Bench to Bedside
Ann Haynos, Ph.D., Department of Psychology
When Ann Haynos was a teenager, she noticed a disturbing trend. At her all-girls high school, many students struggled with harmful eating habits. “About 10% of my graduating class had eating disorders,” said Haynos, an assistant professor in the Department of Psychology. “Being around people with various experiences of disordered eating made me wonder, how do people get caught in these disorders, and why can’t they get out?” Today, Haynos researches eating disorders and behavioral decision-making processes with the goal of improving outcomes for patients.
What was it about this topic that interested you?
One thing that is really striking with eating disorders is how difficult it is to break the patterns that we see. There is a lot of cycling through in-patient units and other types of treatment centers: Things get much better, then the patient goes back to their life and struggles to implement what they learned. People really want to recover, so it’s not a motivation issue, but there is something in their brain that makes it difficult to keep eating in the way they need to. The illness is really sticky, and people get stuck repeating the same patterns of eating disorder behaviors over and over again, even though they know it is harming them.
You use a multimethod approach in your research, which you describe as founded in a “bench-to-bedside philosophy.” Can you explain what that means?
When I started working in the field, I was interested in developing and adapting treatments for eating disorders, and I learned very quickly that we need to know much more in order to treat them. I began to explore neuroscience, and I started using brain imaging and cognitive tests to understand what is going on in the brain that keeps people in those tricky patterns. There are plenty of people doing treatment research and plenty of people doing neuroscience research, but they are not regularly talking to one another. I was passionate about creating a lab that unites those two goals: have active research studies to help understand how the thought processes work, then incorporate those results into treatment.
What have you discovered so far? How can eating disorder treatments be improved?
I have found that people with anorexia have problems in the way that the brain processes rewards. The average person, when they interact with a friend or make money or eat a donut, for example, they experience this reward that is both felt subjectively – you feel good – and you can also see those patterns in the brain; the reward centers of your brain light up. For people with anorexia, we see that they actually don’t respond as well to those types of rewards. They do engage those reward centers of their brain when they look at a pair of running shoes or a thin body. So we know that something in the basic way that their brain processes what to pay attention to and what to care about in the world is different.
We’ve also realized that people with anorexia are very rigid in their thinking and decision-making. They will very quickly learn what they like and stick with it. From these findings, we’ve adapted a treatment called Positive Affect Treatment to target these types of rigid patterns of behavior that we found in our neuroscience. What that treatment involves is helping people with anorexia find joy in the everyday things in their life that we know that their brain doesn’t usually attend to. We also try to shrink the hold that the eating disorder has on them. One key way we promote that is by decreasing that sort of rigidity in rewards and encouraging people to have a much greater variety of pleasant activities and pleasant experiences in their life, and to really get out those ruts where they keep doing the same thing over and over again to make themselves feel better.
What would most people be surprised to know about eating disorders?
I always like to emphasize that eating disorders are very serious disorders. These are often debilitating disorders that really negatively impact people’s lives. Anorexia nervosa has the second-highest mortality rate of any psychological concern, preceded only by opioid use disorder.
The other thing that is important for people to know is that there is an eating disorder stereotype – skinny, white, affluent girls – but we’ve seen that many more people have eating disorders who are in normal- weight or higher-weight bodies than who are underweight. People of color, people at a wide range of socioeconomic statuses, and midlife and older people are also affected by eating disorders at much higher rates than a lot of people often realize. One thing my lab is increasingly passionate about is building a more inclusive research pipeline to ensure we are understanding and assisting all individuals struggling with these difficult and sometimes life-threatening illnesses.