Bulimia Nervosa (BN) is a serious and complex eating disorder characterized by repeated episodes of binge eating followed by compensatory behaviours, such as vomiting, excessive exercise, or misuse of laxatives. Affecting primarily adolescent and young adult women, bulimia is associated with profound psychological distress, medical complications, and a high comorbidity with mood disorders such as depression and anxiety.
Despite the availability of psychotherapy and pharmacotherapy, a substantial number of patients experience incomplete symptom control or treatment resistance. This has led to growing interest in innovative neuromodulation techniques like Repetitive Transcranial Magnetic Stimulation (rTMS), a non-invasive brain stimulation method that offers new hope in the management of bulimia nervosa.
Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnetic pulses to target specific brain areas involved in self-control, impulse regulation, mood, and eating behaviours. In the context of bulimia, the primary stimulation site is the left dorsolateral prefrontal cortex (DLPFC) — a brain region associated with decision-making, emotional regulation, and inhibition of compulsive behaviours.
• High-frequency (typically 10–20 Hz) stimulation over the left DLPFC has been shown to enhance prefrontal activity, improving cognitive control over food cravings and emotional impulsivity.
• Neuroimaging studies reveal that bulimia nervosa is associated with hypoactivity in prefrontal regions and hyperactivity in emotional and reward-related areas. By rebalancing these networks, Repetitive Transcranial Magnetic Stimulation(rTMS) may reduce binge urges and associated depressive symptoms.
Several clinical trials, meta-analyses, and case studies have evaluated Repetitive Transcranial Magnetic Stimulation (rTMS) for bulimia, with promising results:
• Reduction in Binge and Purge Episodes:
Multiple studies reported significant reductions in the frequency of binge eating and purging behaviors after rTMS treatment. Some patients even achieved complete remission following several sessions of high-frequency rTMS.
• Improvement in Depression and Mood Symptoms:
Since bulimia often co-occurs with depression, rTMS’s known antidepressant effects contribute to better overall outcomes. Functional imaging studies showed that stimulation of the DLPFC improves serotonergic transmission and normalizes mood regulation.
• Food Craving and Impulse Control:
Repetitive Transcranial Magnetic Stimulation (rTMS) appears to help reduce intense food cravings and improve inhibitory control — crucial elements in managing binge episodes.
• Safe and Well-Tolerated:
Across studies, rTMS was generally very well tolerated, with only mild side effects such as transient headache or scalp discomfort reported. No serious adverse events, such as seizures, were observed.
Research suggests several possible mechanisms by which rTMS alleviates bulimic symptoms:
• Enhancing Prefrontal Cortex Activity: improving top-down control over emotional and impulsive behaviors.
• Normalizing Serotonergic Dysfunction: modulating neurotransmitter systems implicated in both depression and bulimia.
• Reducing Hyperactivity in Emotional Brain Centers: like the anterior cingulate cortex and orbitofrontal cortex.
• Facilitating Neuroplasticity: promoting healthier brain circuit reorganization over time.
Repetitive Transcranial Magnetic Stimulation (rTMS) may be particularly suitable for:
• Patients with treatment-resistant bulimia nervosa who have not responded adequately to psychotherapy or medication.
• Individuals with coexisting depression or anxiety.
• Those seeking a non-pharmacological, brain-directed therapy.
• Patients aiming for improved impulse control and reduced food cravings without additional drug burden.
Sessions typically last around 20–30 minutes, are performed on an outpatient basis, and require multiple sessions to achieve optimal results.