Kopland Maren C G, Vrabel KariAnne, Slof-Op 't Landt Margarita, Hoffart Asle, Johnson Sverre Urnes, Giltay Erik J
Modum Bad Psychiatric Hospital, Vikersund, Norway.
Department of Psychology, University of Oslo, Oslo, Norway.
Int J Eat Disord. 2024 Feb;57(2):316-326. doi: 10.1002/eat.24097. Epub 2023 Nov 25.
Most network analyses on central symptoms in eating disorders (EDs) have been cross-sectional. Longitudinal within-person analyses of therapy processes are scarce. Our aim was to investigate central change processes in therapy in a transdiagnostic sample, considering the influence of childhood maltreatment.
We employed dynamic time warping analyses to identify clusters of symptoms that tended to change similarly across therapy on a within-person level. Symptoms were measured by a 28-item Eating Disorder Examination Questionnaire (EDE-Q). Furthermore, we examined the temporal direction of symptom change to identify symptoms that tended to precede and predict other symptoms. Finally, we estimated two directed, temporal networks in patients with and without a history of childhood maltreatment.
Our analysis included 122 ED patients (mean age = 30.9, SD = 9.7; illness duration = 14.2 years, SD = 8.9; prior treatment = 5.6 years, SD = 5.1). The initial network revealed three robust clusters of symptoms over time: (1) ED behavior, (2) inhibition, and (3) cognitions and feelings about body and weight. Overvaluation of shape had the highest out-strength preceding and predicting other symptoms. Dissatisfaction with weight preceded and predicted other symptoms in the maltreatment network. The non-maltreatment network showed a similar structure to the transdiagnostic network.
Targeting and monitoring feelings and cognitions related to shape may be crucial for achieving lasting symptom improvement in a transdiagnostic sample. Furthermore, our findings highlight the need for further investigation into the different processes driving EDs based on maltreatment status.
There is limited understanding of the processes that occur for patients with eating disorders between admission and discharge in therapy, especially for patients with a history of childhood maltreatment. Our analyses suggest that changes in cognitions regarding shape precede and predict changes in cognitions about weight. Different processes may be driving the eating disorder according to maltreatment status, which might further illuminate the riddle of dropout and relapse in therapy for patients with a history of childhood maltreatment. These findings suggest the need for further investigation into the specific dynamics occurring during therapy for individuals with a history of childhood maltreatment.
大多数关于饮食失调（EDs）核心症状的网络分析都是横断面研究。对治疗过程进行纵向的个体内分析较为匮乏。我们的目的是在一个跨诊断样本中研究治疗中的核心变化过程，并考虑童年期虐待的影响。
我们采用动态时间规整分析来识别在个体内水平上，在整个治疗过程中倾向于以相似方式变化的症状群。症状通过一份包含28个条目的饮食失调检查问卷（EDE-Q）进行测量。此外，我们研究了症状变化的时间方向，以识别那些倾向于先于并预测其他症状的症状。最后，我们估计了有和没有童年期虐待史患者的两个有向时间网络。
我们的分析纳入了122名饮食失调患者（平均年龄 = 30.9岁，标准差 = 9.7；病程 = 14.2年，标准差 = 8.9；先前治疗时间 = 5.6年，标准差 = 5.1）。初始网络显示随着时间推移有三个稳定的症状群：（1）饮食失调行为，（2）抑制，以及（3）对身体和体重的认知与感受。体型过度重视在先于并预测其他症状方面具有最高的出强度。在受虐待网络中，对体重的不满先于并预测其他症状。非受虐待网络显示出与跨诊断网络相似的结构。
针对并监测与体型相关的认知和感受，对于在跨诊断样本中实现持久的症状改善可能至关重要。此外，我们的研究结果凸显了基于虐待状况对驱动饮食失调的不同过程进行进一步研究的必要性。
对于饮食失调患者在治疗入院和出院之间发生的过程，尤其是有童年期虐待史的患者，了解有限。我们的分析表明，关于体型的认知变化先于并预测关于体重的认知变化。根据虐待状况，不同的过程可能在驱动饮食失调，这可能进一步阐明有童年期虐待史患者治疗中的脱落和复发之谜。这些发现表明需要对有童年期虐待史个体在治疗期间发生的特定动态进行进一步研究。
