A Week in the Life of a Postdoctoral Fellow at the UNC Center of Excellence for Eating Disorders…

Often, when I tell people I’m a postdoctoral fellow with the Center of Excellence for Eating Disorders at UNC, I get a confused look. Most are not familiar with the job title of a ‘postdoctoral fellow’ and have no clue what this job would entail. This question inspired me to write this post. First, to answer the question what exactly a postdoctoral fellow does, and second, to describe all the different activities that are happening here within the eating disorders program.

The UNC Center of Excellence for Eating Disorders has had a NIH training fellowship grant funded for six continuous years, under the direction of Dr. Cynthia Bulik. This training fellowship funds postdoctoral fellows for two years to obtain intensive research training in eating disorders. This training grant was the first funded research training fellowship in eating disorders in the United States. So what exactly does a postdoctoral fellow do? Well, since this is an intensive research training program, a majority of our time is spent conducting research. However, as many of the postdoctoral fellows have been clinicians, we spend some of our time doing clinical work. The best way to describe the life of a postdoctoral fellow is to share a typical week’s schedule. Below, I discuss all the different activities that I am involved with during a sample week!

One of my main duties as a postdoctoral fellow is to coordinate the “Genetics of Anorexia Nervosa (GCAN)” study (http://www.med.unc.edu/psych/eatingdisorders/research%20eating%20disorders/anorexia-studies/gcan). This study is a Wellcome Trust funded grant to conduct a genomewide association on over 4000 DNA samples from individuals with a lifetime history of anorexia nervosa. This project involves collaborations with over 16 countries. My duties as a project coordinator mostly include participant recruitment and assessments. We are currently recruiting individuals seeking treatment within our program and community members who have a current or past history of anorexia nervosa.

Another one of my main duties is to conduct assessments for our clinical research studies, which currently includes CBT4BN (http://www.med.unc.edu/psych/eatingdisorders/research%20eating%20disorders/bulimia-studies) and UCAN (http://www.med.unc.edu/psych/eatingdisorders/research%20eating%20disorders/anorexia-studies/ucan-uniting-couples-in-the-treatment-of-anorexia-nervosa). CBT4BN is a comparison for face-to-face and Internet-based cognitive behavior therapy for bulimia nervosa. UCAN is a treatment for anorexia nervosa and examines two comprehensive treatments integrating couples therapy into treatment. The assessments for these clinical research studies include baseline assessments, which assess whether an individual is eligible for the study, as well as follow-up assessments to assess changes in eating disorder symptoms after treatment.

A large proportion of my time is spent conducting my own research. Within the UNC Center of Excellence for Eating Disorders, there are ample opportunities to get involved with research. For us research geeks, it’s like being a kid in a candy store! For example, I have worked with the Swedish Twin Registry exploring the genetic overlap between bulimia nervosa and an alcohol use disorder, and the Swedish Twin Study of Child and Adolescent development exploring the genetic overlap between age at menarche and eating disorder symptoms (http://www.ncbi.nlm.nih.gov/pubmed/23084171) as well as the risk for eating disorder symptoms during puberty in boys and girls (http://www.ncbi.nlm.nih.gov/pubmed/22522282). I’m currently working on four projects that take up most of my research time during any given week. First, I’m exploring the heritability of muscle and height dissatisfaction in adolescent boys and the associations between this dissatisfaction and externalizing behaviors. Second, I’m collaborating with Dr. Cristin Runfola, another postdoctoral fellow, on a review paper of the presentation of eating disorders in men. Third, I’m examining the association between eating disorder symptoms in women during midlife and reproductive hormones. Finally, I’m collaborating with Dr. Kim Brownley and exploring the association between appetite hormones during pregnancy and the development of postpartum depression.

Finally, because I am a clinical psychologist, I spend a few hours a week involved with our clinical program. I currently conduct outpatient therapy with individuals with an eating disorder and co-lead a group on our partial hospitalization program. In the past, I’ve also conducted individual therapy on our inpatient and partial program and co-led outpatient therapy groups.

In sum, I’d have to say being a postdoctoral fellow with the UNC Center of Excellence for Eating Disorders and getting to work with Dr. Bulik has provided with me so many amazing opportunities that will surely guide me in my future endeavors as a researcher and a clinician. One of the major perks of being a postdoctoral fellow is the flexibility in the activities in which you can be involved, and the major perk of being a postdoctoral fellow here is the massive amount of activities that are available!

By: Dr. Jessica Baker

Read Full Post »

24TH ANNUAL WALK FOR HOPE: Instilling hope in others one step at a time

Last Sunday, the UNC Eating Disorders Program clinical and research team members walked amongst over 4,000 parents, children, siblings, and friends at the 24^th Annual Walk for Hope, creating what appeared to be an ocean of blue flooding the streets of Raleigh. Cars honked and teenagers cheered as walkers joined together for one cause: to support those affected by mental illness and to raise money for prevention and treatment.

The event began with the national anthem and the release of six, white homing doves, freed into the sky to instill new hope in those suffering from mental illness that recovery and liberation from the disease are possible.

Walkers then embarked on a stroll that was nothing short of picturesque—the sky was clear, the sun beamed, and hearty green foliage bounded the streets. Smiling walkers appeared engaged in light-hearted conversation, and UNC team members chatted ardently about exciting upcoming research projects and treatment programs. Money raised from this annual walk has supported ongoing research on the genetics of eating disorders, including studies stemming from the Swedish Twin Registry and the Genetic Consortium for Anorexia Nervosa (GCAN), which includes collaborations between UNC and 16 other countries. Kelty Bailey, Instructor for the UNC XDS Program at the Wellness and Recovery Center, wrote, “It’s always feels great to raise money that comes directly back to my clinic and my colleagues’ labs.”

This year, the UNC Department of Psychiatry team broke its goal of raising over $6,500 for the Foundation of Hope. Raffle prizes and top fundraisers were celebrated and awarded with $75-$500 gift certificates and a 42’’ Television & Stereo Home Theatre system.

All participants were also rewarded with an array of delicious Angus Barn food, including hamburgers, vegetarian chili, cole slaw, and double chocolate chip cookies (yum!). Adults danced and sang along to live music, while children jumped jubilantly in inflatable bounce houses. Dr. Jennifer Richards, Medical Director of the UNC Eating Disorders inpatient unit is pictured left with her husband, Charles, and oldest daughter, Riley.

This event is definitely worth experiencing. If you missed it this year, you can still donate or join us next year at the 25^th Annual Walk for Hope! Next year’s goal is to collectively raise a dollar for every one of the 13,500 steps we took on our 6 mile walk for hope this year!

The Foundation of Hope for Research and Treatment of Mental Illness is a 501 (c)(3) non-profit organization raising money for mental illness research http://www.walkforhope.com.

2011 Picture Gallery: http://www.walkforhope.com/gallery.aspx

By: Dr. Cristin Runfola

Read Full Post »

2012 Eating Disorder Research Society Recap

The 2012 conference for the Eating Disorder Research Society (EDRS) was held from September 20-22 in Porto, Portugal, and several members of the Bulik lab were fortunate enough to attend and present. This year’s conference was a great opportunity for members of the worldwide scientific community to disseminate and discuss the field’s most leading-edge research in addition to enjoying all that Porto had to offer. Short paper sessions and poster presentation topics spanned from epidemiology, classification, and assessment (with an emphasis on DSM-5 and the changes it will bring about) to neuropsychology and treatment and prevention. Dr. Hans Hoek kicked off the conference with an opening lecture focused on the future of epidemiological research, and several other investigators presented their recent work including: Dr. James Mitchell (eating disorders after bariatric surgery) and Dr. Ruth Striegel (work productivity in obesity and binge eating). Both senior and junior investigators were present to contribute to discussion about the state of the field and the ways in which current efforts are moving us forward into the next generation of research. In this regard, it was a unique experience to witness the collaboration between scientists (particularly across disciplines) in an effort to further understand and better treat eating disorders. The closing session embodied the multidisciplinary nature of the field as UNC’s Dr. Patrick Sullivan gave a keynote on genetics in psychiatric disorders and how recent findings might be applied to eating disorders, particularly AN. UNC’s Dr. Bulik followed him with an update on the latest results from the Wellcome Trust-funded Genetic Consortium for Anorexia Nervosa study. Between the research presentations and the lively discussion at the conference dinner reception, the 2012 EDRS conference was a great success during which the field’s experts could advance current knowledge while enjoying the scenic beauty of Porto!

A list of presentations and posters from the UNC Group follows:

1. Bulik, C.M., Collier, D., Zeggini, E., Sullivan, P.F., Boraska, V., Genomewide Association Study for anorexia nervosa Consortium, WTCCC3 AN Consortium. “WTCCC3 and GCAN: A genomewide scan for anorexia nervosa.” Eating Disorders Research Society, Porto, Portugal (September, 2012).
2. Baker, J.H., Thornton, L.M., Runfola, C., Lichtenstein, P., Bulik, C.M. “Body Dissatisfaction in Adolescent Boys.” (Poster) Eating Disorder Research Society, Porto, Portugal (September, 2012).
3. Runfola, C.D., Von Holle, A., Peat, C.M., Gagne, D.A., Brownley, K.A., Hofmeier, S.M., Bulik, C.M. “Characteristics of women with body size satisfaction at midlife: Results of the gender and body image study” (GABI). (Poster) Eating Disorder Research Society, Porto, Portugal (September, 2012).
4. Trace, S.E., Thornton, L.M., Mazzeo, S.E., Bergin, J.E., Maxwell, M., Lichtenstein, P., Pedersen, N.L., Bulik, CM. “A comparison of personality characteristics, psychiatric comorbidity and stressful life events in monozygotic twins discordant for anorexia nervosa.” (Poster) Eating Disorder Research Society, Porto, Portugal (September, 2012).

By: Dr. Christine Peat

Read Full Post »

The Role of Genetics in Eating Disorders

A pervasive myth about eating disorders is that they are somehow caused by the fashion and entertainment industry promoting images of the “perfect” skinny body. Anorexia and bulimia nervosa have been trivialized as girls or women trying to achieve this ideal which has led to the false belief that these are simply disorders of choice. This belief has hampered our understanding of and empathy for people who suffer from eating disorders and fails to account for the fact that although just about every woman is exposed to this societal thin ideal, only a fraction of them develop eating disorders.

However, research over the past decade has revealed that genetics play a role in eating disorders. But what does that mean? Genetic research is also challenging to understand for families and sufferers. First off, we know that eating disorders do run in families. Relatives of individuals with anorexia nervosa are over 10 times more likely to have an eating disorder themselves. But, everyone with an eating disorder doesn’t necessarily have a relative with an eating disorder—and given the stigma that surrounds eating disorders—even if they did have a relative with an eating disorder, they might not know.

But, disorders or traits can run in families for two reasons. They can run in families because genes are involved and they are heritable. Or they can run in families because of modelling or exposure. If you see a family member dieting or binge eating when stressed, you might learn that behaviour and develop it yourself with nothing to do with your genes.

One way of teasing out genetic from environmental reasons for a trait or a disorder running in families is through large twin studies. We have studied several large twin cohorts—many having over 40,000 twin pairs. The beauty of these large twin studies is that they contain both identical and fraternal twins. Identical twins actually share 100% of their genes. For most intents and purposes, they are clones. Fraternal twins are no more genetically similar than regular siblings—they share 50% of their genes. They do however share the womb, and grow up at the same time, so their environment is more similar than siblings who are different ages. By documenting the frequency with which both members of identical twin pairs have the disorder in comparison to both members of fraternal twin pairs, you can estimate how heritable a disorder is. So if you find that both members of a large population of identical twins have anorexia about 50% of the time, but both members of fraternal twin pairs only both have the disorder about 20% of the time—that is a strong clue that genes play a role. We can then put numbers to those statistics. Studies that have used this approach reveal that genetic factors account for approximately 28% to 58% of an individual’s likelihood to develop anorexia. For bulimia, those numbers have ranged from 54% to 83% and for binge eating disorder about half of the liability is due to genetic factors.

Now that suggests that genes play a role, but since those estimates aren’t 100%, genes don’t explain the entire picture. Environment is not off the hook because the rest of the liability is due to environmental factors. Extreme dieting, a toxic food environment, pervasive dissatisfaction with shape and weight, and pressures to attain picture perfect body ideals all can lead an individual down a path of restricting, binge eating, extreme exercise, and other behaviors that can be the first signs of the slippery slope towards an eating disorder.

We do not yet know which genes influence eating disorders risk. UNC is leading a 17 country study—the Genetic Consortium for Anorexia Nervosa (GCAN) which is funded by the Wellcome Trust in the United Kingdom and locally by the Foundation of Hope (http://www.walkforhope.com/ ). We have collected DNA from over 4000 individuals with anorexia nervosa to conduct a genomewide association study. This allows us to scan the entire genome and look for differences between these people with anorexia nervosa and a matched control group of people without anorexia. We are looking forward to results from that study in the summer of 2011.

We are very interested in how learning about the genetic contribution to eating disorders influences how people think about eating disorders. Many parents and loved ones have reported that understanding that biology is involved has helped them have more compassion for people with eating disorders and helped them understand how challenging recovery can be. Many patients have felt relieved that people are no longer saying that their disorder is because of vanity or is just a choice. This information helps them understand themselves more. But just because genes are involved does not mean that recovery is not possible. Many people are comforted to know that it simply means that recovery requires an uphill battle against your biology. Whereas for some people quitting smoking requires an uphill battle against their liability to become dependent on nicotine—for people with eating disorders, this can mean fighting against the urge to binge or fighting against the urge to restrict. Recovery is possible regardless of your genotype.

This biological understanding can help us all break through the stigma that has surrounded eating disorders. We support fighting stigma with science at every turn. The more we can learn about the causes of all eating disorders—binge eating disorder, bulimia nervosa, and anorexia nervosa, the more effective we will be at ridding the world of false myths and developing effective treatment and prevention strategies.

~ Cynthia M. Bulik, PhD & Jessica Baker, PhD

Read Full Post »

Since 2007, the University of North Carolina Eating Disorders Program has led a world effort to unite clinicians and researchers around the world in an effort to identify genes that may influence risk for eating disorders. This has resulted in the Genetic Consortium for Anorexia Nervosa (GCAN) which currently consists of researchers and clinicians from 16 countries around the world. Together with researcher from Kings College London, the UNC program has been honored to receive a grant from the Wellcome Trust (WTCCC3) to conduct genomewide association on over 4000 DNA samples from individuals with anorexia nervosa. All members of the consortium are gathering information about eating disorders course and genetic material (DNA) from any individual who currently has or has had an eating disorder in the past. This world-wide effort is inviting every person with current or past anorexia nervosa to take the time to roll up their sleeves and help us figure out the cause of eating disorders.

Call Colie Taico today at 919-843-9207 or her at ctaico@med.unc.edu  if you are interested in donating your blood to help us unlock the genetic code of eating disorders.

Read Full Post »