Honors & Awards

  • Early Career Investigator Travel Fellowship, Academy of Eating Disorders (2010)
  • Feasibility of internet-delivered guided self-help for parents of adolescents with anorexia nervosa., Global Foundation for Eating Disorders (October 2013)

Boards, Advisory Committees, Professional Organizations

  • Board Member, National Association for Males with Eating Disorders (2014 - Present)
  • Co-Chair, Electronic Media Committee, Academy of Eating Disorders (2014 - Present)
  • Co-Chair, Males and Eating Disorders SIG, Academy of Eating Disorders (2012 - Present)
  • Chairman of the Board, Bodywhys, the National Eating Disorders Association of Ireland (2007 - 2007)

Professional Education

  • Postdoctoral Fellowship, Stanford University School of Medicine & American Psychiatric Association, DSM5 Field Trials (2011)
  • Postdoctoral Fellowship, Stanford University School of Medicine, Child and Adolescent Psychiatry, Eating Disorders (2008)

Research & Scholarship

Current Research and Scholarly Interests

As a scientist, I am interested in building an evidence base that informs the development, adoption and implementation of internet and mobile health behavior change applications in mental health care. Particularly exciting is the potential these technologies offer for individualized medicine and targeted prevention and/or treatment. To date I have pioneered the use of Massive Open Online Course (MOOC) platforms for clinical training in eating disorders and am testing it in an NIH funded trial. Early in my research career, I built the first Internet-delivered support group for people with Eating Disorders in Europe. Currently I am exploring the feasibility of offering internet-delivered guided self-help to parents of adolescents with anorexia nervosa.

Another line of my research has been understanding eating disorders among adolescent boys and young adult men.

Another speciality has been the neurocognitive profile of adolescents with anorexia nervosa and bulimic spectrum eating disorders. Our lab has pioneered this work with a view to elucidating the neurocognitive effect of length of illness on cognitive flexibility and central coherence.


All Publications

  • Central coherence in adolescents with bulimia nervosa spectrum eating disorders INTERNATIONAL JOURNAL OF EATING DISORDERS Darcy, A. M., Fitzpatrick, K. K., Manasse, S. M., Datta, N., Klabunde, M., Colborn, D., Aspen, V., Stiles-Shields, C., Labuschagne, Z., Le Grange, D., Lock, J. 2015; 48 (5): 487-493


    Weak central coherence-a tendency to process details at the expense of the gestalt-has been observed among adults with bulimia nervosa (BN) and is a potential candidate endophenotype for eating disorders (EDs). However, as BN behaviors typically onset during adolescence it is important to assess central coherence in this younger age group to determine whether the findings in adults are likely a result of BN or present earlier in the evolution of the disorder. This study examines whether the detail-oriented and fragmented cognitive inefficiency observed among adults with BN is observable among adolescents with shorter illness duration, relative to healthy controls.The Rey-Osterrieth Complex Figure Test (RCFT) was administered to a total of 47 adolescents with DSM5 BN, 42 with purging disorder (PD), and 25 healthy controls (HC). Performance on this measure was compared across the three groups.Those with BN and PD demonstrated significantly worse accuracy scores compared to controls in the copy and delayed recall condition with a moderate effect size. These findings were exacerbated when symptoms of BN increased.Poorer accuracy scores reflect a fragmented and piecemeal strategy that interferes with visual-spatial integration in BN spectrum disorders. This cognitive inefficiency likely contributes to broad difficulties in executive functioning in this population especially in the context of worsening bulimic symptoms. The findings of this study support the hypothesis that poor global integration may constitute a cognitive endophenotype for BN.

    View details for DOI 10.1002/eat.22340

    View details for Web of Science ID 000356684500006

  • Development and Evaluation of a Treatment Fidelity Instrument for Family-Based Treatment of Adolescent Anorexia Nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Forsberg, S., Fitzpatrick, K. K., Darcy, A., Aspen, V., Accurso, E. C., Bryson, S. W., Agras, S., Arnow, K. D., Le Grange, D., Lock, J. 2015; 48 (1): 91-99


    This study provides data on the psychometric properties of a newly developed measure of treatment fidelity in Family-Based Treatment (FBT) for adolescent anorexia nervosa (AN). The Family Therapy Fidelity and Adherence Check (FBT-FACT) was created to evaluate therapist adherence and competency on the core interventions in FBT.Participants were 45 adolescents and their families sampled from three randomized clinical trials evaluating treatment for AN. Trained fidelity raters evaluated 19 therapists across 90 early session recordings using the FBT-FACT. They also rated an additional 15 session 1 recordings of an alternate form of family therapy-Systemic Family Therapy for the purpose of evaluating discriminant validity of the FBT-FACT. The process of development and the psychometric properties of the FBT-FACT are presented.Overall fidelity ratings for each session demonstrated moderate to strong inter-rater agreement. Internal consistency of the measure was strong for sessions 1 and 2 and poor for session 3. Principal components analysis suggests sessions 1 and 2 are distinct interventions.The FBT-FACT demonstrates good reliability and validity as a measure of treatment fidelity in the early phase of FBT. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:91-99).

    View details for DOI 10.1002/eat.22337

    View details for Web of Science ID 000346768200013

  • Relapse From Remission at Two- to Four-Year Follow-Up in Two Treatments for Adolescent Anorexia Nervosa JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY le Grange, D., Lock, J., Accurso, E. C., Agras, W. S., Darcy, A., Forsberg, S., Bryson, S. W. 2014; 53 (11): 1162-1167
  • What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? Surgery for obesity and related diseases Robinson, A. H., Adler, S., Stevens, H. B., Darcy, A. M., Morton, J. M., Safer, D. L. 2014; 10 (4): 697-704


    Prior evidence indicates that predictors of weight loss outcomes after gastric bypass surgery fall within 5 domains: 1) presurgical factors, 2) postsurgical psychosocial variables (e.g., support group attendance), 3) postsurgical eating patterns, 4) postsurgical physical activity, and 5) follow-up at postsurgical clinic. However, little data exist on which specific behavioral predictors are most associated with successful outcomes (e.g.,≥50% excess weight loss) when considering the 5 domains simultaneously. The objective of this study was to specify the behavioral variables, and their respective cutoff points, most associated with successful weight loss outcomes.Signal detection analysis evaluated associations between 84 pre- and postsurgical behavioral variables (within the 5 domains) and successful weight loss at≥1 year in 274 postgastric bypass surgery patients.Successful weight loss was highest (92.6%) among those reporting dietary adherence of>3 on a 9-point scale (median = 5) who grazed no more than once-per-day. Among participants reporting dietary adherence<3 and grazing daily or less, success rates more than doubled when highest lifetime body mass index was<53.7 kg/m(2). Success rates also doubled for participants with dietary adherence = 3 if attending support groups. No variables from the physical activity or postsurgical follow-up domains were significant, nor were years since surgery. The overall model's sensitivity = .62, specificity = .92.To our knowledge, this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss. Such data may inform prospective study designs and postsurgical interventions.

    View details for DOI 10.1016/j.soard.2014.01.030

    View details for PubMedID 24913590

  • What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? SURGERY FOR OBESITY AND RELATED DISEASES Robinson, A. H., Adler, S., Stevens, H. B., Darcy, A. M., Morton, J. M., Safer, D. L. 2014; 10 (4): 697-704
  • Validation of a Six-Item Male Body Image Concerns Scale (MBICS) EATING DISORDERS Weisman, H. L., Patten, E., Montanez-Leaks, M., Yee, M., Darcy, A. M., Mazina, V., Zhang, A., Bailey, J. O., Jones, M., Trockel, M., Taylor, C. B. 2014; 22 (5): 420-434


    Elevated body image concerns may be a risk factor for eating disorders among males and contribute to a range of other mental health problems. This study tested a 6-item measure of general male body image concerns in two studies with adolescent males ages 14-18 (total N = 122). The measure showed strong convergent validity, scale score reliability, and test-retest reliability, and was significantly correlated with the number of episodes of binge eating in the past month. A short scale will relieve participant burden and provide a useful research tool for studies with males at risk for or with eating disorders.

    View details for DOI 10.1080/10640266.2014.925768

    View details for Web of Science ID 000342308000004

  • How smartphone applications may be implemented in the treatment of eating disorders: case reports and case series data Advances in Eating Disorders: Theory, Research and Practice Darcy, A., Adler, S., Miner, A., Lock, J. 2014
  • Do in-vivo behaviors predict early response in family-based treatment for anorexia nervosa? BEHAVIOUR RESEARCH AND THERAPY Darcy, A. M., Bryson, S. W., Agras, W. S., Fitzpatrick, K. K., Le Grange, D., Lock, J. 2013; 51 (11): 762-766


    The aim of the study is to explore whether identified parental and patient behaviors observed in the first few sessions of family-based treatment (FBT) predict early response (weight gain of 1.8 kg by session four) to treatment. Therapy film recordings from 21 adolescent participants recruited into the FBT arm of a multi-site randomized clinical trial were coded for the presence of behaviors (length of observed behavior divided by length of session recording) in the first, second and fourth sessions. Behaviors that differed between early responders and non-early responders on univariate analysis were entered into discriminant class analyses. Participants with fewer negative verbal behaviors in the first session and were away from table during the meal session less had the greatest rates of early response. Parents who made fewer critical statements and who did not repeatedly present food during the meal session had children who had the greatest rates of early response. In-vivo behaviors in early sessions of FBT may predict early response to FBT. Adaptations to address participant resistance and to decrease the numbers of critical comments made by parents while encouraging their children to eat might improve early response to FBT.

    View details for DOI 10.1016/j.brat.2013.09.003

    View details for Web of Science ID 000327052800007

  • A review of attention biases in women with eating disorders COGNITION & EMOTION Aspen, V., Darcy, A. M., Lock, J. 2013; 27 (5): 820-838


    There is robust evidence that women with eating disorders (EDs) display an attention bias (AB) for disorder-salient stimuli. Emerging data suggest that the presence of these biases may be due, in part, to neurological deficits, such as poor set shifting and weak central coherence. While some have argued that these biases function to predispose and/or act to maintain disordered eating behaviours, evidence supporting this view has rarely been examined. This report summarises and integrates the existing literature on AB in EDs and other related psychiatric disorders to better understand its potential role in the development and maintenance of an ED. The domains reviewed include experimental data using the dot-probe and modified Stroop task and neurobiological findings on AB in women with EDs as well as the role of AB in current theoretical models. We conclude by proposing an integrated model on the role of AB in EDs and discuss treatment approaches aimed at modifying these biases.

    View details for DOI 10.1080/02699931.2012.749777

    View details for Web of Science ID 000321171400004

  • The Eating Disorder Examination Questionnaire (EDE-Q) among university men and women at different levels of athleticism EATING BEHAVIORS Darcy, A. M., Hardy, K. K., Lock, J., Hill, K. B., Peebles, R. 2013; 14 (3): 378-381


    The aim of the current study was to establish norms for the Eating Disorder (ED) Examination Questionnaire (EDE-Q) among competitive athletes and to explore the contribution of level of athletic involvement and gender to ED psychopathology, as measured by the EDE-Q. University students (n=1637) from ten United States universities were recruited online via a social networking website and asked to complete an anonymous survey. The sample was then divided according to gender and level of sports participation. Females scored higher than males regardless of level of athleticism. Lower mean scores were frequently observed among those involved in competitive sports exclusively and highest scores among those involved in recreational sports (alone or in addition to competitive athletics). Recreational activity seems to be important in stratifying risk among competitive athletes; gender is an important interaction term in athletic populations.

    View details for DOI 10.1016/j.eatbeh.2013.04.002

    View details for Web of Science ID 000323586700025

    View details for PubMedID 23910784

  • Factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in male and female college athletes BODY IMAGE Darcy, A. M., Hardy, K. K., Crosby, R. D., Lock, J., Peebles, R. 2013; 10 (3): 399-405


    The study explored the psychometric properties of the Eating Disorder Examination Questionnaire (EDE-Q) among 1637 university students. Participants were divided into male (n=432) and female (n=544) competitive athletes, and male (n=229) and female (n=429) comparison groups comprised of individuals who had not engaged in competitive sports for at least one year. All groups were subjected to confirmatory factor analysis (CFA) to test the fit of the published factor structure in this population, and then exploratory FA (EFA). A three-factor solution was the best fit for three out of four groups, with a two-factor solution providing best fit for the male comparison group. The first factor for all groups resembled a combined Shape and Weight Concern subscale. The factor structure among male and female competitive athletes was remarkably similar; however, non-competitive athletic/low activity males appear qualitatively different from other groups.

    View details for DOI 10.1016/j.bodyim.2013.01.008

    View details for Web of Science ID 000321088000015

    View details for PubMedID 23453695

  • Set-shifting among adolescents with anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Fitzpatrick, K. K., Darcy, A., Colborn, D., Gudorf, C., Lock, J. 2012; 45 (7): 909-912


    Set-shifting difficulties are documented for adults with anorexia nervosa (AN). However, AN typically onsets in adolescents and it is unclear if set-shifting difficulties are a result of chronic AN or present earlier in its course. This study examined whether adolescents with short duration AN demonstrated set-shifting difficulties compared to healthy controls (HC).Data on set-shifting collected from the Delis-Kaplan executive functioning system and Wisconsin card sort task (WCST) as well as eating psychopathology were collected from 32 adolescent inpatients with AN and compared with those from 22 HCs.There were no differences in set-shifting in adolescents with AN compared to HCs on most measures.The findings suggest that set-shifting difficulties in AN may be a consequence of AN. Future studies should explore set-shifting difficulties in a larger sample of adolescents with the AN to determine if there is sub-set of adolescents with these difficulties and determine any relationship of set-shifting to the development of a chronic from of AN.

    View details for DOI 10.1002/eat.22027

    View details for Web of Science ID 000310271600014

    View details for PubMedID 22692985

  • Set-Shifting Among Adolescents With Bulimic Spectrum Eating Disorders PSYCHOSOMATIC MEDICINE Darcy, A. M., Fitzpatrick, K. K., Colborn, D., Manasse, S., Datta, N., Aspen, V., Shields, C. S., Le Grange, D., Lock, J. 2012; 74 (8): 869-872


    Set-shifting difficulties are observed among adults with bulimia nervosa (BN). This study aimed to assess whether adolescents with BN and BN spectrum eating disorders exhibit set-shifting problems relative to healthy controls.Neurocognitive data from 23 adolescents with BN were compared with those from 31 adolescents with BN-type eating disorder not otherwise specified and 22 healthy controls on various measures of set-shifting (Trail Making Task [shift task], Color-Word Interference, Wisconsin Card Sorting Test, and Brixton Spatial Anticipation Task).No significant differences in set-shifting tasks were found among groups (p >.35), and effect sizes were small (Cohen f < 0.17).Cognitive inflexibility may develop over time because of the eating disorder, although it is possible that there is a subset of individuals in whom early neurocognitive difficulty may result in a longer illness trajectory. Future research should investigate the existence of neurocognitive taxons in larger samples and use longitudinal designs to fully explore biomarkers and illness NCT00879151.

    View details for DOI 10.1097/PSY.0b013e31826af636

    View details for Web of Science ID 000310047800011

    View details for PubMedID 23001391

  • Are we asking the right questions? A review of assessment of males with eating disorders. Eating disorders Darcy, A. M., Lin, I. H. 2012; 20 (5): 416-426


    Most of the commonly used eating disorders (ED) assessments were normed and developed for females, and their status among male populations is rarely addressed in the literature. Recently, some male-specific instruments have been developed that may have some utility with this population. This article aims to: (a) briefly outline some special considerations and challenges when assessing ED in male populations; (b) review the utility of some of the most commonly used ED assessments with males; and (c) review some of the measures that have recently been developed to assess male-specific ED-related symptoms, with the hope that a greater understanding of male-specific presentation may be elucidated.

    View details for DOI 10.1080/10640266.2012.715521

    View details for PubMedID 22985238

  • The eating disorders examination in adolescent males with anorexia nervosa: How does it compare to adolescent females? INTERNATIONAL JOURNAL OF EATING DISORDERS Darcy, A. M., Doyle, A. C., Lock, J., Peebles, R., Doyle, P., Le Grange, D. 2012; 45 (1): 110-114


    The study aimed to explore the Eating Disorder Examination (EDE) for adolescent males with eating disorders (EDs) compared with adolescent females with EDs.Data were collected from 48 males and matched on percent median body weight (MBW) and age to 48 females at two sites.Adolescent males with anorexia nervosa-type presentation scored significantly lower than matched females on Shape Concern, Weight Concern, and Global score. They also scored lower on a number of individual items.The EDE has clinical utility with adolescent males with anorexic-type presentation although males' scoring ranges are consistently lower than those from adolescent females with similar clinical presentations. Males scored significantly lower on a number of items representing core symptoms such as desire to lose weight. More research is needed to gain a better understanding of the experience of adolescent males with EDs, particularly in relation to the nature of shape concern.

    View details for DOI 10.1002/eat.20896

    View details for Web of Science ID 000298063600014

    View details for PubMedID 22170022

  • Use of Mirtazapine in an Adult with Refractory Anorexia Nervosa and Comorbid Depression: A Case Report INTERNATIONAL JOURNAL OF EATING DISORDERS Safer, D. L., Darcy, A. M., Lock, J. 2011; 44 (2): 178-181


    The objective of this report was to describe an efficacious treatment of an adult with long-standing anorexia nervosa (AN). A 50-year-old woman with an over 7-year history of AN and comorbid major depression had been treated unsuccessfully with numerous psychotropic medications, manualized cognitive behavior therapy, and an intensive outpatient treatment program before referral. After treatment with mirtazapine, she gained weight and her depression improved. A 9-month follow-up revealed a maintenance of these benefits. Mirtazapine may be useful for older, chronically ill patients presenting with AN and comorbid depression.

    View details for DOI 10.1002/eat.20793

    View details for Web of Science ID 000287551500011

    View details for PubMedID 20127940

  • All Better? How Former Anorexia Nervosa Patients Define Recovery and Engaged in Treatment EUROPEAN EATING DISORDERS REVIEW Darcy, A. M., Katz, S., Fitzpatrick, K. K., Forsberg, S., Utzinger, L., Lock, J. 2010; 18 (4): 260-270


    The purpose of this study was to explore how individuals with anorexia nervosa (AN) engage in treatment and define recovery. A mixed methods design was used to triangulate the experience of 20 women with a history of AN. Interview data were analysed thematically to explore frequency of emergent themes and current eating disorder psychopathology was assessed using standardized self-report measures. Participants' mean age was 29.35 (SD = 12.11). Participants' scores were indicative of persistent psychopathology. Those with more involvement in treatment choice had better motivation to change and normalized eating. Participants' definition of recovery mapped on well to current research conceptualizations, though a substantial proportion of the group expressed some ambivalence around the concept. Results are interpreted in the context of self-determination theory of motivation and suggest that patients should be involved collaboratively in the formulation of shared goals and concepts of recovery in treatment settings.

    View details for DOI 10.1002/erv.1020

    View details for Web of Science ID 000280080100003

    View details for PubMedID 20589765

  • A clinical profile of participants in an online support group EUROPEAN EATING DISORDERS REVIEW Darcy, A. M., Dooley, B. 2007; 15 (3): 185-195


    To explore the clinical characteristics of users of an online support group for people with eating disorders (EDs).One hundred and thirty-eight support group participants were recruited online and completed measures that were specifically adapted for internet administration. These included two subscales of the Eating Disorder Inventory-2 (EDI-2); the 26-item version of the Eating Attitudes Test (EAT-26); the Hospital Anxiety and Depression Scale (HADS); and the Rosenberg Self-Esteem Scale (RSE).Participants scored significantly higher than published normative data on all measures. In addition, while the group scored in line with traditional clinical samples, some self-reported diagnostic groups scored significantly higher on all of the factors.Participants demonstrated a clinical profile, in terms of reported distress, comparable to, and on some measures in excess of, samples diagnosed with an ED. Online support groups may be ideally placed to offer support and information to some people with EDs.

    View details for DOI 10.1002/erv.775

    View details for Web of Science ID 000247478800004

    View details for PubMedID 17676688