Eating disorders represent a significant concern because they come with risks of physical health problems, high morbidity rates, and mortality. Current treatment for eating disorders revolves around nutritional education and therapy to address any underlying factors, but in many of these treatments, fewer than half of patients see any substantial recovery. For that reason, TMS for eating disorders has become a popular area of research. 

TMS therapy for eating disorders has seen a growing interest as a non-invasive brain stimulation technique as a novel therapeutic approach.

Understanding Eating Disorders

Eating disorders are a group of mental health disorders characterized by chronic and severely impaired eating behaviors. Around the world, eating disorders affect women more than men, with the most common being:

1.  anorexia nervosa
2.  bulimia nervosa
3.  binge eating disorder

Anorexia comes with high rates of morbidity and significant risks for overall health. Those who live with anorexia have an intense fear of gaining weight, and this fear leads them to avoid the foods they should consume, which generally keeps them at a below-ideal level for body weight. It’s not uncommon for people with anorexia to be in denial about low body weight and to view weight or shape differently than is real. 

Characteristics like starvation, over-exercising, and purging mean that anorexia has one of the highest mortality rates of all mental health disorders. An average of 12% of people with anorexia take their own life or die because of health complications.

Bulimia and binge eating disorders are very similar. With bulimia, an individual will utilize binge eating and then try to compensate for how much they consume with things like laxatives, excessive exercise, or vomiting. Binge eating disorder is when an individual has uncontrollable binge eating episodes, but they don’t follow up with compensatory behaviors.

Challenges in Eating Disorder Treatment

There are several challenges in eating disorder treatment because eating disorders are generally multifactorial, which means they involve several factors:

• Neurobiological factors
• Negative emotionality, OCD, or perfectionism
• Genetic factors

In many people who have an eating disorder, the reward system in the brain promotes unhealthy behaviors. However, current treatment centers on conventional therapy like cognitive behavioral therapy as well as antidepressants. However, less than half of patients actually recover from anorexia, and only one-third see any improvement at all, even when using medication and therapy at the same time. This means that there is a significant demand for a more effective form of treatment.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation has been introduced as a potential treatment for several Eating Disorders, including:

1.  Anorexia
2.  Bulimia nervosa
3.  Unspecified eating disorders

Evidence for TMS in Eating Disorder Treatment

TMS eating disorder treatment shows great promise.

Results across several clinical studies have shown that TMS offers promising therapeutic effects for many affective functioning experienced by those with eating disorders, including anxious symptoms, negative affectivity, and depressive symptoms. Moreover, there have been large improvements in body mass index for those struggling with eating disorders.

But how does it work?

Mechanisms of TMS Action in Eating Disorders

Transcranial magnetic stimulation is a non-invasive procedure that relies on magnetic stimulation directed into deep areas of the brain. This stimulates blood flow and helps areas that are over or underactive. There are several mechanisms of TMS action in eating disorders.

Reward Center

With anorexia, many individuals have dysfunction in the neuro-circuitries for their dopamine pathways, which means they have malfunctions between their limbic and cortical systems and their body image, emotional processing, and reward-based behaviors. 

TMS anorexia treatment can target structural abnormalities in the following ways:

1. Dorsolateral prefrontal cortex 
2. Anterior cingulate cortex

By targeting both of these areas, individuals have improved self-regulatory mechanisms that can help them control their eating behavior and change their cognition about eating, weight, and exercise. 

TMS for eating disorders like bulimia can, instead, target neural networks in the:

1. Ventral limbic network
2. Dorsal cognitive frontostriatal neural networks

Doing so helps to improve self-regulatory abilities, which decreases erratic eating behaviors and changes the reward system for them.

Neuromodulation 

Neuromodulation by way of TMS therapy can change the functions of the central nervous system. Emotional and eating behaviors are influenced by that function. As such, the use of TMS can be used to target deep areas of the brain responsible for eating disorder symptoms and offer neuromodulation that elicits changes. 

Several studies with a wide range of participants have found that such neuromodulation through TMS eating disorders treatment has clinical potential. 

Safety and Tolerability of TMS

Several studies have confirmed the safety and tolerability of TMS anorexia treatment, with side effects limited to short-term:

• Headaches
• Local tingling at the stimulation site
• Dizziness

Since 2008, when the FDA approved the use of TMS for other treatments like MDD, the safety and tolerability have been regularly tested. The safety record of TMS as a treatment for mental health conditions continues to be supported. 

Integrating TMS into Multimodal Treatment

TMS should be integrated into multimodal treatment. it should not be the only form of treatment. Things like traditional therapy used to improve self-regulation or tackle genetic contributors can still be useful when used in conjunction with TMS. 

In fact, TMS can improve facets of the brain that make it more challenging for lessons learned in therapy about regulation to take hold, which means the efficacy of therapy is increased when used in conjunction with TMS.

Patient Experiences and Perspectives

Many patients experience improvement within the first few weeks of treatment. TMS eating disorders treatment is best when used in conjunction with other forms of treatment particularly therapy and nutritional education.

Summing Up

TMS shows great promise for eating disorder treatment because it offers a way to change areas of the brain, which imaging has revealed to be heavily associated with various eating disorders. TMS therapy is a promising treatment modality for eating disorders, and those who are struggling with these challenging conditions should further explore TMS as an option for existing treatment plans.