Cheri Levinson

• Washington University in St. Louis

Network analysis is a popular method researchers use to characterize the structure of psychopathology and inform personalized treatments. Typically, applied researchers, based on network theory, interpret symptoms with the highest strength centrality as most important to network structure and represent amenable treatment targets. This study examine...

Individuals with eating disorders present with heterogenous cognitive-affective symptom profiles, whereas behavioral symptoms tend to be more homogenous. For example, dietary restriction is a common behavioral symptom across the eating disorders; however, the cognitive-affective factors that predict restriction may vary among persons. The aim of th...

Obsessive–compulsive disorder (OCD) and eating disorders (EDs) are highly comorbid. Despite the high comorbidity, there is little understanding of why these disorders coexist and even less research on how to best treat this co-occurrence. In this article, we review the literature on comorbid OCD-ED and discuss potential underlying shared mechanisms...

Objective: Psychological treatment effects and response rates have largely plateaued over the past few decades. A potential answer to this problem is personalized treatment approaches, which match treatment to a client’s specific presenting concerns, which should increase its precision and efficacy. Examining predictors and moderators of treatment...

We provide commentary on the Grilo and Pittman (2024). Exploring Dietary Restraint as a Mediator of Behavioral and Cognitive‐Behavioral Treatments on Outcomes for Patients With Binge‐Eating Disorder With Obesity article published in the International Journal of Eating Disorders . Grilo and Pittman show that weight loss in the Behavioral Weight Loss...

Individuals with eating disorders (EDs) often engage in exercise no matter potential negative long-term outcomes (e.g., weight loss, injury). Yet exercising may temporarily attenuate ED symptoms, but whether exercise also affects network structure and pairwise associations of ED symptoms remained unclear. We used a novel approach called Moderated M...

Interoception (e.g., abilities to recognize/attend to internal sensations) is robustly associated with psychopathology. One form of interoception, body trust, is relevant for the development of disordered eating and suicidal thoughts/behaviors. However, measures of body trust are narrow, despite research suggesting body trust is multifaceted. The a...

Eating disorders (EDs) and social anxiety disorder (SAD) are highly comorbid. Research to date suggests that social appearance anxiety (SAA), or fear of negative evaluation based on appearance is a type of social anxiety most related to EDs. Additionally, shame, guilt, and pride have each been shown to play a role in both EDs and SAD; however, they...

Background No evidence-based treatments exist for atypical anorexia nervosa (AAN) and little is known about differences in response to treatment between anorexia nervosa (AN) and AAN. The purpose of this paper is to explore treatment outcomes in two pilot trials for those with AN and AAN. Methods Study 1 (N = 127) examined treatment outcomes in a...

Objectives Mindfulness has been proposed as a potential intervention for eating disorders (EDs). However, a better understanding of the relationships between state mindfulness and restrictive ED symptoms for those with anorexia nervosa and atypical anorexia nervosa (AN-spectrum) is needed to design effective mindfulness-based interventions. Additio...

Exposure therapy has been examined as a treatment for eating disorders, but research has yet to determine how to adapt these approaches for those in larger bodies who experience weight stigma. This case study reports on the use of values-based exposure interventions to reduce body dissatisfaction and body-related concerns in a woman with binge eati...

Objective: Although eating disorders are associated with high rates of psychological and physical impairments and mortality, only about 20% of individuals with eating disorders receive treatment. No study has comprehensively assessed treatment access for those with these disorders in the United States. The authors examined access to eating disorde...

Background Suicidal thoughts and behaviors are elevated among active-duty service members (ADSM) and veterans compared to the general population. Hence, it is a priority to examine maintenance factors underlying suicidal ideation among ADSM and veterans to develop effective, targeted interventions. In particular, interpersonal risk factors, hopeles...

The research–practice gap refers to the fact that most evidence-based treatments created by researchers are not used in routine clinical care, which affects real-world treatment outcomes negatively. One key reason that evidence-based care is not used more frequently is its nonpersonalized format. For example, most evidence-based treatments are base...

Fear approach is a theorized mechanism of exposure treatment for anxiety-based disorders. However, there are no empirically established self-report instruments measuring the tendency to approach feared stimuli. Because clinical fears are heterogeneous, it is important to create a measure that is adaptable to person- or disorder-specific fears. The...

Eating disorders (EDs) have been traditionally viewed as a disorder affecting cisgender, heterosexual women. Yet, the prevalence of EDs among queer and trans (QnT) individuals, coupled with the lack of interventions that attend to contextual factors related to sexual orientation and gender identity, underscore a critical health disparity issue requ...

Individuals with eating disorders (EDs) often engage in exercise no matter potential negative long-term outcomes (e.g., weight loss, injury). Yet exercising may temporarily attenuate ED symptoms, but whether exercise also affects network structure and pairwise associations of ED symptoms remained unclear. We used a novel approach called Moderated M...

Objective: Body mass index (BMI) is the primary criterion differentiating anorexia nervosa (AN) and atypical anorexia nervosa despite prior literature indicating few differences between disorders. Machine learning (ML) classification provides us an efficient means of accurately distinguishing between two meaningful classes given any number of featu...

Eating disorders are severe and often chronic mental illnesses that are associated with high impairment and mortality rates. Recent estimates suggest that eating disorder prevalence rates are on the rise, indicating an increased need for accurate assessment and detection. The current review provides an overview of transdiagnostic eating disorder as...

Item selection is a critical decision in modeling psychological networks. The current preregistered two-study research used random selections of 1,000 symptom networks to examine which eating disorder (ED) and co-occurring symptoms are most central in longitudinal networks among individuals with EDs (N = 71, total observations = 6,060) and tested w...

Diet culture is a societal norm that ranks thin bodies as superior to other body types and has been associated with negative outcomes, such as eating disorders. Wellness has evolved into a term that is often used to promote diet culture messages. One possible way to combat diet culture is through single-session, digital mental health interventions...

Labelling specific psychiatric concerns as ‘niche’ topics relegated to specialty journals obstructs high-quality research and clinical care for these issues. Despite their severity, eating disorders are under-represented in high-impact journals, underfunded, and under-addressed in psychiatric training. We provide recommendations to stimulate broad...

Eating disorders (EDs) often require intensive ED treatment, yet little is known about relapse rates across levels of care and treatment centers in the US. The current study examined preliminary rates of relapse after intensive ED treatment across multiple treatment centers (n=46). ED participants (n=124) enrolled within four-months of discharge fr...

Background Eating disorders (ED) are serious psychiatric disorders, taking a life every 52 minutes, with high relapse. There are currently no support or effective intervention therapeutics for individuals with an ED in their everyday life. The aim of this study is to build idiographic machine learning (ML) models to evaluate the performance of phys...

Item selection is a critical decision in modeling psychological networks. The current pre-registered two-study research used random selections of 1,000 symptom networks to examine which eating disorder (ED) and co-occurring symptoms are most central in longitudinal networks among individuals with EDs (N = 71, total observations = 6,060) and tested...

The Fear of Food Measure (FOFM) was developed to assess eating-related anxiety and evaluate outcomes of food exposure treatment. The FOFM scores in adult community and clinical samples have demonstrated good factor structure, reliability, and validity, but the FOFM has yet to be evaluated in adolescents, despite eating disorders (EDs) being extreme...

Objective: Weight stigma comprises negative attitudes and weight-related stereotypes that result in rejection, discrimination, and prejudice against individuals in larger bodies. Both internalized and experienced weight stigma are associated with negative mental health outcomes, yet it remains unknown how types of stigmatizing experiences (e.g., s...

Ecological momentary assessment (EMA) data have a broad base of application in the study of time trends and relations. In EMA studies, there are a number of design considerations which influence the analysis of the data. One general modeling framework is particularly well-suited for these analyses: state-space modeling. Here, we present the state-s...

Objective: Although eating disorders (EDs) are associated with high rates of psychological and physical impairments and high mortality rates, only 20% of those with EDs will receive treatment. No comprehensive treatment access climate assessment has occurred, and little is known about how barriers to treatment access differ across demographic (e.g....

Introduction: Eating disorders (EDs) have high rates of relapse. However, it is still not clear which factors are the strongest predictors of ED relapse, and the extent to which predictors of relapse may vary due to study and individual differences. Objective: We conducted a meta-analysis to quantify and compare which factors predict relapse in...

Anorexia nervosa (AN) is a chronic and debilitating psychiatric disorder. Unfortunately, current treatments are lacking, with only 30-50% of individuals with AN recovering after treatment. We developed a beta-version of a digital mindfulness-based intervention for AN called Mindful Courage-Beta, which includes: (a) one foundational multimedia modul...

Objective: Treatments for adults with eating disorders (EDs) only work in about 50% of individuals, and for some diagnoses (e.g., anorexia nervosa; atypical anorexia nervosa), there are no existing evidence-based treatments. Part of the reason that treatments may only work in a subset of individuals is because of the high heterogeneity present in t...

Healthcare providers play a key role in early identification of eating disorders (EDs), especially in underserved states where ED treatment resources are lacking. Currently, there is little known about ED screening and treatment practices in underserved states. The current study assessed current ED screening and treatment practices among healthcare...

Clinical fear is at the core of anxiety disorders. Considerable research has examined processes through which clinical fears are learned and unlearned (i.e., acquisition, generalization, extinction, return of fear) in anxiety disorders. Empirically supported models of these processes implicate both associative and instrumental learning. Research ha...

Despite having the second highest mortality rate of any psychological disorder (Keel et al., 2003; Smink, Van Hoeken, & Hoek, 2012), most individuals with an eating disorder (ED) never access treatment (Hart et al., 2011). While studies have begun to elucidate ED treatment access inequities (Innes, Clough, & Casey, 2016), several gaps in the litera...

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis....

Eating disorders are serious psychiatric illnesses with treatments ineffective for about 50% of individuals due to high heterogeneity of symptom presentation even within the same diagnoses, a lack of personalized treatments to address this heterogeneity, and the fact that clinicians are left to rely upon their own judgment to decide how to personal...

Eating disorders (EDs) and social anxiety disorder (SAD) are characterized by high levels of fear and effectively treated with exposure therapy. Physiological markers of fear can elucidate how exposure influences psychophysiological processes underlying psychopathology. In the current study ( N = 109), we measured heart rate variability, heart rate...

Individuals with eating disorders (EDs) often present with somatic concerns in treatment, such as bloating, fullness, and feeling tight clothes on skin. However, most research generally focuses on general interoception (e.g., heartbeat) rather than sensations relevant to EDs (e.g., sensations related to the gastrointestinal system or body movement)...

Individuals with eating disorders (EDs) experience somatic deficits that may contribute to the maintenance of ED psychopathology. This paper proposes new directions to consider using in future research examining somatic concerns in EDs. We reviewed articles examining ED psychopathology and somatic sensations (e.g., interoception, exteroception, and...

Eating disorders (EDs) are serious mental illnesses that are highly comorbid with depressive and anxiety disorders. However, the underlying psychological mechanisms of this comorbidity are not yet clearly delineated. One such mechanism is self-criticism (i.e., harsh and overly critical self-evaluation). In this review, we summarize the literature i...

Eating disorders are severe mental illnesses characterized by the hallmark behaviors of binge eating, restriction, and purging. These disordered eating behaviors carry extreme impairment and medical complications, regardless of eating disorder diagnosis. Despite the importance of these disordered behaviors to every eating disorder diagnosis, our cu...

Eating disorders (EDs) are highly comorbid with obsessive-compulsive disorder (OCD), with comorbidity rates as high as 41%. In the current review, we summarize the literature regarding the prevalence of ED-OCD comorbidity. We also identify and review the literature assessing shared features (i.e., shared characteristics or symptoms) and mechanisms...

Purpose Network studies of eating disorder (ED) symptoms have identified central and bridge symptoms in Western samples, yet few network models of ED symptoms have been tested in non-Western samples, especially among preadolescents. The current study tested a network model of ED symptoms in Iranian preadolescents (ages 9 to 13), as well as a model...

Eating disorders are serious psychiatric illnesses with treatments ineffective for about 50% of individuals due to 1) high heterogeneity of symptom presentation even within the same diagnoses, 2) a lack of personalized treatments to address this heterogeneity, and 3) the fact that clinicians are left to rely upon their own judgment to decide how to...

Eating disorders are severe mental illnesses with the second-highest mortality rate of all psychiatric illnesses. Eating disorders are exceedingly deadly because of their complexity. Specifically, eating disorders are highly comorbid with other psychiatric illnesses (up to 95% of individuals with an eating disorder have at least one additional psyc...

Objective: Fear and anxiety are key maintaining factors for eating disorder (ED) pathology. Maladaptive fears lead to ED behaviors and avoidance, which provide temporary relief, but ultimately reinforce the fear and contribute to a cycle that maintains the ED. To date, fears of food and weight gain are the most explored fears underlying ED patholo...

Eating disorders (ED) are highly impairing and dangerous conditions that typically onset in adolescence. However, very few prospective studies have examined early childhood risk factors for ED pathology. Given well-established links between temperament and psychopathology, examination of these factors could inform prevention efforts. The current mu...

Eating disorders (EDs) are serious psychiatric illnesses with high mortality and societal cost. Despite their severity, there are few evidence-based treatments, and only 50% of individuals respond to existing treatments. This low response rate may be due to the fact that EDs are highly heterogeneous disorders. Precision treatments are needed that c...

Disordered eating (DE) poses a large societal burden, yet limited research has examined DE from a developmental epidemiological perspective. It is important to consider how demographic influence DE symptoms to inform prevention and early intervention programs across diverse subpopulations. Therefore, we conducted network analyses using a large nati...

Background Several unsuccessful attempts have been made to reach a cross-disciplinary consensus on issues fundamental to the field of eating disorders in the United States (U.S.). In January 2020, 25 prominent clinicians, academicians, researchers, persons with lived experience, and thought leaders in the U.S. eating disorders community gathered at...

Background Eating disorders (EDs) are severe mental illnesses, with high morbidity, mortality, and societal burden. EDs are extremely heterogenous, and only 50% of patients currently respond to first-line treatments. Personalized and effective treatments for EDs are drastically needed. Methods The current study (N = 34 participants with an ED diag...

Obsessive-compulsive disorder (OCD) and eating disorders (EDs) frequently co‐occur. Intrusive thoughts are a mechanism that may maintain this comorbidity. This study used network analysis to identify central ED-related intrusive thoughts and tested which intrusive thoughts connected ED and OCD symptoms. Two cross-sectional graphical LASSO networks...

Objective: This study employed network analysis to characterize central autism spectrum disorder (ASD) traits and suicide symptoms within an active duty military sample as well as to identify symptoms that may bridge between ASD traits and suicidality (i.e., suicidal ideation and behaviors). Method: Participants were active duty U.S. military se...

Polyvictimization (i.e., the experience of multiple types of victimization) increases the risk for post-traumatic stress disorder (PTSD) relative to single-type victimization. Network analysis has been used to conceptualize PTSD among children and adolescents exposed to specific types of victimization (e.g., maltreatment, natural disasters), but no...

Objective Repetitive negative thinking (RNT) is associated with eating disorder (ED) symptoms, but few studies have evaluated how RNT may relate to specific ED behaviors (e.g., fasting, binge eating). Furthermore, little research has examined RNT in adolescent girls, a critical population for ED development. Concern over mistakes perfectionism (i.e...

More than 50% of individuals with an eating disorder (ED) will readmit to treatment within 6 months of treatment discharge and often due to persistent cognitive ED pathology. Interventions addressing unremitted cognitive ED pathology following discharge from intensive treatment are crucial to prevent readmission. Imaginal exposure therapy facilitat...

Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest...

Background : Sleep, anxiety, and worry are strongly related to psychiatric illness and in particular to eating disorder (ED) symptoms. However, it is unclear how these specific sleep and anxiety symptoms are interrelated with anorexia nervosa (AN) pathology. Methods : We utilized network analysis to test our theoretically-based conceptual model, b...

Introduction Eating disorders (EDs) are serious mental illnesses with high rates of mortality, morbidity, and personal and societal costs. Onset of the Covid-19 pandemic led to increased ED diagnoses in the general public, as well as worsening of ED symptoms in those with an existing ED diagnosis. Heightened prevalence and severity of EDs during th...

Mindfulness is a two-component skill that includes mindful awareness (attentional monitoring of present moment experience) and mindful acceptance (adopting an attitude of acceptance toward this experience). Although mindfulness-based interventions (MBIs) are efficacious for many conditions, there is a lack of research on MBIs for eating disorders (...

Objective Growing literature suggests that emotions influence the maintenance of eating disorder (ED) symptoms. However, most research has studied the relationship between ED symptoms and affect broadly (i.e., negative affect [NA], positive affect [PA]), rather than examining models comprised of multiple specific affective states (e.g., upset, prou...

Objective Suicide is a leading cause of death in early adolescents (i.e., children ages 11–14), underscoring the need for a more complex understanding of suicidality in youth. Syndemics framework posits that the overlap of multiple maladaptive behaviors (or risk factors) produces worse health outcomes compared to each behavior alone. The use of thi...

Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive ex...

Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders...

Background: Impulsivity and perfectionism are transdiagnostic personality factors that have been studied extensively and shown to relate to externalizing and internalizing pathology respectively. Typically, these personality factors are antithesized, with impulsivity characterized by lack of control and perfectionism characterized by rigid overcon...

Background Eating disorders (ED) and obsessive-compulsive disorder (OCD) are highly comorbid, but little is known about how this comorbidity is maintained. Prior research suggests that obsessive thoughts and perfectionism may be shared maintenance factors for EDs and OCD. Methods The current study used network analysis to (1) identify bridge pathw...

Eating disorders and alcohol misuse are common problems among college women. Individually, both have high prevalence rates and are associated with a significant economic burden. Yet eating disorders and alcohol misuse also frequently present simultaneously, which may increase symptom severity and related impairment. These associations are especiall...

Aim Engagement in risky behaviours, including substance use, disordered eating, suicidal behaviour, and peer victimization/violence, during adolescence is becoming increasingly prevalent. These risky behaviours are highly comorbid and associated with long‐term consequences for health, relationships, and socioeconomic status, representing an importa...

Several studies have identified risk factors that predict future onset of eating disorders (ED) in adolescence, however, it is currently unknown how specific ED symptom dynamics operate both across time and within individuals. Advances in network methodologies allow for the study of how dynamic symptoms interrelate and predict each other within-per...

Objective Eating disorders (EDs) are highly comorbid with obsessive‐compulsive disorder (OCD). In order to develop treatments which better address commonly comorbid ED and OCD symptoms, it is important to identify potential shared mechanisms. Two potential shared mechanisms are maladaptive perfectionism and intolerance of uncertainty (IU). We aimed...

Enhanced cognitive–behavioral therapy (CBT‐E) is one of the primary evidence‐based treatments for adults with eating disorders (EDs). However, up to 50% of individuals do not respond to CBT‐E, likely because of the high heterogeneity present even within similar diagnoses. This high heterogeneity, especially in regard to presenting pathology, makes...

Objective: Anorexia nervosa (AN) is a disorder characterized by a profound fear of weight gain, resulting in significant weight loss, as well as behavioral symptoms that interfere with weight normalization. In concert, weight gain remains a proximal goal of treatment, and patient weighing is a critical component of treatment. However, divergent ap...

Background Exposure therapy is the most effective treatment for anxiety and related disorders and its efficacy in the eating disorders is rapidly gaining support. Despite the strong evidence behind exposure therapy, many anxiety disorder providers do not endorse the usage of exposure therapy. Limited research has explored the use of exposure therap...

PurposeThe sociocultural theory of eating disorders (EDs) posits that thin-ideal internalization may interact with social risk factors to influence ED development. Social appearance anxiety (SAA) is a potential social risk factor for EDs that may influence the relationship between thin-ideal internalization and EDs.Methods The current study (N = 52...

Objective: Eating-related fear and anxiety are hallmark symptoms of eating disorders (EDs). However, it is still unclear which fears are most important (e.g., food, weight gain), which has practical implications, given treatments for eating-related fear necessitate modifications based on the specific fear driving ED pathology. For example, exposur...

Objectives Higher trait mindfulness (i.e., bringing one’s attention to the present moment with an attitude of acceptance and non-judgment) is associated with lower eating disorder (ED) psychopathology. However, it is not yet clear how mindfulness results in lower ED psychopathology. One possibility is that mindfulness may decrease body checking, pa...

Background Eating disorders (EDs) are most always accompanied by cognitive-affective comorbidities, such as anxiety and depression. In addition to these common comorbidities, EDs are unique in that they are characterized by affective symptoms centered on body image and weight. Two of these primary, yet understudied, affective symptoms are feelings...

Objective The network theory of psychopathology examines networks of interconnections across symptoms. Several network studies of disordered eating have identified central and bridge symptoms in Western samples, yet network models of disordered eating have not been tested in non‐Western samples. The current study tested a network model of disordere...

Background: Few evidence-based treatments for eating disorders (EDs) exist. Imaginal exposure therapy is a key component of effective treatment for anxiety disorders and post-traumatic stress disorder. However, imaginal exposure has not been systematically tested as a treatment for EDs. The current study aimed to develop and test online imaginal ex...

Objectives Eating disorders are associated with significant physical, psychological, and social impairment, but existing treatments are effective only half of the time and relapse rates are high. Mindfulness-based programs (MBPs) are growing in empirical support and present a promising area of research to fill a crucial treatment gap for eating dis...