About

Nancy Lee Zucker is a Professor in Psychiatry and Behavioral Sciences at Duke University, with a focus on studying individuals who have difficulty detecting, interpreting, and using signals from their bodies to guide adaptive behavior. Her laboratory explores how disruptions in these capacities contribute to psychosomatic disorders such as functional abdominal pain and anorexia nervosa, as well as feeding disorders of childhood. Her research emphasizes understanding how deficits in interoception and integration of internal arousal influence these conditions, with particular attention to conditions like anorexia nervosa, Avoidant Restrictive Food Intake Disorder (ARFID), and pediatric functional abdominal pain. She investigates how children’s disorder etiology, maintenance, and course can be better understood by minimizing the impact of malnutrition on brain function and examining prior learning history. Zucker is passionate about designing and testing novel treatments that help individuals feel safe in their bodies and achieve this in engaging ways. Her work also examines how individuals sense others, especially in cases where sensing oneself is impaired, to better understand the interaction between sensing oneself and understanding others. She holds current appointments as a Professor in Psychiatry and Behavioral Sciences, Director of Graduate Studies in the Department of Psychology and Neuroscience, and Professor of Psychology and Neuroscience at Duke, with affiliations at the Duke-UNC Brain Imaging and Analysis Center.

Research topics

• Psychology
• Medicine
• Psychiatry
• Internal medicine
• Psychotherapist
• Developmental psychology
• Pediatrics
• Radiology
• Clinical psychology
• Audiology

Selected publications

• A Randomized Trial Testing a Body-Focused Exposure Treatment of Functional Abdominal Pain in Children

  The American Journal of Gastroenterology · 2026-03-31

  article1st authorCorresponding

  INTRODUCTION: Functional abdominal pain (FAP) in young children is common, persistent, and associated with significant impairment and risk of later anxiety disorders. Current treatments often emphasize distraction from pain, which may preclude long-term fear reduction. We tested a novel exposure-based intervention that encourages children to focus on potentially uncomfortable bodily sensations with playful curiosity (Feeling and Body Investigators; FBI) compared with developmentally modified components of current best practices emphasizing distraction (Caregivers in Action; CIA). METHODS: In a randomized clinical trial, 107 parent-child dyads (children ages 5-9 with FAP) were assigned to either the FBI or CIA condition, each consisting of 10 weekly sessions. Primary outcomes were child and parent-reported pain intensity, frequency, duration, and interference. Secondary outcomes were negative affect and pain-related distress. Mixed-model and nonparametric analyses evaluated within-group and between-group changes. RESULTS: Both interventions resulted in significant reductions in pain intensity, frequency, duration, and interference, as well as improvements in negative affect and distress (all P < 0.01). However, neither approach was shown to be superior. Both treatments were rated highly acceptable by parents and children, with over 90% of parents reporting that the treatment helped them manage their child's symptoms. DISCUSSION: Both the FBI and CIA interventions reduced pain and improved emotional functioning in young children with FAP. Although the 2 approaches differed in their focus on attention to pain and use of exposure strategies, they were not significantly different. These findings provide pediatricians and mental health providers with evidence-based options for treating young children with FAP.

  PublisherDOI

• The Feasibility of Using Best Practice Alerts in Pediatric Primary Care for Obesity Research

  Academic Pediatrics · 2026-03-26

  article
  PublisherDOI

• The diagnosis of avoidant restrictive food intake disorder in the presence of gastrointestinal disorders: Opportunities to define shared mechanisms of symptom expression

  UNC Libraries · 2026-04-16

  articleOpen access1st authorCorresponding

  OBJECTIVE: Individuals with a gastrointestinal (GI) disorder often alter their diet to manage GI symptoms, adding complexity to understanding the diverse motivations contributing to food avoidance/restriction. When a GI disorder is present, the DSM-5 states that Avoidant/Restrictive Food Intake Disorder (ARFID) can be diagnosed only when eating disturbance exceeds that expected. There is limited guidance to make this determination. This study attempts to address this gap by characterizing the presentation of ARFID in adults with and without a self-reported GI disorder. METHOD: Participants were 2,610 adults ages 18-44 who self-identified as "picky eaters." Participants reported on motivations for food avoidance, affective experiences towards food, and perceived impairment. Responses were compared across four groups: GI issues and likely ARFID (L-ARFID/GI), L-ARFID-only, GI-only, and No-ARFID/No-GI. RESULTS: Groups with a GI disorder (L-ARFID/GI, GI-only) reported more fear of aversive consequences of eating than those without a GI disorder, while groups with L-ARFID (L-ARFID, L-ARFID/GI) evidenced significantly greater sensory aversion to food and indifference to food or eating, negative emotional reactions to food and overall disgust sensitivity, and eating related impairment. DISCUSSION: Consideration of the interplay of a GI disorder with ARFID can add precision to case conceptualization. Food avoidance may be attempts to manage fears of aversive consequences that are augmented by a history of GI symptoms, while sensory aversions and negative emotional reactions towards foods may be more elevated in ARFID. These findings emphasize the need to consider an ARFID diagnosis in patients with GI disorders to optimize care.

  PublisherDOI

• Peer support: Current status and future opportunities for college mental health promotion

  Journal of American College Health · 2025-07-14

  articleSenior authorCorresponding

  The past decade has seen a 60% increase in the number of programs providing peer mental health support. The availability, nature, and training requirements of programs varied widely, with implications for quality of support and stress on trainees. Greater collaboration may improve the impact of these programs.

  PublisherDOI

• BALANCING FLEXIBILITY AND FIDELITY: ADAPTING PROTOCOL-BASED INTERVENTIONS FOR SEVERE AND ENDURING RESTRICTIVE EATING DISORDERS

  Journal of the American Academy of Child & Adolescent Psychiatry · 2025-10-01

  articleSenior authorCorresponding
  PublisherDOI

• Facets of Dietary Restraint Associated With Disordered Eating Behaviors Among Children and Adolescents With Higher Weight

  Obesity · 2025-11-18

  articleOpen access

  OBJECTIVE: Self-directed dietary restraint (i.e., outside of evidence-based weight management programs) has been associated with disordered eating in youth. This study examined associations between maladaptive facets of dietary restraint and disordered eating among youth with higher weight. METHODS: Participants (N = 529; mean age = 10.8 ± 2.08; BMI ≥ 85th percentile) self-reported dietary restraint (restraint over eating, avoidance of eating, food avoidance, desire for an empty stomach, and dietary rules) and disordered eating behaviors (i.e., objective and subjective binge eating, driven exercise, and vomiting) over the past 3 months. Network analysis estimated partial correlations between restraint factors and disordered eating behaviors. RESULTS: The restraint item most strongly associated with disordered eating behaviors was "dietary rules," which was associated with "driven exercise" and "subjective binge eating." The disordered eating behavior most strongly connected to restraint was "subjective binge eating," which was positively associated with "dietary rules," "desire for an empty stomach," and "food avoidance." CONCLUSIONS: Trying to follow definite dietary rules may be associated with disordered eating behaviors in youth with higher weight. Prospective research is needed to examine causality among youth undergoing weight management interventions, which could inform screening and monitoring of restraint prior to and during weight management.

  PublisherOA PDFDOI

• The Gender Euphoria Scale (GES): Development of a tool to measure gender euphoria

  International Journal of Transgender Health · 2025-01-20 · 5 citations

  articleOpen access

  Background: Gender euphoria is a concept that arose from within the trans and gender diverse (hereafter trans) community to describe positive feelings associated with gender identity, expression, and affirmation. Despite its importance within the trans population, there is currently no consistent, valid or reliable way of measuring gender euphoria. Accordingly, this article describes the development and validation of a tool to measure gender euphoria in trans individuals. Method: An initial 121-item pool for the scale was developed based on qualitative research and a review of existing tools measuring related psychological constructs in trans adults. Trans researchers and experts in trans health reviewed and revised the items, enabling development of a preliminary scale which was pilot tested with a trans community advisory group before being further refined and administered to a larger cohort of trans individuals. A subgroup of individuals within the cohort repeated the scale two weeks following the initial completion to assess for test-retest reliability. Results: = .88), and some evidence of discriminant and convergent validity. Conclusion: The GES is a reliable and consistent tool to measure gender euphoria in trans individuals and is likely to be of value in both research and clinical settings.

  PublisherOA PDFDOI

• A Feasibility Study of Group Caregiver Training for the Prevention of Obesity (GCT-O) in African American Preschoolers

  UNC Libraries · 2025-09-18

  articleOpen access

  Obesity prevention is a priority for African American (AA) children. However, effective programs are sparse. We therefore conducted a feasibility study of an 8-week group caregiver training program for obesity prevention (GCT-O) targeting parental self-efficacy in family-based lifestyle change. Twenty primary caregivers of overweight and obese (BMI z score M = 2.46, SD = .93), AA preschoolers (M = 4.10 y, SD = 1.48, 70% female) participated in an open-trial of GCT-O within a community setting serving primarily low-income, AA families. Caregivers completed assessments of parenting and child behavior at baseline and postintervention, and feasibility/acceptability questionnaires at postintervention. Child height and weight were measured at both time points and at 3-month follow-up. Retention through postintervention was 75%. Average attendance was M = 5.12, SD = 2.12 of 8 sessions. Caregivers reported enjoying the program (100%), and found it helpful (87%) and feasible (79%). Postintervention, caregivers reported less authoritarian (p = .02) and permissive (p = .03) parenting, improved feeding practices (p = .03), and a reduction in youth&rsquo;s lifestyle-related problem behaviors (p = .01). Caregiver report of children&rsquo;s daily caloric intake decreased from baseline to postintervention (p = .04). Parental self-efficacy did not improve postintervention (p = .23). Child BMI z score was unchanged postintervention (p = .70), but decreased significantly by 3-month follow-up (p = .02). GCT-O was feasible and acceptable to program completers. Preliminary results suggest that GCT-O may improve caregiver and child behavior and prevent excess weight gain among AA preschoolers. An adequately powered and controlled efficacy trial is warranted.

  PublisherDOI

• Interactive cooking lessons improve attitudes towards food and weight statuses among preschool children

  Health Education Journal · 2025-02-06

  articleOpen accessSenior author

  Objective: Data demonstrate that children in the USA eat below the recommended amount of fruits and vegetables, which has been linked with increased risk of obesity and low weight. Previous school-based interventions promoting healthy eating and enjoyment of food have yielded outcomes such as improved weight and children’s willingness to try novel foods. Therefore, we explored whether interactive cooking lessons could be an effective means of food exposure to fruit and vegetables, and improve weight statuses among young children. Design: This study utilised a community-based intervention. Setting: Head Start classrooms in a southern state of the USA. Methods: Monthly lessons led by classroom teachers introduced students to novel foods and explained nutritional benefits and guiding children through snack preparation and mindful appreciation of the new food. Teachers completed the Food Fussiness and Food Enjoyment subscales of the Child Eating Behaviour Questionnaire and recorded body mass index (BMI) percentiles, which were collected by trained Family Engagement Specialists, for each student at the beginning and end of the school year. Results: Among 614 Head Start students, children demonstrated a significant decrease in food fussiness ( p &lt; .001) and increase in food enjoyment ( p &lt; .001). There were significant changes ( p &lt; .001) in BMI percentile. Children with high weight lost 16.9 percentile points over the year compared to those with healthy weight. Conversely, children with low weight gained 24.7 percentile points. Conclusion: Developmentally appropriate interactive cooking lessons that expose young children to fruit and vegetables in a social setting may be an effective strategy for improving attitudes towards food and weight statuses. Additional data are required to fully understand the mechanisms that cause beneficial weight changes in preschool age children.

  PublisherDOI

• Longitudinal associations of trauma exposure with disordered eating: lessons from the Great Smoky Mountains Study

  2025-01-27

  book-chapter

  Disordered eating is prevalent among trauma survivors, yet little is known about mechanisms underlying this relation. We explored cross-sectional and longitudinal associations of trauma exposure and posttraumatic stress disorder symptoms (PTSD) with disordered eating among 1,420 community-based youth participating in the Great Smoky Mountain Study. Participants were interviewed about trauma exposure, PTSD symptoms, and disordered eating at regular intervals throughout childhood, adolescence, and early adulthood. Our findings confirmed associations of all forms of trauma exposure (violent, sexual, and other) with disordered eating symptoms in childhood and adulthood, although the pattern of results varied by disordered eating symptom and trauma exposure type. Only non-sexual, non-violent trauma exposure in childhood had significant associations with any disordered eating symptoms in adulthood. Within childhood, trauma exposures but not PTSD symptoms showed significant longitudinal associations with bulimia nervosa symptoms and sustained appetite changes and preoccupation with eating. In adulthood, PTSD symptoms but not trauma exposures showed significant longitudinal associations only with bulimia nervosa symptoms. The association of specific PTSD clusters on bulimia nervosa symptoms was significant for reexperiencing, whereas hyperarousal symptoms trended toward significance. The impact of trauma exposures on disordered eating may vary by developmental period.

  PublisherDOI

Recent grants

• NIH Grant R21MH097959

  NIH · $495k · 2016

• NIH Grant K23MH070418

  NIH · $667k · 2010

• Feelings/Body Investigators:Interoceptive Exposure for Children w/Abdominal Pain

  NIH · $819k · 2013–2019

• NIH Grant RC1MH088678

  NIH · $993k · 2012

• NIH Grant R01MH078211

  NIH · $387k · 2010

Frequent coauthors

• Rhonda M. Merwin

  Duke University Hospital

  43 shared

• Cynthia M. Bulik

  Karolinska Institutet

  41 shared

• Mickaël Tanter

  Inserm

  32 shared

• Sophie Pezet

  Centre National de la Recherche Scientifique

  32 shared

• Alexandre Bergel

  CTI BioPharma (Italy)

  32 shared

• M Matei

  Inserm

  32 shared

• Scott H. Kollins

  Duke University

  28 shared

• Ashley A. Moskovich

  Duke University

  27 shared