BN symptomsfear of weight gain & overevaluation of weight and shapeBridge symptoms - connect anxiety or depression symptoms to BN Physical sensations: unsteady, fears of losing control, choking, difficulty concentrating may be bridge symptoms Slide18

Fear of weight gain

Fear of weight gain is central to BN networkBinge eating and purging on the peripheryTreatments that focus on fear of weight gain may have maximal impact Weekly weighingExposureSlide19

Physical Sensations

Physical sensations bridge BN & anxiety/depressionExaggerated insula response in eating disorders?Sensitivity to physical sensationsInteroceptive ExposuresKim et al., 2012; Fassino

, Pierò, Gramaglia, & Abbate-Daga, 2004;

Klabunde et al., 2013; Oberndorfer et al., 2013Slide20

Limitations

Data is cross-sectional – no causalityLimited measurement of each symptomApplying network analysis to psychopathology is newNo fit indicesNo measures of reliabilityLimited by measures and symptoms chosen for the networkSlide21

Future directions

Does change in a core symptom produce changes in other network symptoms?Do symptom networks become less strong after treatment and with symptom remission?Slide22

Acknowledgments & Disclosures

Dr. Bulik is a grant recipient and consultant for Shire Pharmaceuticals and has consulted for Ironshore. Dr. Marcus is on the Scientific Advisory Board of Weight Watchers International, Inc. Dr. Peat is recipient of a contract from RTI and Shire Pharmaceuticals and has consulted for Sunovion Pharmaceuticals, L.E.K consulting, and Nexus Global Solutions. Dr. Watson is supported by a research grant from Shire awarded to UNC-Chapel Hill. Dr. Zerwas has consulted for L.E.K consulting. This research was supported by a National Institute of Mental Health (NIMH) grant (R01MH080065), a Clinical Translational Science Award (UL1TR000083), and the Alexander von Humboldt-

Stiftung. Dr. Zerwas is supported by a NIMH career development grant (K01MH100435). Drs. Peat and Runfola were supported by a NIMH post-doctoral training grant (T32MH076694). Dr. Runfola was supported by the Global Foundation for Eating Disorders (PIs:

Bulik and Baucom; www.gfed.org). Benjamin Zimmer was supported by a Fellowship for Postdoctoral Researchers from the German Academic Exchange Service (DAAD). Dr. Bulik acknowledges support from the Swedish Research Council (VR Dnr: 538-2013-8864). We wish to honor the incredible contribution and legacy of our colleague Dr. Robert Hamer, who passed away in December 2015.