(PS5-50) Eating Disorder Symptoms, Avoidant/Restrictive Food Intake Disorder Symptoms, and Emotion Dysregulation among Adolescents: Multi-Time-Point Network Analysis

Avoidant/restrictive food intake disorder (ARFID), first recognized in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), involves restrictive eating behaviors leading to weight loss, nutritional deficiencies, supplement dependence, and/or psychosocial impairment. Despite its prevalence in Western societies, little is known about ARFID in non-Western contexts like Iran. One study found that 6–46% of Iranian adolescents reported ARFID symptoms, which are correlated with eating disorder (ED) symptoms common in Iran, where 17–19% of the non-clinical population exhibits clinically significant disordered eating. ED symptoms also co-occur with psychiatric conditions like depression and anxiety, yet factors such as emotion dysregulation remain understudied. While traditional approaches view psychopathology as stemming from a latent variable, network theory offers a new perspective, emphasizing symptom interactions. Though some Iranian studies have applied network theory to ED and psychological symptoms, they are all cross-sectional, highlighting the need for longitudinal research to examine temporal relationships. Therefore, this study aimed to examine the relation among ED symptoms, ARFID symptoms, and emotion dysregulation using a network approach over time. Thus, participants (N=1,243) were recruited virtually and completed measures assessing ED symptoms, ARFID symptoms, and emotion dysregulation at three time points (baseline, one month, three months). We used network analysis to identify influential symptoms and key connections across temporal, contemporaneous, and between-subject networks, highlighting predictors and bridging symptoms driving ED symptoms, ARFID symptoms (i.e., picky eating, appetite, fear), and emotion dysregulation facets (i.e., lack of emotional clarity, difficulties engaging in goal-directed behavior, impulsive control difficulties, limited access to effective emotion regulations strategies, nonacceptance of emotional responses). We found that in the temporal network, non-acceptance exhibited the highest In-Expected Influence, indicating that it was the most influenced node by other variables, while strategies demonstrated the highest Out-Expected Influence, making it the strongest predictor of changes in other nodes over time. In both the contemporaneous and between-subject networks, strategies emerged as the most influential node. Regarding bridge centrality, we found that binge eating (BE) had the highest Bridge Expected Influence (BEI1 and BEI2) in the temporal network, fear showed the highest BEI1 and BEI2 in the contemporaneous network, and both appetite and fear demonstrated the highest BEI1 and BEI2 in the between-subject network. Targeting non-acceptance and strategies is crucial in treating eating disorders, as they are central to symptom influence and change. Additionally, addressing binge eating key bridging symptom—can improve treatment by targeting both core and interconnected symptoms. This underscores the value of network-based approaches in intervention design.