Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy.
Int J Eat Disord. 2019 Nov;52(11):1263-1273. doi: 10.1002/eat.23137. Epub 2019 Jul 16.
Research evidence suggests the need to identify treatments based on a more precise characterization of psychopathology and psychiatric comorbidity in anorexia nervosa. Network analysis provides a new method to conceptualize psychopathology. We use this approach to investigate the relationships between eating disorder and general psychiatric symptoms in adolescents with anorexia nervosa.
Four-hundred and five adolescents with anorexia nervosa and illness duration less than 3 years were consecutively recruited from those admitted to inpatient treatment. They completed the following questionnaires: the Eating Disorder Inventory-3, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Youth Self Report. A network analysis was conducted, including eating psychopathology measures, anxiety and depressive symptoms, and obsessive-compulsive and post-traumatic stress problems. We employ a novel approach, the bridge function, to identify symptom clusters.
Depression symptoms and personal alienation were the nodes with the highest centrality in the network, followed by asceticism, post-traumatic stress problems, drive to thinness, low self-esteem, and anxiety physical symptoms. Three symptom clusters (relative to eating disorder psychopathology, self-esteem problems, and internalizing difficulties) were identified. Depression symptoms, personal alienation, low self-esteem, and interoceptive deficits showed the highest bridge centrality. Besides eating disorder core symptoms, negative affect and internalizing symptoms seem to contribute to anorexia nervosa psychopathology independently from illness duration effects.
These findings suggest that anorexia nervosa is characterized by a broad psychopathological spectrum rather than the mere eating disorder core symptoms, confirm the need to re-conceptualize psychiatric comorbidity in this disorder, and provide intriguing diagnostic and therapeutic implications.
研究证据表明，需要根据厌食症中精神病理学和精神共病的更精确特征来确定治疗方法。网络分析提供了一种新概念化精神病理学的新方法。我们使用这种方法来研究厌食症青少年中饮食障碍与一般精神症状之间的关系。
从接受住院治疗的患者中连续招募了 405 名患有厌食症且患病时间少于 3 年的青少年。他们完成了以下问卷：饮食障碍问卷-3、多维焦虑量表儿童版、儿童抑郁量表和青少年自我报告。进行了网络分析，包括饮食心理病理学测量、焦虑和抑郁症状以及强迫和创伤后应激问题。我们采用一种新的方法，即桥梁功能，来识别症状群。
抑郁症状和个人异化是网络中中心性最高的节点，其次是禁欲、创伤后应激问题、变瘦的欲望、低自尊和焦虑躯体症状。确定了三个症状群（与饮食障碍心理病理学、自尊问题和内化困难有关）。抑郁症状、个人异化、低自尊和内脏感觉缺失表现出最高的桥梁中心性。除了饮食障碍核心症状外，负性情绪和内化症状似乎独立于疾病持续时间的影响，对厌食症的精神病理学有贡献。
这些发现表明，厌食症的特点是广泛的精神病理学谱，而不仅仅是单纯的饮食障碍核心症状，证实了需要重新概念化这种障碍中的精神共病，并提供了有趣的诊断和治疗意义。
