About

C. Alix Timko, PhD, is an Associate Professor of Psychiatry at the Children's Hospital of Philadelphia, affiliated with the Department of Psychiatry. She holds a Bachelor of Science degree in Psychology and German from St. Lawrence University, obtained in 1996, a Master of Arts in Clinical Health Psychology from MCP Hahnemann University in 2000, and a PhD in Clinical Psychology from Drexel University in 2003. Dr. Timko's research focuses on eating disorders, food cravings, and disordered eating behaviors, particularly in pregnant populations. She has contributed to the validation of assessment tools related to food cravings and intolerance of uncertainty, and has conducted clinical trials on acceptance-based online interventions targeting disordered eating. Her work also includes the clinical characterization of co-morbid autoimmune diseases and eating disorders, as well as exploring cognitive flexibility in eating disorder treatments.

Research topics

• Family medicine
• Gerontology
• Psychology
• Environmental health
• Medicine
• Social psychology

Selected publications

• Protocol for a pilot trial assessing the acceptability, feasibility, and psychoeducation effectiveness of a single-session online parent-focused intervention targeting predictors of body image disturbance in young children

  Contemporary Clinical Trials · 2026-04-27

  article
  PublisherDOI

• Calculating developmental weight suppression in practice: A commentary demonstrating the use and misuse of Singh and colleagues’ new approach

  Appetite · 2026-02-26

  articleSenior author
  PublisherDOI

• Editorial: Challenges in eating behavior

  Frontiers in Psychology · 2025-02-11

  editorialOpen access

  Eating is a complex human behavior and a core component of lifestyle medicine. Given the ever changing influences of an interconnected society, new challenges further complicate our perceptions, food choices, and motivations to eat. The goal of this Research Topic was to examine the challenges in eating behavior research and practice. The five articles in this Topic represent a wide range of challenges including characterizing the unhealthy food behaviors in Indian adolescents, socioeconomic meat consumption patterns, body recognition challenges in people with binge eating disorder (BED), standardization of automatically assessing bite counts in meal events, and determining the role of humor on "healthy" food posts on social media.Adolescence is a critical developmental stage for establishing adult eating behaviors (Daly et al., 2022). Jena and colleagues (Jena et al., 2023) examined the regional differences of unhealthy food behavior in India, which has one of the world's largest populations of adolescents. Using a scoping review framework of the available literature, the authors reviewed the data from 33 articles to discuss the differences in knowledge and perceptions of unhealthy foods, unhealthy food practices, and factors influencing unhealthy food choices. Most of the studies (23 out 33) provided sex-stratified results based on unhealthy food choices with a predominance of the studies representing the Southern zone of India (13 out of 33). The authors discuss the significant challenges of unhealthy food choices among Indian adolescents and the recommendations for addressing these challenges.Animal protein or meat is a readily available food source of essential amino acids and micronutrients in the human diet (Massey, 2003). Societal meat consumption patterns are dependent on interrelated economic, environmental, and cultural factors (Petersen and Hirsch, 2023). Therefore, establishing sustainable practices to address the consumer demand for meat is often a challenge for the industry, policy makers, and regulatory agencies. One strongly influencing consideration is related to whether a country has a developed or emerging economy. Delley and colleagues (Delley et al., 2024) surveyed random populations of people in a developed country, Switzerland (n = 643 participants), and emerging country, Vietnam (n = 616 participants), to profile and segment meat consumption patterns. Cluster analysis of the sampled population indicated five segments with three segments common to both Switzerland and Vietnam. These included meat lovers (20% in Switzerland vs. 19% in Vietnam), proactive (22% in Switzerland vs. 14% in Vietnam), and suggestible (19% in Switzerland vs. 25% in Vietnam). Not common segments were traditional (19%) and basic (20%) in the Swiss population, whereas confident (16%) and anxious (26%) were indicated in the Vietnamese population. The results were reported by cluster and country for diet type (Omnivores vs. Flexitarians), average weekly meat consumption, food choice importance, and socio-demographic factors. Practical implications for implement meat reduction strategies per segment and countries are discussed, as well as possible educational and regulatory measures.Using reflexive thematic analysis, Olsen and colleagues (Olsen et al., 2024) examined the relationship of body experiences and BED. On the last day of inpatient treatment for BED, six women (25-50 years old) consented to participate in a semi-structured in-depth interview (45-90 min) regarding body, food, social relations and treatment experiences. Interviews were conducted within 3 months after discharge. The collected interviews were subjected to a six phase reflexive data analysis by the authors and resulted in three meta-themes. These themes were: Relational challenges and feeling could not be talked about at home, Contempt for body image disturbs the experience of self and others, and Their body has not been a theme in previous treatment. Olsen colleagues discuss these meta-themes and related themes in BED psychopathology. Additionally, there is an emphasis on the challenge of recognition of body experience in therapy and "living with BED in a big body". Individual meal events, such as eating activity or chewing bouts, are informative metrics for assessing eating behaviors. Several challenges are that current laboratory-based methods for assessing meal-related eating behavior relies on investigator-based visual assessments, detailed manual annotations of meals, and ensuring consistency between individual annotators (Tufano et al., 2022). These methods are time consuming and prone to subjectivity. To address these issues, Turfano and colleagues (Tufano et al., 2024) developed an automated processing of the threshold for facial key points and rule-based criteria to count bites. The objective of the study was to assess the performance of the automated processing with manual annotations of meal video recordings from 15 participants. The automated system varied from 36.6% to 94.6% accuracy compared with manual annotation and it performed consistently across food textures. The authors discuss the potential opportunities for future research applications.Social media influences food choices (Mc Carthy et al., 2022). In a brief research report Reijnen and colleagues (Reijnen et al., 2024) explored the effect of humor on the intention of purchasing of healthy foods on a social media platform. The study design used four embedded jokes posts (2 of the 4, explicitly included the word "fat") and six non-joke filler posts, each post contained a repost and emoji-like slider option in an artificial Instagram feed. The influence of the joke post on the willingness to buy the subsequent healthy food post was tested in the study participants (n = 411; mean age 24.19 ± 4.24 yrs old, 70.6% female). Results indicated a relationship between joke type and intention to buy recognized healthy food options. Purchase intent was decreased when the word " fat" was used in the joke post. The authors further discuss the influence of humorous or non-humorous on food choices.Overall, the mix of original research articles, reviews, and brief reports in this Topic represent the varied challenges in the field of eating behavior. Eating behavior will continue to be a dynamic and intriguing area, even as we continue to make progress in understanding the biological, psychological, and social underpinnings of eating. Identifying and addressing challenges, such as those represented here, will be crucial for the ongoing tasks of destigmatizing disordered eating, promoting healthy lifestyles, and developing effective therapeutic options.

  PublisherOA PDFDOI

• Base Rates of Low Delis Kaplan Executive Function System Scores in Individuals With Anorexia Nervosa

  European Eating Disorders Review · 2025-04-27 · 1 citations

  articleOpen accessSenior authorCorresponding

  OBJECTIVE: Inefficiencies in cognitive flexibility (CF) are a potential vulnerability trait for anorexia nervosa (AN). Yet, much of the research on CF in AN has been conducted in adult samples, with mixed results from research on adolescents. Knowledge of the prevalence of low scores on assessments can help avoid erroneous interpretations of test scores. The current study examined the prevalence of low scores on the Delis Kaplan Executive Function System (D-KEFS) in adolescents and adults with AN and adolescent healthy controls. METHOD: We conducted a secondary analysis of D-KEFS data from 739 participants (552 adolescents with AN [aged 15.39 ± 1.91, 92% female], 69 adults with AN [aged 26.5 ± 6.1, 98.6% female], and 118 adolescent healthy controls [HC] [aged 15.09 ± 2.14, 98.3% female]). RESULTS: Low scores on the D-KEFS were common across all groups. Adults with AN exhibited the highest proportion of individuals with abnormally low scores, followed by adolescents with AN and adolescent HC. Adolescents with a higher proportion of low scores had a lower BMI z-score and longer length of illness. CONCLUSIONS: Results highlight differences between adults and adolescents and lend support to the hypothesis that inefficiencies in flexibility are either a marker of persistent course or a scar of AN illness.

  PublisherOA PDFDOI

• Identifying Distinct Latent Profiles of Executive Functioning Among Adolescents and Adults With Anorexia Nervosa and Adolescent Healthy Controls

  European Eating Disorders Review · 2025-10-23

  articleOpen accessSenior authorCorresponding

  OBJECTIVE: Research suggests executive functioning (EF) inefficiencies contribute to anorexia nervosa (AN) onset and maintenance. Identifying EF subtypes in adolescents and adults with AN compared to healthy controls (HC) may provide insights into differences in illness severity, risk for prolonged illness, and highlight who could respond best to different treatments. METHOD: We conducted secondary analysis of 751 participants: adolescents (n = 559) and adults with AN (n = 74), and adolescent HC (n = 118). Latent profiles of six Delis Kaplan Executive Function System scores measuring EF constructs implicated in AN were derived. Differences across profiles on demographics, eating disorder cognitions (EDE/EDE-Q score), BMI/BMI z-score, length of illness, weight suppression, and full-scale IQ were examined. RESULTS: A three-profile solution best fit the data: Profile 1 (n = 324)-'high verbal', Profile 2 (n = 349)-'average', and Profile 3 (n = 78)-'low flexibility and inhibition'. The low flexibility and inhibition profile comprised 10.6% of adolescents with AN, 30.0% of adults with AN, and 1.7% of adolescent HCs. Compared to other profiles, this profile was older, had a longer illness duration, higher EDE global scores, lower BMI z-scores, and lower full-scale IQ scores. No profile differences emerged in BMI or EDE-Q global scores. DISCUSSION: Only a small subset of our sample showed marked difficulties in flexibility and inhibition, challenging the notion that EF difficulties are a core feature of AN. Adolescents with AN in this profile showed greater illness severity, suggesting vulnerability to a more prolonged course of illness. These findings are a first step towards developing tailored treatment strategies based on EF profiles.

  PublisherDOI

• Does cognitive functioning improve with weight restoration? An examination of changes in intelligence quotient scores in adolescents with anorexia nervosa before and after treatment

  Eating Disorders · 2025-09-10 · 1 citations

  articleSenior authorCorresponding

  = .02) scores. These findings suggest that IQ scores can improve throughout treatment, with shorter illness duration linked to greater improvements, underscoring the importance of early nutritional intervention.

  PublisherDOI

• Validation of the food craving acceptance and action questionnaire (FAAQ) in pregnancy

  Eating Behaviors · 2025-03-31

  articleSenior author
  PublisherDOI

• Visuospatial and Neuropsychological Functions in Eating Disorders

  2025-07-21 · 1 citations

  book-chapter1st authorCorresponding

  Abstract This chapter discusses the visuospatial and neuropsychological functioning in individuals with anorexia nervosa and bulimia nervosa. It briefly touches on binge-eating disorder, but does not cover avoidant/restrictive food intake disorder. This chapter focuses on central coherence, perceptual errors, memory, attention, and processing speed. The state of the research in adults with eating disorders is reviewed. While some impairments are consistently observed, data are equivocal for others. The research has been inconsistent due to the lack of standardization of measures, different normative groups, and small sample sizes. Moreover, research has primarily been cross-sectional in nature and conducted in adults (specifically white women), raising questions about whether deficits or alterations in function observed are part of general disorder etiology, a scar of the illness, or a risk factor in those with a chronic course. An overarching theoretical model linking visuospatial and neuropsychological functioning to eating disorder etiology and/or maintenance is largely missing from the literature. An alternative view highlights the need to focus efforts in this area in youth with eating disorders, specifically longitudinal research focusing on development. Future research on sex differences is needed. Last, different aspects of neuropsychological functioning need to be studied in tandem (as opposed to in isolation) to better understand how they impact one another.

  PublisherDOI

• Validation of the intolerance of uncertainty scale-12 in a sample of pregnant people

  BMC Pregnancy and Childbirth · 2025-03-27 · 2 citations

  articleOpen access

  BACKGROUND: Intolerance of uncertainty (IU) has been proposed as a transdiagnostic mechanism driving anxiety, depression, and eating disorder symptoms. Pregnancy is a time of significant uncertainty, yet few studies have examined the measurement of IU and its impacts on pregnant people. The current study aimed to examine the psychometric performance of two versions of the Intolerance of Uncertainty Scale (IUS-27 and IUS-12) and their associations with psychopathologies common in pregnancy. METHODS: This study is a secondary analysis of participants (n = 254) recruited for a larger study of a single-session intervention targeting disordered eating in pregnancy. We examined fit of participant baseline data with IUS-27 and IUS-12 factor structures using confirmatory factor analyses. We also assessed associations between IU and emotion dysregulation and depression and eating disorder symptoms, controlling for age, parity, and perceived social status. RESULTS: The IUS-12 provided superior fit to the data (CFI = 0.95; TLI = 0.93; RMSEA = 0.09) compared to the IUS-27. The IUS-12 was significantly (all p < 0.05) correlated with measures of emotion dysregulation (r = 0.67), depression (r = 0.58), and eating disorders (r = 0.37). Inhibitory IU rather than prospective IU was generally significantly associated with greater psychopathology (ß range = 0.46 - 3.51, p's < 0.01). CONCLUSIONS: Results from this study provide initial support for the IUS-12 as a valid measure of IU in pregnant people and suggest that IU is strongly associated with measures of depression, emotion dysregulation, and eating disorder behaviors in this population. Severe psychological distress in pregnancy has been linked to complications in gestation and delivery and overall poor birth outcomes. Clinicians and doctors should consider using the IUS-12 as a general measure of psychological distress among pregnant patients. TRIAL REGISTRATION: The trial from which these data were drawn is registered at clinicaltrials.gov, NCT06129461 (registered on November 10, 2023).

  PublisherOA PDFDOI

• Calculating Developmental Weight Suppression in Practice: A Commentary Demonstrating the Use and Misuse of Singh and Colleagues’ New Approach

  SSRN Electronic Journal · 2025-01-01

  preprintOpen accessSenior author
  PublisherDOI

Recent grants

• NIH Grant R21MH085975

  NIH · $406k · 2012

• Shifting Perspectives: Enhancing outcomes in adolescent anorexia nervosa with cognitive remediation therapy

  NIH · $739k · 2019–2021

• Shifting Perspectives: Enhancing outcomes in adolescent anorexia nervosa with cognitive remediation therapy

  NIH · $672k · 2019–2022

Frequent coauthors

• Giuseppe Riva

  26 shared

• Julia M. Hormes

  Albany State University

  25 shared

• Rebecka Peebles

  University of Pennsylvania

  24 shared

• Antonios Dakanalis

  University of Milano-Bicocca

  20 shared

• Nancy Zucker

  University of Pennsylvania

  19 shared

• Aletha Y. Akers

  17 shared

• Massimo Clerici

  Istituti di Ricovero e Cura a Carattere Scientifico

  15 shared

• Natalia C. Orloff

  Children's Hospital of Philadelphia

  14 shared

Labs

• Timko Research GroupPI

Education

• PhD, Dept. of Psychology

  Drexel University