Cognitive and Interpersonal Factors in Adolescent Inpatients with Anorexia Nervosa: A Network Analysis.

The cognitive-interpersonal model of anorexia nervosa (AN) posits that cognitive and interpersonal traits contribute to the development and maintenance of AN. We investigated cognitive and interpersonal factors put forward by the model in a sample of 145 adolescent inpatients with AN using network analysis. Our main outcomes included core eating disorder symptoms, cognitive style, socio-affective factors, and mood symptoms. We estimated a cross-sectional network using graphical LASSO. Core and bridge symptoms were identified using strength centrality. Goldbricker was used to reduce topological overlap. The node with the highest strength centrality was Concern over Mistakes, followed by Eating Preoccupation, Social Fear, and Overvaluation of Weight and Shape. The nodes with the highest bridge strength were Concern over Mistakes, Doubt about Actions, Overvaluation of Weight and Shape, and Depression. Notably, both performance on a cognitive flexibility task and BMI were not connected to any other nodes and were subsequently removed from the final network. We provide partial support for the cognitive-interpersonal model while also supporting certain premises put forward by the transdiagnostic cognitive-behavioral model. The high centrality of Concern over Mistakes and Social Fear supports the theory that both cognitive and interpersonal difficulties contribute to AN, particularly in adolescence.

Subclinical eating disorders and their comorbidity with mood and anxiety disorders in adolescent girls.

The present study assesses the prevalence of subclinical eating disorders and examines their comorbidity with mood and anxiety disorders in a sample of adolescent girls. A DSM-III-R computerized self-reported interview was administered to 833 adolescent girls (mean age=15.7±0.5 years) from a population sample to assess the prevalence of subclinical eating disorders, major depression, dysthymia, separation anxiety, and generalized anxiety disorders. The prevalence of subclinical anorexia nervosa (restricting subtype) was 3.5%, 13.3% for weight concerns (restricting subtype), 3.8% for subclinical bulimia nervosa, and 10.8% for subclinical binge eating disorder. Girls with subclinical anorexia nervosa had a higher prevalence of separation anxiety diagnosis, and they reported significantly more major depressive and generalized anxiety symptoms compared with girls reporting no eating disorders. Girls with weight concerns reported significantly more major depressive, separation, and generalized anxiety symptoms compared with girls reporting no eating disorders. Girls with subclinical bulimia nervosa or binge eating disorder had a higher prevalence of mood disorders (major depression and dysthymia) compared with girls reporting no eating disorders. Furthermore, girls with subclinical bulimia nervosa or binge eating disorder also reported significantly more anxiety symptoms (separation anxiety and generalized anxiety) compared with girls reporting no eating disorders. In summary, adolescent girls suffering from subclinical eating disorders should be investigated concomitantly for mood and anxiety disorders while those suffering from mood and anxiety disorders should be investigated simultaneously for subclinical eating disorders.

Is major depressive episode related to anxiety disorders in anorexics and bulimics?

OBJECTIVE: To determine whether the presence of anxiety disorders is related to depressive comorbidity in subjects with eating disorders (ED), while taking into account certain variables that may be related to depression (subjects' age, ED duration, prior incidents of anorexia nervosa in bulimic subjects, inpatient or outpatient status, nutritional state [as measured by body mass index]). METHOD: We evaluated the frequency of depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview, DSM-IV version. RESULTS: A multivariate analysis reveals that anxiety disorders do not all have the same influence in terms of risk of onset of major depressive episode in anorexics and bulimics when adjusted on variables related to depression. CONCLUSION: Depression in subjects with ED can be explained in part by comorbidity with obsessive-compulsive disorder, generalized anxiety, social phobia, and panic disorder.

Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study.

Women who were referred with an eating disorder (ED) were compared with a matched normal control group to answer the following questions: What are the frequencies of anxiety disorders in cases of anorexia and bulimia nervosa diagnosed according to DSM-IV criteria? Are anxiety disorders significantly more frequent among women with an eating disorder than among women from the community? We assessed the frequencies of six specific anxiety disorders among 271 women with a current diagnosis of anorexia or bulimia nervosa and 271 controls, using the Mini-International Neuropsychiatric Interview, French DSM-IV version. A lifetime comorbidity with at least one anxiety disorder was found in 71% of both the anorexic and the bulimic subjects, significantly higher than the percentage of controls with an anxiety disorder. The prevalence was significantly higher in the eating disorder groups than in controls for most types of anxiety disorder, and between 41.8 and 53.3% of comorbid cases had an anxiety disorder preceding the onset of the eating disorder. Anxiety disorders are significantly more frequent in subjects with eating disorders than in volunteers from the community, a finding that has important etiological and therapeutic implications.