Central Symptoms Predict Posttreatment Outcomes and Clinical Impairment in Anorexia Nervosa: A Network Analysis

Network analysis can be used to identify central symptoms of eating disorders such as anorexia nervosa (AN), but the validity of this approach has been questioned. Using network analysis, in the present study we identify central symptoms of adult AN, identify key bridge symptoms between AN and anxiety/depression, and examine whether central symptoms at baseline are important predictors of treatment outcomes. We conducted network analyses for AN and comorbid depression and anxiety using longitudinal data (N = 142) with measurements at baseline, and at 6-month, 12-month, and 24-month postrandomization follow-ups. We identified central symptoms and bridge symptoms and tested whether centrality values calculated at baseline were related to the prognostic utility of symptoms longitudinally. Feeling fat and fear of weight gain were among the most central symptoms of AN. Feelings of worthlessness had the highest bridge centrality connecting depression to AN. Symptom centrality at baseline was strongly related to prognostic utility (r(2) = .52, .55). The finding that symptom centrality was strongly related to prognostic utility supports the validity of network theory in that central symptoms may have a particularly strong influence on clinical impairment and recovery. These analyses generate useful hypotheses about the etiology and maintenance of AN and related comorbidities and may inform future treatment development.