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 aDiagnostic 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. (PsycINFO Database Record
authors.affiliation: Department of Psychological and Brain Sciences.
authors.forename: Cheri A
authors.initials: CA
authors.lastname: Levinson
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Zerwas
authors.affiliation: Department of Psychological and Brain Sciences.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Calebs
authors.affiliation: Department of Psychology, The University of Kansas.
authors.forename: Kelsie
authors.identifier: 0000-0002-5900-4204
authors.initials: K
authors.lastname: Forbush
authors.affiliation: Center for Psychotherapy Research, University of Heidelberg.
authors.forename: Hans
authors.initials: H
authors.lastname: Kordy
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill.
authors.forename: Hunna
authors.initials: H
authors.lastname: Watson
authors.affiliation: Veritas Collaborative.
authors.forename: Sara
authors.initials: S
authors.lastname: Hofmeier
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center.
authors.forename: Michele
authors.initials: M
authors.lastname: Levine
authors.affiliation: Neuropsychiatric Research Institute.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Department of Psychiatry and Neurosurgery, University of North Carolina at Chapel Hill.
authors.forename: Christine
authors.initials: C
authors.lastname: Peat
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill.
authors.forename: Cristin D
authors.initials: CD
authors.lastname: Runfola
authors.affiliation: Center for Psychotherapy Research, University of Heidelberg.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zimmer
authors.affiliation: Center for Psychotherapy Research, University of Heidelberg.
authors.forename: Markus
authors.initials: M
authors.lastname: Moesner
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center.
authors.forename: Marsha D
authors.initials: MD
authors.lastname: Marcus
authors.affiliation: Department of Psychiatry and Nutrition, University of North Carolina at Chapel Hill.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Bulik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications*; D052018:Bulimia Nervosa / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D003627:Data Interpretation, Statistical; D003863:Depression / Q000150:complications*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015430:Weight Gain; D055815:Young Adult