A machine learning analysis of psychopathological features of Eating Disorders: a retrospective study

Graziella Orru, Mario Miniati, Ciro Conversano, Rebecca Ciacchini, Laura Palagini, Mauro Mauri, Angelo Gemignani


Background: The clinical presentation of Eating Disorders (EDs) is often characterized by a great phenotypic variability and by a substantial instability over time of diagnostic categories. For these reasons, it has been proposed a different approach to EDs, encompassing both their dimensional and categorical descriptions, in a lifetime perspective, namely the ‘Anorexic-Bulimic Spectrum’ (ABS). Here we report a retrospective study with the interview built and validated for the assessment of ABS signs and symptoms, the ‘Structured Clinical Interview for Anorexic-Bulimic Spectrum’ (SCI-ABS), administered together with the ‘Mood Spectrum Self Report’ (MOODS-SR), a questionnaire able to assess sub-threshold mood spectrum dysregulations often comorbid with EDs signs and symptoms.

The main aim of the study was twofold: to assess and better characterize clinical phenotypes of EDs; to highlight potential lifetime sub-threshold mood dysregulations that might occur comorbid with EDs, and that patients might consider relevant to their ‘subjective experience of illness’. In order to obtain these goals, we decided to utilize a machine learning analysis.

Methods: two groups were recruited and compared, namely patients with EDs (n=53) and healthy controls (HC) (n=54). Both groups underwent psychological testing with MOODS-SR and SCI-ABS.

Results: in discriminating and classifying EDs individuals from HC, machine learning classifiers obtained an accuracy higher than 70%. Based on all variables considered, the analysis revealed that SCI-ABS ‘Phobias’ domain (more in detail, ‘Weight Gain Phobia’ total score), the ‘Impairment and Insight’ item 5, (‘…your relationship with food was all you could think about?’) and the MOODS-SR item 154 (‘you were less sexually active than is typical for you?’) were the best psychological elements in discriminating EDs patients from HC (accuracy range: 72.90-86.92%). Given the large number of predictors, we run a supervised attributes selection procedure. The procedure yielded an accuracy of 90.65% in classifying EDs patients from HC.

Conclusions: the very high overall accuracy is indicative that the selected combinations of features capture the most important determinants in the discrimination of EDs patient’s vs HC. The items selected by the machine learning analysis confirmed that an extreme polarization of ideas on weight and food control characterize the cognitive asset of EDs patients.


Anorexia nervosa; Bulimia nervosa; Eating disorders; Clinical psychology; Machine learning.

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Ackard, D. M., Richter, S., Egan, A., Engel, S., & Cronemeyer, C. L. (2014). The meaning of (quality of) life in patients with eating disorders: A comparison of generic and disease‐specific measures across diagnosis and outcome. International Journal of Eating Disorders, 47(3), 259-267. https://doi.org/10.1002/eat.22193

Ágh, T., Kovács, G., Supina, D., Pawaskar, M., Herman, B. K., Vokó, Z., & Sheehan, D. V. (2016). A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating and Weight Disorders Studies on Anorexia, Bulimia and Obesity, 21(3), 353-364. https://doi.org/10.1007/s40519-016-0264-x

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry, 68(7), 724-731. https://doi.org/10.1001/archgenpsychiatry.2011.74

Baker, M. (2016). 1,500 scientists lift the lid on reproducibility. Nature News, 533(7604), 452. https://doi.org/10.1038/533452a

Bamford, B., & Sly, R. (2010). Exploring quality of life in the eating disorders. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 18(2), 147-153. https://doi.org/10.1002/erv.975

Bamford, B., Barras, C., Sly, R., Stiles‐Shields, C., Touyz, S., Le Grange, D., ... & Lacey, H. (2015). Eating disorder symptoms and quality of life: where should clinicians place their focus in severe and enduring anorexia nervosa?. International Journal of Eating Disorders, 48(1), 133-138. https://doi.org/10.1002/eat.22327

Bentley, C., Gratwick‐Sarll, K., Harrison, C., & Mond, J. (2015). Sex differences in psychosocial impairment associated with eating disorder features in adolescents: A school‐based study. International Journal of Eating Disorders, 48(6), 633-640. https://doi.org/10.1002/eat.22396

Borenstein, M., Cooper, H., Hedges, L., & Valentine, J. (2009). Effect sizes for continuous data. The handbook of research synthesis and meta-analysis, 2, 221-235. https://doi.org/10.1037/13621-006

Cassano G.B., Dell'Osso L., Frank E., Miniati M., Fagiolini A., Shear K., Pini S., Maser J. (1999). The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord., 54(3):319-28. https://doi.org/10.1016/s0165-0327(98)00158-x

Cassano, G.B., Miniati, M., Pini, S., Rotondo, A., Banti, S., Borri, C., Camilleri, V., Mauri, M. (2003). Six-month open trial of haloperidol as an adjunctive treatment for anorexia nervosa: a preliminary report. Int J Eat Disord., 33(2):172-7. https://doi.org/10.1002/eat.10130

Cohen, J. (1988). The effect size. Statistical Power Analysis for the Behavioral Sciences, 77-83. https://doi.org/10.4324/9780203771587

Cohen, W.W. (1995). Fast Effective Rule Induction. In: Twelfth International Conference on Machine Learning, 115-123, 1995. https://doi.org/10.5555/3091622.3091637

Coin, A., Najjar, M., Catanzaro, S., Orru, G., Sampietro, S., Sergi, G., et al. (2009). A retrospective pilot study on the development of cognitive, behavioral and functional disorders in a sample of patients with early dementia of Alzheimer type. Arch. Gerontol. Geriatr. 49(Suppl. 1), 35–38. https://doi.org/10.1016/j.archger.2009.09.010

de la Rie, S.M., Noordenbos, G. & van Furth, E.F. Quality of life and eating disorders. Qual Life Res 14, 1511–1521 (2005). https://doi.org/10.1007/s11136-005-0585-0

de Vos, J. A., LaMarre, A., Radstaak, M., Bijkerk, C. A., Bohlmeijer, E. T., & Westerhof, G. J. (2017). Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis. Journal of eating disorders, 5(1), 1-14. https://doi.org/10.1186/s40337-017-0164-0

Dell’Osso, L., Armani, A., Rucci, P., Frank, E., Fagiolini, A., Corretti, G., Shear, M.K., Grochocinski, V.J., Maser, J.D., Endicott, J., Cassano, G.B. (2002). Measuring mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr. Psychiatry. 43(1):69–73. https://doi.org/10.1053/comp.2002.29852

Fagiolini, A., Dell’Osso, L., Pini, S., Armani, A., Bouanani, S., Rucci, P., Cassano, G.B., Endicott, J., Maser, J., Shear, M.K., Grochocinski, V.J., Frank, E. (1999). Validity and reliability of a new instrument for assessing mood symptomatology: the structured clinical interview for mood spectrum (SCI-MOODS). Int J Methods Psychiatr Res., 8:71–81. https://doi.org/10.1002/mpr.58

Fairburn, C. G., & Walsh, B. T. (2002). Atypical eating disorders (eating disorder not otherwise specified). Eating disorders and obesity: A comprehensive handbook, 2, 171-177. https://dx.doi.org/10.1016%2Fj.brat.2004.06.011

Ferrarese, A., Sartori, G., Orrù, G., Frigo, A. C., Pelizzaro, F., Burra, P., & Senzolo, M. (2021). Machine Learning in Liver Transplantation: a tool for some unsolved questions?. Transplant International, 34(3), 398-411. https://doi.org/10.1111/tri.13818

Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402-1413. https://doi.org/10.1093/ajcn/nqy342

GoMdart N.T., Perdereau F., Rein Z., Berthoz S., Wallier J., Jeammet P., Flament M.F. (2007). Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord., 97(1–3):37–49. https://doi.org/10.1016/j.jad.2006.06.023

Grange, D. L., & Loeb, K. L. (2007). Early identification and treatment of eating disorders: prodrome to syndrome. Early Intervention in Psychiatry, 1(1), 27-39. https://doi.org/10.1111/j.1751-7893.2007.00007

Grisset, N. I., & Norvell, N. K. (1992). Perceived social support, social skills, and quality of relationships in bulimic women. Journal of consulting and clinical psychology, 60(2), 293. https://doi.org/10.1037/0022-006X.60.2.293

Grubb, H. J., Sellers, M. I., & Waligroski, K. (1993). Factors related to depression and eating disorders: Self-esteem, body image, and attractiveness. Psychological Reports, 72(3), 1003-1010. https://doi.org/10.2466/pr0.1993.72.3.1003

Hall, M. A. (1998). Correlation-based feature subset selection for machine learning. Thesis submitted in partial fulfillment of the requirements of the degree of Doctor of Philosophy at the University of Waikato. https://www.cs.waikato.ac.nz/~mhall/thesis.pdf

Hall, M., Frank, E., Holmes, G., Pfahringer, B., Reutemann, P., & Witten, I. H. (2009). The WEKA data mining software: an update. ACM SIGKDD explorations newsletter, 11(1), 10-18. https://doi.org/10.1145/1656274.1656278

Hasan, H. A., Najm, L., Zaurub, S., Jami, F., Javadi, F., Deeb, L. A., ... & Radwan, H. (2018). Eating disorders and body image concerns as influenced by family and media among university students in Sharjah, UAE. Asia Pacific Journal of Clinical Nutrition, 27(3), 695-700. https://doi.org/10.6133/apjcn.062017.10

Hay, P. (2003). Quality of life and bulimic eating disorder behaviors: Findings from a community‐based sample. International Journal of Eating Disorders, 33(4), 434-442. https://doi.org/10.1002/eat.10162

Ioannou, M., Dellepiane, M., Benvenuti, A., Feloukatzis, K., Skondra, N., Dell'Osso, L., & Steingrímsson, S. (2016). Swedish version of Mood Spectrum Self-Report Questionnaire: Psychometric properties of lifetime and last-week version. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 12, 14. https://dx.doi.org/10.2174%2F1745017901612010014

Ioannou, M., Dellepiane, M., Benvenuti, A., Feloukatzis, K., Skondra, N., & Steingrimsson, S. (2016). Psychometric evaluation of a 33-item subset of MOODS-SR for distinguishing bipolar disorder. European Psychiatry, 33(S1), S223-S223. https://doi.org/10.1016/j.eurpsy.2016.01.548

Johnson, J. G., Spitzer, R. L., & Williams, J. B. W. (2001). Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients. Psychological Medicine, 31,1455–1466. https://doi.org/10.1017/s0033291701004640

Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Current Opinion in Psychiatry, 29 (6), 340-345. https://doi.org/10.1097/yco.0000000000000278

Kohavi, R., & John, G. H. (1997). Wrappers for feature subset selection. Artificial intelligence, 97(1-2), 273-324. https://doi.org/10.1016/S0004-3702(97)00043-X

Laporta-Herrero, I., Jáuregui-Lobera, I., Barajas-Iglesias, B., & Santed-Germán, M. Á. (2018). Body dissatisfaction in adolescents with eating disorders. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 23(3), 339-347. https://doi.org/10.1007/s40519-016-0353-x

Martino, G., Langher, V., Cazzato, V., & Vicario, C. M. (2019). Psychological factors as determinants of medical conditions. Frontiers in Psychology, 10, 2502. https://doi.org/10.3389/fpsyg.2019.02502

Mason, T. B., Wonderlich, S. A., Crosby, R. D., Engel, S. G., Mitchell, J. E., Crow, S. J., ... & Peterson, C. B. (2018). Associations among eating disorder behaviors and eating disorder quality of life in adult women with anorexia nervosa. Psychiatry Research, 267, 108-111. https://doi.org/10.1016/j.psychres.2018.05.077

Mauri M., Borri, C., Banti, S., Baldassari, S., Rucci, P., Cassano, G.B. (2002). The anorexic-bulimic spectrum in patients with eating disorders, mood disorders and controls. Ital J Psychopathol 8:2. https://www.doi.org/10.32044/ijedo.2019.07

Mauri, M., Borri, C., Baldassari, S., Benvenuti, A., Cassano, G. B., Rucci, P., ... & Maser, J. D. (2000). Acceptability and psychometric properties of the Structured Clinical interview for Anorexic‐Bulimic Spectrum (SCI‐ABS). International Journal of Methods in Psychiatric Research, 9(2), 68-78. https://doi.org/10.1002/mpr.81

Mazza, C., Monaro, M., Orrù, G., Burla, F., Colasanti, M., Ferracuti, S., & Roma, P. (2019a). Introducing machine learning to detect personality faking-good in a male sample: a new model based on Minnesota multiphasic personality inventory-2 restructured form scales and reaction times. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00389

Mazza, C., Orrù, G., Burla, F., Monaro, M., Ferracuti, S., Colasanti, M., & Roma, P. (2019b). Indicators to distinguish symptom accentuators from symptom producers in individuals with a diagnosed adjustment disorder: A pilot study on inconsistency subtypes using SIMS and MMPI-2-RF. PloS One, 14(12). https://doi.org/10.1371/journal.pone.0227113

McElroy, S.L., Kotwal, R., Keck, P.E. Jr, Akiskal, H.S. (2005). Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations? J Affect Disord., 86(2–3):107–127. https://doi.org/10.1016/j.jad.2004.11.008

Merlo, E. M. (2019). Opinion Article: The role of psychological features in chronic diseases, advancements and perspectives. Mediterranean Journal of Clinical Psychology, 7(3). https://doi.org/10.6092/2282-1619/2019.7.2341

Milos, G., Spindler, A., Schnyder, U., & Fairburn, C. G. (2005). Instability of eating disorder diagnoses: prospective study. The British Journal of Psychiatry, 187(6), 573-578. https://doi.org/10.1192/bjp.187.6.573

Miniati, M., Benvenuti, A., Bologna, E., Maglio, A., Cotugno, B., Massimetti, G., Calugi, S., Mauri, M., Dell'Osso, L. (2018a). Mood spectrum comorbidity in patients with anorexia and bulimia nervosa. Eat Weight Disord, 23(3):305-311. https://doi.org/10.1007/s40519-016-0333-1

Miniati, M., Callari, A., Maglio, A., Calugi, S. (2018b). Interpersonal psychotherapy for eating disorders: current perspectives. Psychol Res Behav Manag., 5;11:353-369. https://doi.org/10.2147/PRBM.S120584

Miniati, M., Calugi, S., Savino, M., Mauri, M. (2019). The Anorexia-Bulimia Spectrum: an Integrated Approach to Eating and Feeding Disorders. Italian J Eat Dis & Obes. (IJEDO). https://doi.org/10.32044/ijedo.2019.0

Mitchison, D., Hay, P., Slewa-Younan, S., & Mond, J. (2012). Time trends in population prevalence of eating disorder behaviors and their relationship to quality of life. PloS One, 7(11), e48450. https://doi.org/10.1371/journal.pone.0048450

Mitchison, D., Morin, A., Mond, J., Slewa-Younan, S., & Hay, P. (2015). The bidirectional relationship between quality of life and eating disorder symptoms: A 9-year community-based study of Australian women. PLoS One, 10(3), e0120591. https://doi.org/10.1371/journal.pone.0120591

Mula, M., Pini, S., Monteleone, P., Iazzetta, P., Preve, M., Tortorella, A., ... & Maj, M. (2008). Different temperament and character dimensions correlate with panic disorder comorbidity in bipolar disorder and unipolar depression. Journal of Anxiety Disorders, 22(8), 1421-1426. https://doi.org/10.1016/j.janxdis.2008.02.004

Orrù, G., Gemignani, A., Ciacchini, R., Bazzichi, L., & Conversano, C. (2020a). Machine Learning Increases Diagnosticity in Psychometric Evaluation of Alexithymia in Fibromyalgia. Frontiers in Medicine, 6, 319. https://doi.org/10.3389/fmed.2019.00319

Orrù, G., Monaro, M., Conversano, C., Gemignani, A., & Sartori, G. (2020b). Machine learning in psychometrics and psychological research. Frontiers in Psychology, 10, 2970. https://doi.org/10.3389/fpsyg.2019.02970

Orrù, G., Pettersson-Yeo, W.,Marquand, A. F., Sartori, G., and Mechelli, A. (2012). Using support vector machine to identify imaging biomarkers of neurological and psychiatric disease: a critical review. Neurosci. Biobehav. Rev. 36, 1140-1152. https://doi.org/10.1016/j.neubiorev.2012.01.004

Orrù, G., Sampietro, S., Catanzaro, S., Girardi, A., Najjar, M., Giantin, V., et al. (2009). Serial position effect in a free recall task: differences between probable dementia of Alzheimer type (PDAT), vascular (VaD) and mixed etiology dementia (MED). Arch. Gerontol. Geriatr. 49 (Suppl. 1), 207–210. https://doi.org/10.1016/S0887-6177(99)00014-1

Pace, G., Orrù, G., Monaro, M., Gnoato, F., Vitaliani, R., ... & Sartori, G. (2019). Malingering detection of cognitive impairment with the B test is boosted using machine learning. Frontiers in Psychology, 10, 1650. https://doi.org/10.3389/fpsyg.2019.01650

Palagini, L., Carmassi, C., Conversano, C., Gesi, C., Bazzichi, L., Giacomelli, C., & Dell’Osso, L. (2016). Transdiagnostic factors across fibromyalgia and mental disorders: sleep disturbances may play a key role. A clinical review. Clin Exp Rheumatol, 34(96), S00-S00. https://www.ncbi.nlm.nih.gov/pubmed/27157399

Piccinni, A., Origlia, N., Veltri, A., Vizzaccaro, C., Marazziti, D., Catena-Dell'Osso, M., ... & Dell'Osso, L. (2012). Plasma β-amyloid peptides levels: a pilot study in bipolar depressed patients. Journal of Affective Disorders, 138(1-2), 160-164. https://doi.org/10.1016/j.jad.2011.12.042

Rikani, A. A., Choudhry, Z., Choudhry, A. M., Ikram, H., Asghar, M. W., Kajal, D., ... & Mobassarah, N. J. (2013). A critique of the literature on etiology of eating disorders. Annals of Neurosciences, 20(4), 157. https://dx.doi.org/10.5214%2Fans.0972.7531.200409

Sartori, G., Zangrossi, A., Orrù, G., & Monaro, M. (2017). Detection of malingering in psychic damage ascertainment. P5 Medicine and Justice (pp. 330-341). Springer, Cham. https://doi.org/10.1007/978-3-319-67092-8_21

Sauro, C. L., Ravaldi, C., Cabras, P. L., Faravelli, C., & Ricca, V. (2008). Stress, hypothalamic-pituitary-adrenal axis and eating disorders. Neuropsychobiology, 57(3), 95-115. https://doi.org/10.1159/000138912

Schooler, J. W. (2014). Metascience could rescue the ‘replication crisis’. Nature, 515(7525), 9-9. https://doi.org/10.1038/515009a

Settineri, S., & Femminò, N. (2019). Science Communication in Clinical Psychology. Mediterranean Journal of Clinical Psychology, 7(1). https://doi.org/10.6092/2282-1619/2019.7.2142

Settineri, S., Merlo, E.M. (2019). MJCP and Clinical Psychology. Mediterranean Journal of Clinical Psychology, 7(3). https://doi.org/10.6092/2282-1619/2019.7.2346

Smink, F. R., Van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406-414. https://doi.org/10.1007/s11920-012-0282-y

Striegel-Moore, R. (1995). Psychological factors in the etiology of binge eating. Addictive Behaviors, 20(6), 713-723. https://doi.org/10.1016/0306-4603(95)00094-1

Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American Psychologist, 62(3), 181. https://doi.org/10.1037/0003-066x.62.3.181

Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714-723. https://doi.org/10.1001/archgenpsychiatry.2011.22

Swinbourne, J. M., & Touyz, S. W. (2007). The co‐morbidity of eating disorders and anxiety disorders: A review. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 15(4), 253-274. https://doi.org/10.1002/erv.784

Troop, N. A., Holbrey, A., Trowler, R., & Treasure, J. L. (1994). Ways of coping in women with eating disorders. Journal of Nervous and Mental Disease. https://doi.org/10.1097/00005053-199410000-00001

Veltri, A., Scarpellini, P., Piccinni, A., Conversano, C., Giacomelli, C., Bombardieri, S., ... & Dell’Osso, L. (2012). Methodological approach to depressive symptoms in fibromyalgia patients. Clin Exp Rheumatol, 30(Suppl 74), S136-42. https://pubmed.ncbi.nlm.nih.gov/23261013/

Wagner, A. F., Stefano, E. C., Cicero, D. C., Latner, J. D., & Mond, J. M. (2016). Eating disorder features and quality of life: Does gender matter?. Quality of Life Research, 25(10), 2603-2610. https://doi.org/10.1007/s11136-016-1283-9

Ward, Z. J., Rodriguez, P., Wright, D. R., Austin, S. B., & Long, M. W. (2019). Estimation of eating disorders prevalence by age and associations with mortality in a simulated nationally representative US cohort. JAMA network open, 2(10), e1912925-e1912925. https://doi.org/10.1001/jamanetworkopen.2019.12925

Wonderlich, S., Mitchell, J. E., Crosby, R. D., Myers, T. C., Kadlec, K., LaHaise, K., ... & Schander, L. (2012). Minimizing and treating chronicity in the eating disorders: a clinical overview. International Journal of Eating Disorders, 45(4), 467-475. https://doi.org/10.1002/eat.20978

Wu XY, Yin WQ, Sun HW, Yang SX, Li XY, Liu HQ. The association between disordered eating and health-related quality of life among children and adolescents: A systematic review of population-based studies. PLoS One;14(10). https://doi.org/10.1371/journal.pone.0222777

Yarkoni, T. (2019). The generalizability crisis. https://doi.org/10.31234/osf.io/jqw35

Yarkoni, T., & Westfall, J. (2017). Choosing prediction over explanation in psychology: Lessons from machine learning. Perspectives on Psychological Science, 12(6), 1100-1122. https://doi.org/10.1177/1745691617693393

Yau, Y. H., & Potenza, M. N. (2013). Stress and eating behaviors. Minerva Endocrinologica, 38(3), 255. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4214609/

DOI: https://doi.org/10.6092/2282-1619/mjcp-2670


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