1 - (SYM 87) Group- and Individual-dynamics Associated with the Urge to Restrict

Eating disorders (EDs) are serious psychiatric illnesses. Evidence-based ED treatments are only effective for ~50% of individuals (Keel & Brown, 2010). Treatments may not be as effective for most people because EDs are extremely heterogeneous illnesses, yet treatments are manualized as a “one-size-fits-all”. Nevertheless, individuals with EDs share symptom similarities. For example, restriction is a core symptom of most all ED diagnoses (Bray et al., 2023). However, it is likely that the cognitive-affective dynamics that give rise to restriction are unique to the individual. In this study, we examine the shared and idiosyncratic symptom dynamics related to the urge to restrict and identify how these dynamics predict the behavior restriction at the group- and individual level.

Participants (N=28 individuals with EDs) completed ecological momentary assessment four times/day for 90 days. Participants rated momentary experiences of cognitive-affective symptoms (e.g., fear of weight gain, anxiety, sadness), urges to engage ED behaviors (e.g., restriction, binge eating, compensatory behaviors), and engagement in behaviors. We used group iterative multiple model estimation to examine group-level symptom dynamics of restriction and individual models of restriction. We estimated graphical autoregressive (gVAR) models for each participant, allowing different symptoms for each participant. Using the gVAR models we identified the significant paths to restriction and tallied the number that each node predicted restriction.

There were 10 group-level paths identified among participants. For all participants, there were shared paths among self-criticism predicting over-evaluation of weight and shape, which predicted fear of weight gain. Fear of weight gain predicted feeling fat, which predicted the urge to restrict and self-criticism, potentially indicating a cycle of cognitive-affective eating disorder symptoms triggered by self-criticism. However, none of these paths were significant at the individual level. gVAR results displaying idiographic symptom dynamics from associated with restriction will be presented. Clinical implications concerning ED treatment personalization will be discussed.

 
The current study is an initial step toward characterizing shared and distinct mechanisms underlying dietary restriction among individuals with EDs. Clinical implications of this work include refining ED conceptualizations broadly and personalized treatments that target person-specific symptom dynamics of restriction.