5 - (IOP 34) It's Complicated: Personalized Symptom Models of Eating Disorder and OCD Comorbidity

Introduction: Eating disorders (EDs) and obsessive-compulsive disorder (OCD) are highly comorbid, but factors underlying this relationship are not well understood. Cross-sectional comorbidity models of ED and OCD symptoms identified perfectionism and difficulty controlling thoughts as shared symptoms. However, these models are based on averages and fail to account for the heterogeneity of individual presentations. Idiographic network analysis uses ecological momentary data to create personalized symptoms profiles and can illustrate how the nuanced relationship between ED and OCD is maintained on individual level, which can inform precision interventions.

Methods: The current study modeled 38 individual networks in individuals with both EDs and OCD diagnoses. Participants completed surveys of ED and OCD symptoms four times a day for 30 days. Two OCD symptoms (obsessions and compulsions) and the top four endorsed ED symptoms for each individual were included in each network (a total of six symptoms). We identified symptoms with the highest centrality index (i.e., most interconnected symptom) and symptom pathways between ED and OCD symptoms.

Results: The individual comorbidity networks were highly heterogeneous, and no network had the same six symptoms. OCD obsessions and compulsions were the most central symptoms in 37% of the networks. Body checking, compulsive exercise, and disliking how one’s body looks were the most common ED symptoms connected to compulsions. We described the detailed symptom profiles of three individuals. Participant 1’s most central symptom was obsessions, which were connected to eating rules and worry about eating. Participant 2’s most central symptom was compulsions, which was connected to obsessions and excessive exercise. Participant 3’s most central symptom was body checking, connected to both obsessions and compulsions.

Conclusions: Findings demonstrated the feasibility of creating individual ED-OCD comorbidity models that illustrate the way symptoms of both disorders interact and maintain each other. Each of the 38 participants had unique symptom profiles and ED-OCD symptom pathways, which emphasizes the need for personalized interventions. Interventions targeting these pathways (e.g., ritual prevention for body checking and OCD compulsions for Participant 3) can help address both disorders simultaneously.