Research Foci
Historically, males have been understudied in the area of disordered eating. We know there are sex differences in normal brain development, but it is unclear how restrictive eating affects this process and whether or not restrictive eating affects brain development differently in males compared to females. Our research regularly includes males with eating disorders. In addition to potential differences in brain structure and function, we focus on how sex hormones impact the risk and/or onset of AN-R, and sex differences in executive functioning in adolescents with eating disorders. We also study sex differences in caregiver experience. Fathers are frequently neglected in research; we strive to include them and to understand the importance of fathers in understanding how best to treat eating disorders.
Anorexia nervosa is a biologically based disorder; however, research on the neurobiology of the illness remains in its infancy. Because the onset of AN (~12 years old) is during a period of significant brain development, it is important that we focus our understanding of the neurobiology of anorexia in adolescents. Our work in this area focuses primarily on the reward network and frontal parietal network and understanding how functional and structural connectivity may change with re-nourishment. We also have a growing interest in the role of sex hormones and inflammation on eating disorder onset and maintenance. An overarching goal of our research is to identify early risk biomarkers of a longer course of illness.
Executive functioning is an umbrella term that describes a set of skills related to controlling one's actions, emotions, and thoughts in order to plan and achieve goals. Executive functioning continues to develop during adolescence. However, it is unknown how severe malnutrition may impact the development of different facets of executive functioning. In adults with eating disorders, set-shifting ability (also called cognitive flexibility) and central coherence have received significant attention as putative endophenotypes. Not only do adults demonstrate a relative inefficiency in these domains while acutely ill, they continue to demonstrate inefficiencies after re-nourishment. In adolescents, these impairments have not been as consistently observed - leading to the hypotheses that inefficiencies in executive functioning may be either risk markers for a longer course of illness or a scar of the disorder. Our work focuses on understanding the impact of anorexia nervosa and malnutrition on executive functioning in adolescents over time, how inefficiencies in executive functioning interact with social cognitive difficulties (e.g., alexithymia) and harm avoidance, and sex differences in executive functioning.
Treating anorexia nervosa involves a multidisciplinary approach. The current gold standard is Family Based Treatment; yet not adolescents reach remission by the end of treatment. We need to develop new treatments, and/or augment current treatments. Ideally, research into the neurobiology of eating disorders will help us identify those at risk of having a more chronic course of illness – allowing us to develop treatments specifically for this population. The end goal would be have precision treatments for adolescents with eating disorders and prevent these illness from lasting into adulthood.
In addition to Family Based Treatment, our research includes a focus on the use of Cognitive Remediation Therapy and Acceptance and Commitment Therapy (ACT) for the treatment of eating disorders. Cognitive Remediation Therapy (CRT) focuses on strengthening cognitive flexibility and the ability to engage in big picture thinking. ACT fosters acceptance of undesired thoughts and feelings and encourages behavior change in line with one’s values in the presence of these private events.
In addition to treatment for eating disorders, TRG collaborates with other researchers on the use of health coaching to increase health related behavioral change. The health coaching programs developed by Dr. Timko involve the use of Acceptance and Commitment Therapy and Motivational Interviewing. TRG continues to explore ways in which ACT-informed health coaching can be used to increase access to health care and improve outcomes.
Pervasive myths suggest that eating disorders affect only people who look or behave a certain way. However, current evidence affirms that eating disorders actually exist in people of all body sizes, sexes, genders, races, and ethnicities. Not only do these myths falsely imply that eating disorders affect only a small number of people, but they actively cause harm by implying that someone who does not meet this standard could not have an eating disorder. This exacerbates already existing disparities between youth with marginalized identities and their peers. Our work aims to broaden healthcare professionals’ understanding of eating disorder presentations, minimize stigma experienced by patients of higher weights, and increase the accuracy of screening tools that are currently employed in practice.