Abstract
BackgroundEvidence suggests that pathological eating behaviours in bulimia nervosa (BN) are underpinned by alterations in reward processing and self-regulatory control, and by functional changes in neurocircuitry encompassing the dorsolateral prefrontal cortex (DLPFC). Manipulation of this region with transcranial direct current stimulation (tDCS) may therefore alleviate symptoms of the disorder.ObjectiveThis double-blind sham-controlled proof-of-principle trial investigated the effects of bilateral tDCS over the DLPFC in adults with BN.MethodsThirty-nine participants (two males) received three sessions of tDCS in a randomised and counterbalanced order: anode right/cathode left (AR/CL), anode left/cathode right (AL/CR), and sham. A battery of psychological/neurocognitive measures was completed before and after each session and the frequency of bulimic behaviours during the following 24-hours was recorded.ResultsAR/CL tDCS reduced eating disorder cognitions (indexed by the Mizes Eating Disorder Cognitions Questionnaire-Revised) when compared to AL/CR and sham tDCS. Both active conditions suppressed the self-reported urge to binge-eat and increased self-regulatory control during a temporal discounting task. Compared to sham stimulation, mood (assessed with the Profile of Mood States) improved after AR/CL but not AL/CR tDCS. Lastly, the three tDCS sessions had comparable effects on the wanting/liking of food and on bulimic behaviours during the 24 hours post-stimulation.ConclusionsThese data suggest that single-session tDCS transiently improves symptoms of BN. They also help to elucidate possible mechanisms of action and highlight the importance of selecting the optimal electrode montage. Multi-session trials are needed to determine whether tDCS has potential for development as a treatment for adult BN.
Highlights
Bulimia nervosa (BN) is characterised by recurrent episodes of binge-eating and inappropriate compensatory behaviours
TDCS sessions had comparable effects on the wanting/liking of food and on bulimic behaviours during the 24 hours post-stimulation. These data suggest that single-session transcranial direct current stimulation (tDCS) transiently improves symptoms of bulimia nervosa (BN)
Multi-session trials are needed to determine whether tDCS has potential for development as a treatment for adult BN
Summary
Bulimia nervosa (BN) is characterised by recurrent episodes of binge-eating and inappropriate compensatory behaviours. BN [14] and binge-eating more generally [15] are associated with impaired reactive response inhibition, and our group recently observed an increased propensity to devalue delayed rewards (a concept known as temporal discounting; TD) in patients with BN relative to healthy controls [16, 17] Neuroimaging studies suggest these difficulties are related to hypoactivity in circuitry that supports self-regulatory capacities [18, 19]. Evidence suggests that pathological eating behaviours in bulimia nervosa (BN) are underpinned by alterations in reward processing and self-regulatory control, and by functional changes in neurocircuitry encompassing the dorsolateral prefrontal cortex (DLPFC) Manipulation of this region with transcranial direct current stimulation (tDCS) may alleviate symptoms of the disorder
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