A Transdiagnostic Model of Eating Disorders—Comparing Symptom Interactions in Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder

Abstract Purpose The transdiagnostic theory of eating disorders (EDs) states that maintenance mechanisms are largely the same across different ED diagnoses. However, different diagnostic groups show different responses to cognitive behavioral therapy with regard to remission rates and reduction of disordered eating behaviors. We investigated the interplay of proposed maintenance mechanisms such as overvaluation of shape and weight and core low self-esteem and ED behaviors in anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED). Methods We analyzed data from 1,023 adult patients ( n = 406 with AN, n = 366 with BN, and n = 251 with BED) and estimated cross-sectional regularized partial correlation networks. For each network, we identified the most central nodes and compared networks by using the network comparison test. Results Consistent with theory, (a) the networks were very similar, (b) core low self-esteem, overvaluation of shape and weight, and dietary restraint were connected to each other, in both AN and BN, and (c) binge eating and self-induced vomiting were closely linked. In contrast with theory, (a) dietary restraint was not linked with binge eating and b) mood intolerance did not show strong associations with ED behaviors. Core low self-esteem consistently had greatest strength centrality. Conclusions Our study adds to the evidence that low self-esteem is a crucial treatment target. However, our findings do not support the notion that dietary restraint leads to binge eating as proposed by the transdiagnostic theory and restraint theory. Overall, our findings partially support the transdiagnostic theory.