Subjective experience of sensation in anorexia nervosa.


The nature of disturbance in body experience in anorexia nervosa (AN) remains poorly operationalized despite its prognostic significance. We examined the relationship of subjective reports of sensitivity to and behavioral avoidance of sensory experience (e.g., to touch, motion) to body image disturbance and temperament in adult women currently diagnosed with AN (n = 20), women with a prior history of AN who were weight restored (n = 15), and healthy controls with no eating disorder history (n = 24). Levels of sensitivity to sensation and attempts to avoid sensory experience were significantly higher in both clinical groups relative to healthy controls. Sensory sensitivity was associated with body image disturbance (r(56) = .51, p < .0001), indicating that body image disturbance increased with increased global sensitivity to sensation. Sensory sensitivity was also negatively and significantly correlated with lowest BMI (r(2) = -.32, p < .001), but not current BMI (r(2) = .03, p = .18), and to the temperament feature of harm avoidance in both clinical groups. We discuss how intervention strategies that address sensitization and habituation to somatic experience via conditioning exercises may provide a new manner in which to address body image disturbance in AN.





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Publication Info

Zucker, Nancy L, Rhonda M Merwin, Cynthia M Bulik, Ashley Moskovich, Jennifer E Wildes and Jennifer Groh (2013). Subjective experience of sensation in anorexia nervosa. Behaviour research and therapy, 51(6). pp. 256–265. 10.1016/j.brat.2013.01.010 Retrieved from

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Nancy Lee Zucker

Professor in Psychiatry and Behavioral Sciences

Our laboratory studies individuals who have difficulty detecting, interpreting, and/or using signals from their body to guide adaptive behavior towards themselves and their environment.  We explore how disruptions in these capacities contribute to psychosomatic disorders such as functional abdominal pain or anorexia nervosa and how the adaptive development of these capacities helps individuals to know themselves, trust themselves, and flourish.

Our primary populations of study are individuals struggling with eating disorders and feeding disorders of childhood: conditions that are sine quo non for dysregulation of basic motivational drives or conditions in which disruption in these processes may be more likely: such as the presence of pediatric pain. Several conditions are of particular focus due to the presence of profound deficits in interoception or/and integration of internal arousal: anorexia nervosa, a disorder notable for extreme, determined, rigid, and repetitive behaviors promoting malnourishment and the inability to use signals of interoception and proprioception in the service of goal-directed actions, Avoidant Restrictive Food Intake Disorder (ARFID), children with "sensory superpowers" who may be hypersensitive to somatic signals and external sensory features; and pediatric functional abdominal pain, children who may become afraid of their bodies' messages due to generalization of fear of pain to innocuous sensations. Study of children allows us to ask different questions about disorder etiology, maintenance, and course as we can minimize the impact of malnutrition on brain function and perhaps better characterize prior learning history. What we most passionate about is using this conceptualization to design and test novel treatments that enable individuals across the lifespan to feel safe in their bodies and to achieve this in a way that is fun.

Our parallel line of research examines how individuals’ sense others when they have difficulties sensing themselves. Increasing evidence suggests that we understand others via embodied enactments of our own experiences. These findings have profound implications for individuals who have dysfunction in the experience of their bodies as it suggests limited capacities to truly understand others’ experiences. By studying these processes in parallel, we hope to better understand how this interaction between sensing ourselves and others unfolds.


Rhonda M Merwin

Associate Professor in Psychiatry and Behavioral Sciences

Rhonda M. Merwin, PhD, is an Associate Professor in the Department of Psychiatry and Behavioral Sciences. Dr. Merwin completed her doctorate at the University of Mississippi and an NIH-sponsored postdoctoral fellowship in Behavioral Medicine at Duke University Medical Center before joining the Duke faculty in 2008. Dr. Merwin has expertise in eating disorders, Acceptance and Commitment Therapy (ACT), and psychological concerns in the management of Type 1 diabetes. She is 1 of 111 peer-reviewed ACT trainers worldwide and a Fellow and the President-Elect of the Association for Contextual Behavioral Science. Dr. Merwin is leading work to address eating disorders in type 1 diabetes, a dangerous comorbidity that disproportionately affects women. Her research is funded by the National Institutes of Health (e.g., NIDDK, NIMH) and the Juvenile Diabetes Research Foundation (JDRF), among others. She is the author of ACT for Anorexia: A Guide for Clinicians. Dr. Merwin directs the ACT in Context Laboratory, which focuses on the mechanisms and treatment of eating disorders, or more broadly, problems in living that arise from an adversarial relationship with the body or the body's cues, and/or difficulty reading and responding to internal cues to meet one's physical and emotional needs. Her treatment development work integrates digital and mobile technologies to increase treatment access, and for contextually sensitive assessment and intervention, with a focus on processes of change. Dr. Merwin directs the ACT at Duke program, a clinical, research and training program in ACT and process-based therapy, that includes a practicum for psychiatry residents, and psychology fellows and graduate students to receive in-depth training in ACT, as well as community consultation team for local providers and continuing education events. Dr. Merwin teaches a psychotherapy course for psychiatry residents in the School of Medicine. For more information about Dr. Merwin's research, educational and clinical activities, see


Ashley Ann Moskovich

Assistant Professor in Psychiatry and Behavioral Sciences

Dr. Moskovich is interested in the treatment of adolescent and adult eating disorders, anxiety disorders, and mood disorders using acceptance-based interventions, including Acceptance and Commitment Therapy.


Jennifer M. Groh

Professor of Psychology and Neuroscience

Research in my laboratory concerns how sensory and motor systems work together, and how neural representations play a combined role in sensorimotor and cognitive processing (embodied cognition).

Most of our work concerns the interactions between vision and hearing. We frequently perceive visual and auditory stimuli as being bound together if they seem likely to have arisen from a common source. That's why we tend not to notice that the speakers on TV sets or in movie theatres are located beside, and not behind, the screen. Research in my laboratory is devoted to investigating the question of how the brain coordinates the information arising from the ears and eyes. Our findings challenge the historical view of the brain's sensory processing as being automatic, autonomous, and immune from outside influence. We have recently established that neurons in the auditory pathway (inferior colliculus, auditory cortex) alter their responses to sound depending on where the eyes are pointing. This finding suggests that the different sensory pathways meddle in one another's supposedly private affairs, making their respective influences felt even at very early stages of processing. The process of bringing the signals from two different sensory pathways into a common frame of reference begins at a surprisingly early point along the primary sensory pathways.

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