Our Spotlights

You wouldn’t microwave fish around your worst enemy — the smell lingers both in kitchen and memory. It is one few of us like, let alone have positive associations with. But what makes our brains decide a smell is stinky? A new study from UF Health researchers reveals the mechanisms behind how your brain decides you dislike — even loathe — a smell. Or as first author and graduate research fellow Sarah Sniffen puts it: How do odors come to acquire some sort of emotional charge? In many ways, our world capitalizes upon the importance of smells to influence emotions, running the gamut from perfumes to cooking and even grocery store design. “Odors are powerful at driving emotions, and it’s long been thought that the sense of smell is just as powerful, if not more powerful, at driving an emotional response as a picture, a song or any other sensory stimulus,” said senior author Dan Wesson, Ph.D., a professor of pharmacology and therapeutics in the UF College of Medicine and interim director of the Florida Chemical Senses Institute. But until now, researchers have puzzled over what circuitry connects the parts of the brain vital to generating an emotional response with those responsible for smell perception. The team started off with the amygdala, a brain region that curates your emotional responses to sensory stimuli. Although all our senses (sound, sight, taste, touch and smell) interact with this small part of your brain, the olfactory system takes a more direct route to it. “This is, in part, what we mean when we say your sense of smell is your most emotional sense,” Sniffen said. “Yes, smells evoke strong, emotional memories, but the brain’s smell centers are more closely connected with emotional centers like the amygdala.” In the study, researchers looked at mice, who share neurochemical similarities with people. They can learn about odors and categorize them as good or bad. After observing their behavior and analyzing brain activity, the team found two genetically unique brain cell types that allow odors to be assigned into a bucket of good feelings or bad feelings. Initially, the team expected that one cell type would generate a positive emotion to an odor, and another would generate a negative emotion. Instead, the brain’s cellular organization gives the cells the capability of doing either. “It can make an odor positive or negative to you,” Wesson said. “And it all depends upon where that cell type projects in your brain and how it engages with structures in your brain.” But why is knowing more about how we categorize smells important? Well, for starters, smells — and our reactions to them — are a part of life. Sometimes, however, our reactions to them can be outsized, or take on a negative association so strong it disrupts how we live. “We’re constantly breathing in and out and that means that we’re constantly receiving olfactory input,” Sniffen said. “For some people that’s fine, and it doesn’t impact their day-to-day life. They might even think, ‘Oh, odors don’t matter that much.’ But for people who have a heightened response to sensory stimuli, like those with PTSD or anxiety or autism, it’s a really important factor for their day-to-day life.” In the future, the research could help clinicians adjust for heightened sensory response that some people struggle with in their everyday lives, Wesson added. One example? A patient associating a clinic’s smell with transfusions that made them queasy. Based upon the receptor systems in these specific brain pathways, the team members believe they might be able to change those associations. Potentially, medications could suppress some of these pathways’ activity to allow you to overcome stressful and aversive emotional responses. Conversely, these pathways could be activated to restore enjoyment to things that people might have grown indifferent to — like those who lose their appetite from illness. “Emotions in part dictate our quality of life, and we’re learning more about how they arise in our brain,” Wesson said. “Understanding more about how our surroundings can impact our feelings can help us become happier, healthier humans.” This research was supported by funding from the National Institute on Deafness and Other Communication Disorders and the National Institute on Drug Abuse. Sarah Sniffen was supported by a fellowship from the National Institute on Deafness and Other Communication Disorders.

In an extensive study examining the relationship between personality traits and executive pay, CEOs who exhibit more Machiavellianism, characterized by motivation to achieve personal goals and 'win' social interactions, are more likely to have higher total pay and severance pay and to secure higher pay for those on their top management team. Aaron Hill, Ph.D., an associate professor at the University of Florida Warrington College of Business, and his co-authors determined that CEO's who scored higher on Machiavellianism were more motivated and successful in their negotiations. The team used a longitudinal sample of S&P 500 firms to compare compensation data with the executives' personality traits collected by expert clinical psychologists’ analyses of public video recordings. “Broadly, we find that CEO Machiavellianism positively relates to their own pay, their severance pay and the pay of their C-Suite or top management team,” Hill said. “The latter effect – on top management team pay – we find then predicts CEO pay raises. Our findings suggest that in this way, CEOs higher in Machiavellianism may pay their top management team members more to set up their own pay raises.” The team’s research highlights an underlying bias in how this trait can affect pay decisions. In response, those who set pay, such as boards of directors, should work on policies that reinforce the behaviors they want in their executives. They should also place leaders in a position to succeed and accentuate the positive aspects of their innate tendencies. “We all have tendencies that present tradeoffs in terms of having some positive aspects and some negative aspects,” Hill said. “Hopefully, as managers, we can acknowledge those and work to accentuate the positives and limit the potential downsides – in effect, take advantage of the positives and work to mitigate the negatives.” This research is published in the Journal of Applied Psychology.

Armed with a $7 million grant from the Army Corp of Engineers, University of Florida researchers are working to bolster shoreline resilience and restore troubled wetlands in St. Augustine through nature-based solutions. “The idea of nature-based solutions is to build what we sometimes refer to as green infrastructure, to use living, natural components as the building blocks,” said Andrew Altieri, Ph.D., an assistant professor with the Engineering School of Sustainable Infrastructure & Environment and interim director of the Center for Coastal Solutions, also known as CCS. Instead of building man-made structures to protect wetlands, for example, restoration crews can move dredged natural sediment otherwise destined for costly disposal to increase wetlands’ size and elevation, restoring their ability to protect shorelines from storm surge, keep pace with sea-level change, filter toxins, store carbon and provide habitats for wildlife.  The project is in concert with the Army Corps of Engineers’ goal to naturally reuse and repurpose at least 70% of dredged sediment into other natural areas to benefit habitats and restoration by 2030. “It is critical to understand, test and model how natural processes can be harnessed and strategically implemented to sustainably meet the challenge of rapidly intensifying coastal hazards while also providing environmental, economic and social benefits,” Altieri wrote in the project’s technical summary. Overall, the multi-disciplinary project closely examines patterns and processes of change in coastal landscapes. That includes wetlands — marshes and mangroves — and beach/dune systems. The project comes as these coastal areas are facing threats both natural and human. These areas are essential to wildlife, air quality, native vegetation, storm protection and the overall health of the ecosystem. A 2008 study by the U.S. Fish and Wildlife Service reported a net loss of about 361,000 acres of wetlands in the coastal watersheds of the eastern United States between 1998 and 2004 — an average net decrease of 59,000 acres each year, with experts citing sea-level rise as one of the primary factors. “We're trying to understand the patterns of that loss and what's leading to it,” Altieri said. “These systems are essentially the first and sometimes last line of defense against coastal hazards, risks that include storm surges and coastal flooding. They are forming a buffer, this kind of protective layer on our coast. But they're changing, generally for the worse and are in danger of being lost.” With this project, the CCS-led research team plans to advance the science, technology and engineering principles of nature-based solutions. With marshes, the primary concern is elevation loss, which can drown the vegetation critical to the ecosystem. They are sinking, eroding and succumbing to sea-level changes, Altieri said. “The plants are really important for trapping sediment and holding sediment,” he said. “You lose some of the plants, then you get more erosional loss and a lack of the accumulation of sediment.” Sediment is natural muck on the bottom of water bodies. “If we can add sufficient sediment to increase the elevation to a level where the plants thrive, then they will retain that sediment that's been added to hopefully trap more sediment and accumulate more biomass through their growth,” Altieri said. “It’s something that may need to be done periodically. You may stop that decline, but you may even reverse the process of loss and change the trajectory.” As a bonus, this process saves the cost of disposing of dredged sediment, which is usually piped offshore or to a materials-management area. This project is the next step for CCS-led coastal resilience efforts in St. Augustine. In 2024, CCS and WSP Environment & Infrastructure Inc. launched a coastal wetlands-restoration project to keep pace with sea level change and erosion. The 2025 work is a standalone project with separate funding, Altieri said. The current project also has more research disciplines and project partners, including UF researchers from Landscape Architecture, Geological Sciences and the School of Forest, Fisheries and Geomatic Sciences. “Storm surges, wave energy, coastal flooding – all of that can be slowed or reduced because of wetlands,” Altieri said. “They are basically like shock absorbers. These wetlands, beaches and dunes can be lost or eroded to some degree, but the upland area behind them is essentially protected.” Researching the resilience of dunes comes with a different set of dynamics. Here, they are looking at the plants that support the dunes – sea oats and panic grass, for example. That vegetation also provides a habitat for animals such as beach mice, turtles and birds. On the beach, the team also is looking at water energy and how grain size affects the stability of dunes. “It’s understanding water movement, water energy. How is that interacting with depositing sediment, moving sediment around, sorting sediment? With water, you tend to carry finer particles further than coarser materials,” he said. What does success look like after the award’s five years end? “We'll have an understanding of what's changing on our coasts and why,” Altieri said. “We'll have an understanding of how we can work within this system to modify the natural components and utilize the natural processes. And we will hopefully be working with partners through additional funding mechanisms to actually apply that towards implementation of solutions to increase coastal resilience.” The team also includes Peter Adams, Department of Geological Sciences; Julie Bruck, Department of Landscape Architecture, School of Landscape Architecture and Planning; Maitane Olabarrieta, ESSIE; Alex Sheremet, ESSIE; Nina Stark, ESSIE; Ben Wilkinson, Geomatics Program, School of Forest, Fisheries, and Geomatics Sciences; and Xiao Yu, ESSIE.

University of Florida researchers are calling for a national transformation in how we address the ongoing epidemic of obesity and Type 2 diabetes, starting with a fundamental shift in how we approach health, agriculture and food. Published recently in the Proceedings of the National Academy of Sciences, the article argues that fruits and vegetables must be treated not just as food — but as medicine.  With 73% of U.S. adults and 35% of children classified as overweight or obese, the authors warn that the crisis is not only an individual health issue but a national economic and security threat.  Andrew Hanson, Ph.D., a co-author and professor of horticultural sciences at UF/IFAS, emphasized a sense of urgency and collective responsibility toward solving this health crisis.  “This isn’t business as usual. We’re taking a public-interest view. This is the kind of thing we all need to be talking about. It’s too important not to,” he said.  The article proposes a roadmap for change, including creating five National Institutes of Health-supported “Food Is Medicine” centers across the U.S., with Florida as a leading candidate; scaling up domestic fruit and vegetable production to meet national dietary needs; partnering with food producer and processors to make healthy foods more accessible, affordable and appealing; and reforming medical and nutrition education to include horticultural sciences and vice versa. The article highlights that only 1 in 10 adults meets the recommended daily intake of fruits and vegetables, and that U.S. production falls far short of what’s needed to support a healthy population. The authors call for a dramatic expansion of fruit and vegetable production, especially high-impact crops like berries, leafy greens and carrots.  Christopher Gunter, Ph.D., professor and chair of the UF/IFAS Department of Horticultural Sciences, said the team’s goal is to push the role fruit and vegetables crops can play in improving human health into the national consciousness. “As a discipline, horticulture and the science of fruit and vegetables have been largely ignored in this conversation,” Gunter said. “Our goal is to move the needle on health with fruit and vegetables.”   Hanson said about 80% of the nation’s cropland is used to grow soybeans, corn and wheat — most of which are processed into products with low nutritional value that contribute to the obesity and Type 2 diabetes epidemic.  Mike Jaffee, M.D., a co-author and professor of neurology in the UF College of Medicine, stressed the broader implications of a high-vegetable diet on brain health.  “Obesity and insulin resistance are linked to inflammation and neurodegeneration. We’re living longer, but our brains aren’t keeping up. That’s where the real cost to individuals and the health care system comes in,” he said.  Gunter agreed, adding, “This epidemic reduces the longevity and productivity of our citizens. It limits the momentum communities need to grow healthy and resilient families.”  Hanson pointed out that higher socioeconomic groups are better positioned to meet dietary recommendations, making this not just a health issue, but a deeply embedded social and economic one.  “This crisis takes an unduly large toll on people with lower incomes and less time. To eat enough fruits and vegetables in the current system, you need substantial income and time to prepare food. That’s a luxury many don’t have,” he said.  The authors argue that farmers bring essential knowledge to the table.   “They understand how environmental factors impact nutritional quality,” Gunter said.

A team of researchers, including Kevin Butler, Ph.D., a professor in the Department of Computer and Information Science and Engineering at the University of Florida, is sounding the alarm on a disturbing trend in artificial intelligence: the rapid rise of AI-generated sexually explicit images created without the subject’s consent. With funding from the National Science Foundation, Butler and colleagues from UF, Georgetown University and the University of Washington investigated a growing class of tools that allow users to generate realistic nude images from uploaded photos — tools that require little skill, cost virtually nothing and are largely unregulated. “Anybody can do this,” said Butler, director of the Florida Institute for Cybersecurity Research. “It’s done on the web, often anonymously, and there’s no meaningful enforcement of age or consent.” The team has coined the term SNEACI, short for synthetic non-consensual explicit AI-created imagery, to define this new category of abuse. The acronym, pronounced “sneaky,” highlights the secretive and deceptive nature of the practice. “SNEACI really typifies the fact that a lot of these are made without the knowledge of the potential victim and often in very sneaky ways,” said Patrick Traynor, a professor and associate chair of research in UF's Department of Computer and Information Science and Engineering and co-author of the paper. In their study, which will be presented at the upcoming USENIX Security Symposium this summer, the researchers conducted a systematic analysis of 20 AI “nudification” websites. These platforms allow users to upload an image, manipulate clothing, body shape and pose, and generate a sexually explicit photo — usually in seconds. Unlike traditional tools like Photoshop, these AI services remove nearly all barriers to entry, Butler said. “Photoshop requires skill, time and money,” he said. “These AI application websites are fast, cheap — from free to as little as six cents per image — and don’t require any expertise.” According to the team’s review, women are disproportionately targeted, but the technology can be used on anyone, including children. While the researchers did not test tools with images of minors due to legal and ethical constraints, they found “no technical safeguards preventing someone from doing so.” Only seven of the 20 sites they examined included terms of service that require image subjects to be over 18, and even fewer enforced any kind of user age verification. “Even when sites asked users to confirm they were over 18, there was no real validation,” Butler said. “It’s an unregulated environment.” The platforms operate with little transparency, using cryptocurrency for payments and hosting on mainstream cloud providers. Seven of the sites studied used Amazon Web Services, and 12 were supported by Cloudflare — legitimate services that inadvertently support these operations. “There’s a misconception that this kind of content lives on the dark web,” Butler said. “In reality, many of these tools are hosted on reputable platforms.” Butler’s team also found little to no information about how the sites store or use the generated images. “We couldn’t find out what the generators are doing with the images once they’re created” he said. “It doesn’t appear that any of this information is deleted.” High-profile cases have already brought attention to the issue. Celebrities such as Taylor Swift and Melania Trump have reportedly been victims of AI-generated non-consensual explicit images. Earlier this year, Trump voiced support for the Take It Down Act, which targets these types of abuses and was signed into law this week by President Donald Trump. But the impact extends beyond the famous. Butler cited a case in South Florida where a city councilwoman stepped down after fake explicit images of her — created using AI — were circulated online. “These images aren’t just created for amusement,” Butler said. “They’re used to embarrass, humiliate and even extort victims. The mental health toll can be devastating.” The researchers emphasized that the technology enabling these abuses was originally developed for beneficial purposes — such as enhancing computer vision or supporting academic research — and is often shared openly in the AI community. “There’s an emerging conversation in the machine learning community about whether some of these tools should be restricted,” Butler said. “We need to rethink how open-source technologies are shared and used.” Butler said the published paper — authored by student Cassidy Gibson, who was advised by Butler and Traynor and received her doctorate degree this month — is just the first step in their deeper investigation into the world of AI-powered nudification tools and an extension of the work they are doing at the Center for Privacy and Security for Marginalized Populations, or PRISM, an NSF-funded center housed at the UF Herbert Wertheim College of Engineering. Butler and Gibson recently met with U.S. Congresswoman Kat Cammack for a roundtable discussion on the growing spread of non-consensual imagery online. In a newsletter to constituents, Cammack, who serves on the House Energy and Commerce Committee, called the issue a major priority. She emphasized the need to understand how these images are created and their impact on the mental health of children, teens and adults, calling it “paramount to putting an end to this dangerous trend.” "As lawmakers take a closer look at these technologies, we want to give them technical insights that can help shape smarter regulation and push for more accountability from those involved," said Butler. “Our goal is to use our skills as cybersecurity researchers to address real-world problems and help people.”

The slimy algae topping Florida’s waterways are more than just unsightly. They are often toxic to humans, animals and the environment. To mitigate those risks, University of Florida researchers are collaborating with North Carolina State University and University of South Florida scientists on a next-day prediction model to warn and inform water managers about harmful algal blooms. The research is funded by two U.S. Army Corps of Engineers grants for two phases, totaling $4.4 million. The project is led by David Kaplan, Ph.D., a professor with the Engineering School of Sustainable Infrastructure and Environment in the Herbert Wertheim College of Engineering and director of the Howard T. Odum Center for Wetlands, and Mauricio Arias, Ph.D., an associate professor at USF. In a paper published recently in the Journal of Environmental Management, Kaplan, UF assistant professor Elise Morrison, Ph.D., and NCSU’s Maria Menchu Maldonado, Ph.D., chronicled their work with harmful algal blooms in the Caloosahatchee River and Estuary, the environmentally sensitive link between Lake Okeechobee and Florida’s southwestern coast. Maldonado performed the work under the guidance of NCSU collaborator Natalie Nelson. In a collaboration between multiple colleges, organizations, departments and universities, the paper’s other authors are Eric Milbrandt of the Sanibel-Captiva Conservation Foundation, Edward Phlips of UF and Natalie G. Nelson of NCSU. The project’s facilitators include Darlene Velez, research coordinator with the UF Water Institute, and Lisa Krimsky, Ph.D., a water resources regional specialized agent with IFAS. Using water samples and computer algorithms, the team developed prediction models based on two water sources feeding the river: Lake Okeechobee and the river’s watershed – the water run-off from the surrounding land. The models determine levels of chlorophyll-a, which is a pigment in algae that is indicative of algal bloom conditions. “For watershed-dominated conditions, the model was able to predict 49% of the variation in next-day chlorophyll-a, which isn’t bad, but for lake-dominated conditions, the model was much better, explaining 78% of the variation in next-day chlorophyll-a in the water,” Kaplan noted. Unlike traditional forecasting models for algal blooms, which are often complex and require much computing power, these models are designed to be practical for daily decision-making, particularly for the Southwest Florida Water Management District (SWFWMD), which has made improving the health of the Caloosahatchee Estuary a state priority. Ultimately, researchers want to develop an algae-prediction system and tools for water managers to reduce risks in all freshwater bodies. “Definitely, this model could be expanded with the use of more data,” said Maldonado. “The same procedure could be applied in other lakes that are highly managed. And this could be done around the world.” Algal blooms in Florida’s lakes, rivers and estuaries have caused significant environmental and economic damage in recent years, UF researchers contend. Blooms are becoming more frequent and longer lasting. The initial project – called Coupling Lake, Estuarine, and Watershed Models for the Caloosahatchee River and Estuary (CLEW) – designed data- and model-driven guidance for Lake Okeechobee water releases. “The overall motivation is that Lake Okeechobee is a challenging natural resource to manage, particularly deciding when and how much water to discharge from the lake to either estuary,” Kaplan said. “There are many competing needs surrounding management of the lake, which has only so much volume. We don't want to cause flooding or other ecological harm.” The follow-up project is UF’s collaboration with USF to develop tools for end users, meaning agencies and managers to make better decisions. The team wants to deliver a system where water managers press the button to get the one-day risk forecast. The study was organized to predict whether the algae-toxin risk is low, medium or high. “In this case, there is a threshold of algal organisms that is considered harmful,” Maldonado said. “Those waters carry phytoplankton species, a microscopic algae that produce toxins. They can be dangerous to swim in, and they can be harmful to the environment. It can be a liver toxin.” Beginning in the late 19th century, the Caloosahatchee River and its watershed underwent extensive modifications that significantly altered the hydrology of the region, according to SWFWMD. The once-shallow river was deepened and widened into a regulated waterway that was connected to Lake Okeechobee and the Kissimmee Chain of Lakes for navigation, water supply and flood control purposes. “Water quality is a challenge in Lake Okeechobee, including sometimes pretty bad harmful algal blooms,” Kaplan said. “And then, of course, the downstream recipients of whatever water is discharged are very sensitive to the amount of water they're getting and what's in it. They’d prefer it to be only the right amount at only the right times with the best quality."

Imagine a crocodile built like a greyhound — that’s a sebecid. Standing tall, with some species reaching 20 feet in length, they dominated South American landscapes after the extinction of dinosaurs until about 11 million years ago. Or at least, that’s what paleontologists thought, until they began finding strange, fossilized teeth in the Caribbean. “The first question that we had when these teeth were found in the Dominican Republic and on other islands in the Caribbean was: What are they?” said Jonathan Bloch, curator of vertebrate paleontology at the Florida Museum of Natural History. This initial confusion was warranted. Three decades ago, researchers uncovered two roughly 18 million-year-old teeth in Cuba. With a tapered shape and small, sharp serrations specialized for tearing into meat, they unmistakenly belonged to a predator at the top of the food chain. But for the longest time, scientists didn’t think such large, land-based predators ever existed in the Caribbean. The mystery deepened when another tooth turned up in Puerto Rico, this one 29 million years old. The teeth alone weren’t enough to identify a specific animal, and the matter went unresolved. That changed in early 2023, when a research team unearthed another fossilized tooth in the Dominican Republic — but this time, it was accompanied by two vertebrae. It wasn’t much to go on, but it was enough. The fossils belonged to a sebecid, and the Caribbean, far from never having large, terrestrial predators, was a refuge for the last sebecid populations at least 5 million years after they went extinct everywhere else. A research team described the implications of their finding in a new study published in the Proceedings of the Royal Society B. The study’s lead author, Lazaro Viñola Lopez, conducted the research as a graduate student at the University of Florida. He knew his team members had come upon something exceptional when they unearthed the fossils. “That emotion of finding the fossil and realizing what it is, it’s indescribable,” he said. Read more ...

Charities with corporate leaders on their boards spend an average of $130,000 a year lobbying on behalf of their connected companies. That’s according to a first-of-its-kind study that shows how companies benefit from their charitable work — and how charities may be all-too-happy to support their powerful board members in return for lucrative connections. The researchers behind the study say the findings could help policymakers and charity stakeholders keep tabs on a previously hidden form of political influence, but that such arrangements are perfectly legal for now. “Charities stand to gain something by behaving in this way. It doesn’t always have to be corporations pushing charities to behave in a way they don’t want to,” said Sehoon Kim, Ph.D., a professor of finance at the University of Florida and senior author of the new study. “It’s a natural quid pro quo arrangement that arises from the incentives corporations and charities have.” The American Medical Association shows one example of these incentives in action. In the 2010s, they actively lobbied against efforts by federal agencies to curb opioid prescriptions. This benefited companies like Purdue Pharma, the maker of OxyContin widely blamed for exacerbating the opioid epidemic in the U.S. It turned out that Richard Sackler, the former president of the company, sat on the board of AMA Foundation, a relationship viewed by many as controversial at the time. But Sackler had arranged for millions in donations to the foundation, and other charities are likely looking to corporate board members to help engineer large donations for their charitable work by connecting charities to other companies and leaders with deep pockets. Lobbying on behalf of their new friends, then, may simply be the most efficient way to ensure those donations keep flowing. Kim collaborated with UF Professor Joel Houston, Ph.D., and Changhyun Ahn, Ph.D., of the Chinese University of Hong Kong to conduct the analysis, which is forthcoming in the journal Management Science. They painstakingly hand collected data covering more than 400 charities and over 1,000 corporations that identified board connections, donations and lobbying activities that fell both within and outside of the charities’ typical political activity. The researchers focused on larger charities that already engage in some lobbying on their own behalf. These lobbying charities are three times larger than smaller nonprofits that never lobby. After a new corporate board member joined, these charities changed their behavior. They were far more likely to lobby outside of their own interests and to even work to support or defeat legislation that affected their new board member’s company, even when that legislation had nothing to do with their charitable mission. It worked out to about a 14% increase in the charity’s lobbying expenditures. “These were the smoking guns that there’s something going on that’s not supposed to be happening,” Kim said. Because lobbying is such an efficient use of resources, and because charities may lend their friendly brand to these lobbying efforts, this help from charities could significantly benefit these connected corporations. “These are previously unrecognized channels at play in terms of corporate political influence that policymakers need to be mindful of when assessing how influential corporations are likely to be,” Kim said.

When presented with a vignette describing the behaviors and characteristics of a patient with disordered eating, only a quarter of mental health providers who participated in a new study were able to correctly diagnose bulimia nervosa. The findings from researchers at the University of Florida College of Public Health and Health Professions, part of UF Health, appear in the journal Eating Disorders. Two common, yet less-recognized, patient factors may have led to the misdiagnoses, said Dakota Leget, a doctoral student in the college’s Ph.D. program in clinical and health psychology, who conducted the study with her mentor, Rebecca Pearl, Ph.D., an associate professor in the Department of Clinical and Health Psychology. The providers who participated in the study reviewed vignettes about a fictitious patient who was described as either having healthy weight or obesity and who used excessive exercise to compensate for overeating. Many patients with bulimia have average or higher body weight, yet misconceptions persist about the “typical” patient with bulimia, Leget said. “Unfortunately, we have stereotypes that someone with an eating disorder will look ‘very lean’ or ‘sickly,’ but we know that’s not the case for a lot of eating disorders,” she said. The study findings also suggest that providers may not associate excessive exercise with bulimia, despite the fact that it is listed in the Diagnostic and Statistical Manual of Mental Disorders as one of multiple compensatory strategies used by people with bulimia. “I think my biggest takeaway is that excessive exercise may not be on mental health providers’ radar and may be overlooked when patients are presenting for care,” Leget said. For the study, the researchers recruited a nationwide sample of more than 200 mental health providers to read two patient vignettes and then select a diagnosis and recommended number of treatment sessions from a dropdown list of options. The vignettes described fictitious patients who met full diagnostic criteria for their respective disorders, according to the Diagnostic and Statistical Manual of Mental Disorders. Three-quarters of participants correctly diagnosed major depressive disorder in the first patient vignette, which served as a control. Participants were randomly assigned to receive one of two versions of the second vignette. In one version, the patient was described as having a healthy weight; in the second, the patient was described as having obesity. The other patient details were the same for both versions. The patient in the vignette reported she followed a strict diet a few days a week and engaged in a cycle of binge eating accompanied by excessive exercise. The vignette also described the patient’s thoughts and feelings about her appearance and how they affected her activities and relationships. Only 27% of providers correctly diagnosed the patient as having bulimia nervosa, and 38% of providers incorrectly diagnosed the patient with binge eating disorder. Correctly distinguishing between bulimia, binge eating or any other eating disorder is critical, the authors say, not only to ensure patients receive the right treatment, but also to appropriately monitor for other health effects, such as dangerously low sodium levels caused by excessive exercise. “If you are treating the wrong eating disorder, you might not be using the best evidence-based strategy,” Leget said. The findings also point to the need for more continuing education on eating disorders for mental health providers who may not have specialized training, Leget said. “Many people with eating disorders will probably be seen in outpatient settings and they may not be seen by someone with expertise in this area,” Leget said. “Early detection and treatment are crucial. If the community provider is able to detect an eating disorder they can treat that person or guide them to someone with the appropriate expertise so the patient gets the treatment they need sooner rather than later.”