Typology of patients with behavioral addictions or eating disorders during a one-year period of care: Exploring similarities of trajectory using growth mixture modeling coupled with latent class analysis

Abstract

Objectives: Addictions are not restricted to substance-use disorders, and it is now widely recognized that they also include behavioral addictions. Certain individuals with eating disorders also experiment their disorder as an addiction. The objective was to identify typologies of patients presenting with various behavioral addictions or eating disorders according to their evolution within the framework of care, and to specify the factors associated with the differential clinical trajectories.

Methods: We included 302 patients presenting with problem gambling, sexual addiction, compulsive buying, excessive videogame use or eating disorders. The patients completed a multiaxial assessment through a face-to-face structured interview and self-administered questionnaires, including sociodemographic and addiction-related characteristics, psychiatric and addictive comorbidities and several psychological characteristics. The assessment was performed at inclusion and then repeated after 6 and 12 months. The statistical analysis included a combination of growth mixture models and latent class analysis.

Results: We identified five classes of patients with different profiles related to their trajectories during a one-year period of specialized care: "complex patients", "patients with impulsive psychological functioning", "patients with cooperative psychological functioning", "patients with immature psychological functioning," and "patients with resilient psychological functioning".

Conclusions: The typology obtained brings interesting findings to propose patient-centered care strategies adapted to these disorders. Because the typology was independent from the type of disorder, it supports the general concept of behavioral addictions, and the similarities between eating disorders and behavioral addictions. The relevance of this model should be further examined in future studies.

Fig 1. Diagram schematically describing the strategy of the statistical analyses.

Caption: Growth Mixture Model (GMM): - x is the first variable used for the GMM. - traj1 and traj2 represent the different trajectories obtained after the GMM analysis for the variable x. - x₁, x₂, etc. represent the different assignment probabilities associated with each trajectory for the variable x. Change indicator: - change1 (0–0): the variable is absent at T1 and at T3. - change2 (1–0): the variable is present at T1 and absent at T3. - change3 (0–1): the variable is absent at T1 and present at T3. - change4 (1–1): the variable is present at T1 and at T3.

Fig 2. Schematic representation of the five types of patients with behavioral addictions or eating disorders.

(+) High level of the characteristic (relative to the other classes). (-) Low level of the characteristic (relative to the other classes). The (+) and (-) have been positioned to indicate a high level of psychopathology on the right column and a low level on the left column. For example, patients with impulsive psychological functioning have a high capacity to achieve a one-month period of abstinence, which was associated with a low level of psychopathology, but a low capacity to maintain abstinence (low duration), which was associated with a high level of psychopathology. Patients with complex psychological functioning presented with the highest severity, the highest disorder-related damage, the highest level of psychiatric and addictive comorbidity, the highest suicidal risk, the highest level of impulsivity, and the lowest capacity to achieve a one-month period of abstinence, giving a multiple-psychopathological profile.