Venue: CARF
Defense in english
Chantal Delaquis
Team: Ecopsy, INCIA
Thesis supervisor: Sylvie Berthoz
Title
Transdiagnostic Pathways in Disordered Eating: A Network Perspective on Cognitive and Affective Dimensions
Abstract
Eating disorders (EDs) are devastating psychiatric conditions with few effective evidence-based treatments – only half of patients recover and 25% of those patients will relapse. Increasingly, research is shifting beyond eating and weight-related symptoms to examine broader maintenance mechanisms and improve treatment outcomes. Two leading theoretical frameworks, the cognitive-interpersonal model of anorexia nervosa (AN) and the transdiagnostic cognitive-behavioural model, proposing highly compatible, overlapping ED maintenance mechanisms including cognitive rigidity, perfectionism, contingent self-worth, emotion regulation and interpersonal difficulties. To examine the complex interactions between a wide range of symptoms, network analysis offers a uniquely suitable framework by conceptualising psychopathology as a system of interacting symptoms. This approach allows for the identification of central nodes, representing key treatment targets, as well as bridge nodes, which link symptom clusters and may drive comorbidity.
Across five studies, the current thesis aims to understand the interplay between maintenance mechanisms proposed by the leading theoretical models. Chapter 3 investigates cognitive-interpersonal features among adolescent inpatients with AN to identify central and bridge symptoms. Concern over Mistakes, a dimension of perfectionism, emerged as both a central and bridge node. This symptom was significantly more central than core eating disorder symptoms. Chapter 4 extends this work to examine the network structure of cognitive-behavioural symptoms among both adult and adolescent inpatients with AN. Concern over Mistakes again emerged as a central node, alongside Overvaluation of Weight and Shape and Personal Standards, while Self-Esteem and Concern over Mistakes were bridge nodes. Further, anxiety symptoms were significantly more central in restrictive AN compared to the binge-purge subtype. Chapter 5 integrates these studies and tests their replicability modelling both cognitive-interpersonal and cognitive-behavioural features among Australian community members reporting disordered eating symptoms. Concern over Mistakes was again both a central and bridge node. Both Impulsivity/Difficulty with Goal-Directed Behaviour and Overvaluation of Weight and Shape were also central. Given the robust centrality of perfectionism, Chapter 6 examines the distinct yet complementary roles of Concern over Mistakes and Personal Standards among Australians self-reporting an ED compared to controls. Neither dimension differed between ED diagnostic groups nor ED behavioural presentations (restrictive, binge-purge and binge), supporting their transdiagnostic relevance. When controlling for anxiety and depressive symptoms, Concern over Mistakes remained elevated across all ED groups whereas the effect of Personal Standards was largely accounted for by anxiety. Lastly, Chapter 7 addresses literature gap regarding perfectionism and disordered eating among individuals with a high body weight. Following PRISMA guidelines for scoping reviews, we found that while perfectionism had no direct association with BMI, Concern over Mistakes in particular was associated with disordered eating across studies.
Taken together, these findings highlight the robust, central role of Concern over Mistakes as a transdiagnostic feature of eating pathology that transcends diagnostic categories, behavioural presentations, and body weights. The consistent centrality of non-eating related symptoms across network studies challenges the assumption that EDs are defined primarily by their behavioural expression, as current diagnostic classification suggests. Our results, together with a growing body of literature, point towards a cognitive-affective and temperament-informed framework for understanding, classifying, and treating these conditions.
Keywords: Eating Disorders; Perfectionism; Network Analysis
Publications
The papers produced for this thesis by associated papers are:
- Delaquis, C. P., Godart, N. T., EVHAN Group, Fatséas, M., & Berthoz, S. (2023). Cognitive and Interpersonal Factors in Adolescent Inpatients with Anorexia Nervosa: A Network Analysis, Children, 10(4), 730. https://doi.org/10.3390/children10040730
- Delaquis, C. P., Godart, N., Barry, C., Ringuenet, D., Maria, A. S., Nicolas, I., & Berthoz, S. (2024). Perfectionism, Self-Esteem and Affective Symptoms in Anorexia Nervosa: A Network Analysis of French Adolescent and Adult Inpatients, Journal of Clinical Psychology, 80(8), 1852–1875. https://doi.org/10.1002/jclp.23698
- Delaquis, C. P., Brown, Y., Spirou, D., Matthews, R., Raman, J., & Berthoz, S. (2026). The Interplay Between Cognitive-Behavioural and -Interpersonal Factors in Disordered Eating: A Network Analysis.
- Delaquis, C. P., Brown, Y., Spirou, D., Matthews, R., Raman, J., & Berthoz, S. (2026). Concern over Mistakes and Personal Standards Across Transdiagnostic Eating Disorder Behavioural Presentations.
- Delaquis, C. P., Brown, Y., Spirou, D., Matthews, R., Raman, J., & Berthoz, S. (2026). Perfectionism in Overweight and Obesity: A Scoping Review. Obesity Reviews, e70162. https://doi.org/10.1111/obr.70162
Papers included in the appendix to complement the results discussed in the current thesis:
- Cuerva, K., Spirou, D., Cuerva, A., Delaquis, C. P, & Raman, J. (2024). Perspectives and preliminary experiences of psychedelics for the treatment of eating disorders: A systematic scoping review, European Eating Disorders Review, 32(5), 980–1001. https://doi.org/10.1002/erv.3101
- Delaquis, C. P*., Spirou, D*., Brown, Y., Wood, K., Smith, E., Raman, J., & Berthoz, S. (2025, March 28). A Network Analysis of Disordered Eating and Emotional Dimensions Among Individuals with a High Body Mass Index. PsyArXiv. https://doi.org/10.31234/osf.io/dy247_v1 (*equal contributors)
Jury
- Mme BERTHOZ Sylvie – Chargée de recherche, INSERM – Directrice de thèse
Mme GRALL-BRONNEC Marie – Professeure des universités – praticienne hospitalière, Faculté de Médecine de Nantes et CHU de Nantes – Rapportrice
M CARRÉ Arnaud – Professeur des universités, Université Savoie Mont Blanc – Rapporteur
Mme ROEFS Anne – Full professor, Maastricht University – Présidente
Invited member : Mme GRYNBERG Delphine – Professeure des universités,Université de Lille – Invitée