Abstract
The term “eating disorders” (ED) encompasses a wide variety of disordered eating and compensatory behaviors, and so the term is associated with considerable clinical and phenotypic heterogeneity. This heterogeneity makes optimizing treatment techniques difficult. One class of treatments is non-invasive brain stimulation (NIBS). NIBS, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), are accessible forms of neuromodulation that alter the cortical excitability of a target brain region. It is crucial for NIBS to be successful that the target is well selected for the patient population in question. Targets may best be selected by stepping back from conventional DSM-5 diagnostic criteria to identify neural substrates of more basic phenotypes, including behavior related to rewards and punishment, cognitive control, and social processes. These phenotypic dimensions have been recently laid out by the Research Domain Criteria (RDoC) initiative. Consequently, this review is intended to identify potential dimensions as outlined by the RDoC and the underlying behavioral and neurobiological targets associated with ED. This review will also identify candidate targets for NIBS based on these dimensions and review the available literature on rTMS and tDCS in ED. This review systematically reviews abnormal neural circuitry in ED within the RDoC framework, and also systematically reviews the available literature investigating NIBS as a treatment for ED.
Highlights
The term “eating disorders” (ED) encompasses a wide variety of disordered eating and compensatory behaviors that inappropriately alter the patient’s body shape or weight, or the subjective experience of one’s own body shape or weight
On resting-state fMRI, we found increased resting-state functional connectivity in fronto-striatal salience network circuits in the treatment responders but not non-responders (Dunlop J. et al, 2015), consistent with similar findings for DMPFC-rTMS in MDD and obsessive-compulsive disorder (Salomons et al, 2014; Dunlop K. et al, 2015)
These findings suggest that DMPFC-rTMS may improve bulimic symptoms through an improvement of topdown cognitive control over urges, via frontostriatal circuits through salience-network nodes
Summary
The term “eating disorders” (ED) encompasses a wide variety of disordered eating and compensatory behaviors that inappropriately alter the patient’s body shape or weight, or the subjective experience of one’s own body shape or weight. The lifetime prevalence of the top three EDs according to the DSM-5 diagnostic criteria is 2.3, 1.7, and 0.8% for adolescent binge eating disorder (BED), anorexia nervosa (AN), and bulimia nervosa (BN), respectively (Golden et al, 2003; Hudson et al, 2007; Smink et al, 2014). BED is associated with recurrent episodes of binging, typically during negative affect (Leehr et al, 2015), and with the absence of inappropriate compensatory behaviors to avoid weight gain. Both AN and BN are associated with disturbances in the subjective experience of one’s own body shape or weight; this phenotype is known as body. AN has two subtypes, restricting (ANR) and binge-eating/purging (ANBP), with the latter distinguished from the former by the presence of binges and/or purges
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