Network dynamics of self‐compassion, anxiety, and depression during eating disorder therapy

• Published in: European eating disorders review 2025-01, Vol.33 (1), p.35-52
• Main Authors: Kopland, Maren C. G., Vrabel, KariAnne, Landt, Margarita Slof‐Op 't, Hoffart, Asle, Johnson, Sverre Urnes, Giltay, Erik J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anxiety - psychology; Child abuse & neglect; clinical; Compassion; co‐morbidity; Depression - psychology; Depression - therapy; Eating disorders; Empathy; Feeding and Eating Disorders - psychology; Feeding and Eating Disorders - therapy; Female; Humans; in‐patient; Male; Middle Aged; Residential Treatment; Self Concept; Young Adult
• ISSN: 1072-4133; 1099-0968; 1099-0968
• DOI: 10.1002/erv.3121

Background Recovery processes during residential treatment for eating disorders, especially in patients with a history of maltreatment, are insufficiently understood. This study aimed to explore the temporal relationships among comorbid factors, including depression, anxiety, and self‐compassion, with the influence of childhood maltreatment. Method Using Dynamic Time Warp (DTW), weekly scores from the Symptom Checklist‐5, Eating Disorder Examination, and Self‐Compassion Scale were analysed over 12 weeks. The study generated undirected and directed networks to identify influential symptoms in a transdiagnostic sample, comparing patients with and without childhood maltreatment. Results The study included 124 patients with eating disorders (ED) (97% women), mean age of 30.9 years (SD = 9.7, range 18–61 years). Diagnoses included anorexia nervosa (26%), bulimia nervosa (38%), and other specified feeding and eating disorders (36%). The directed DTW network showed that hopelessness, worrying, and restlessness had the highest out‐strength, predicting changes in self‐compassion and ED behaviour. In maltreatment cases, hopelessness and low acceptance predicted changes, while worry, restlessness, and nervousness were predictive in non‐maltreatment cases. Conclusion Temporal network analyses suggest that a change in hopelessness, worrying, and restlessness drives symptom improvement in ED behaviour and the development of self‐compassion during residential treatment. These processes vary between patients with and without a history of childhood maltreatment separately, indicating the need for further analyses. Key points Temporal network analysis can contribute to further advances in personalised medicine. Our study indicates that patients with eating disorders (ED) and a history of childhood maltreatment differ from patients without a history of childhood maltreatment in network dynamics, indicating different therapy processes. We find that a change in hopelessness and acceptance of disliked personality traits preceded and predicted change in ED behaviour and the ability to feel self‐compassionate in patients with ED and a history of childhood maltreatment. These findings point to a need to study patients with a history of maltreatment separately to further advance the field of personalised medicine in ED treatment.