fMRI TMS Can Identify and Correct the Network Causing an Eating Disorder

Decreased fronto-caudate connectivity in a patient with anorexia nervosa (cortical-subcortical view)

There is a commonly-held misconception that eating disorders are a lifestyle choice. Eating disorders (EDs) are serious and are associated with severe disturbances in people’s eating behavior, related thoughts, and emotions.

Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa (AN), bulimia nervosa (BM), and binge-eating disorder.

In the study of brain circuitry underlying EDs, scientists have focused on the reward circuitry. Eating palatable food increases activation in regions involved in reward such as the ventral and dorsal striatum, midbrain, amygdala, and orbitofrontal cortex1.

Decreased fronto-caudate connectivity in a patient with anorexia nervosa (subcortico-cortical view)

Increased or decreased functional resting-state connectivity has also been observed in EDs compared to controls, implicating networks associated with executive function, reward processing, and perception2. Choosing low-fat vs. high-fat foods increases connectivity between dorsal caudate and dorsolateral prefrontal (DLPFC) regions in patients with AN, which is implicated in actual food intake eaten, thus making the DLPFC a region of considerable interest3.

There is evidence for EDs symptom reduction following rTMS in both AN and BN4-6. As such, TMS has potential for reducing EDs symptomatology and related behaviours, and for altering food intake and body weight.

By identifying the underlying network associated with the disorder through fMRI imaging, we can treat the biological side of this disorder. Call us to understand more about our unique approach.


1. Val-Laillet D, Aarts E, Weber B, Ferrari M, Quaresima V, Stoeckel LE, Alonso-Alonso M, Audette M, Malbert CH, Stice E. Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity. Neuroimage Clin. 2015 Mar 24;8:1-31.

2. Frank GKW, Shott ME, DeGuzman MC. The Neurobiology of Eating Disorders. Child Adolesc Psychiatr Clin N Am. 2019 Oct;28(4):629-640.

3. Foerde K, Steinglass JE, Shohamy D, Walsh BT. Neural mechanisms supporting maladaptive food choices in anorexia nervosa. Nat Neurosci. Nov 2015;18(11):1571-1573.

4. McClelland J, Bozhilova N, Campbell I, Schmidt U. A systematic review of the effects of neuromodulation on eating and body weight: evidence from human and animal studies. Eur Eat Disord Rev. 2013 Nov;21(6):436-55.

5. Van den Eynde F, Guillaume S, Broadbent H, Campbell IC, Schmidt U. Repetitive transcranial magnetic stimulation in anorexia nervosa: a pilot study. Eur Psychiatry. 2013 Feb;28(2):98-101.

6. McClelland J, Kekic M, Bozhilova N, Nestler S, Dew T, Van den Eynde F, David AS, Rubia K, Campbell IC, Schmidt U. A Randomised Controlled Trial of Neuronavigated Repetitive Transcranial Magnetic Stimulation (rTMS) in Anorexia Nervosa. PLoS One. 2016 Mar 23;11(3):e0148606.

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