Eating disorders are serious mental health conditions that can disrupt multiple aspects of a person’s life. While many people find relief through traditional treatments like therapy or nutritional support, not everyone responds to conventional care. In fact, up to 30% of people with eating disorders – particularly those with anorexia nervosa – experience treatment-resistant symptoms that don’t improve over time.
In recent years, researchers have explored new ways to support recovery in those hard-to-treat cases. One of the most promising developments is TMS, a non-invasive brain stimulation therapy already approved by the FDA for depression, OCD, and anxiety. In this article, we’ll explore all you need to know about TMS for eating disorders, including how it works and what the research says.
What is an eating disorder?
An eating disorder is a serious mental health condition that affects the way a person thinks and feels about food, eating, and their body. It involves more than just unhealthy eating habits – it’s a complex psychological and physical illness that can severely impact a person’s emotional well-being, physical health, and daily life.
Eating disorders can happen to anyone, regardless of their age, gender, body type, background, or lifestyle. They’re often driven by a combination of genetic, emotional, and environmental factors. While some eating disorders involve eating very little, others involve eating large amounts of food in a short time or feeling out of control around food.
According to the American Psychological Association, eating disorders are marked by a ‘pathological disturbance of attitudes and behaviors related to food’. The National Eating Disorders Association describes them as both mental and physical illnesses that can be treated with the right support.
Types of eating disorders
There are several types of eating disorders, including:
- Anorexia nervosa: Characterized by restricted eating and significant weight loss that often results in a very low BMI. Individuals may have a distorted body image and an intense fear of gaining weight.
- Bulimia nervosa: Involves repeated cycles of binge eating (eating large amounts of food in one sitting) followed by purging behaviors such as vomiting, over-exercising, or using laxatives.
- Binge eating disorder (BED): Marked by frequent episodes of eating large quantities of food while feeling a loss of control. Unlike bulimia, BED doesn’t follow with purging.
- Avoidant/restrictive food intake disorder (ARFID): Involves limiting food intake due to low interest in food, sensory sensitivities, or fear of choking or vomiting – without concerns of weight or body image.
- Other specified feeding and eating disorders (OSFED): When a person shows disordered eating patterns but doesn’t meet the full criteria for one specific diagnosis.
Some individuals experience symptoms that overlap multiple disorders or don’t fit neatly into one category. These are often referred to as atypical or sub-clinical eating disorders. While they may not meet the formal criteria for diagnosis, they’re still very real and can be just as distressing. It’s important that these conditions are taken seriously.
Eating disorders and mental health
While eating behaviors are the most visible symptoms of an eating disorder, they are often rooted in deeper emotional struggles. Eating disorders may serve as a way to cope with feeling like anxiety, shame, fear, or lack of control. For this reason, understanding and treating the emotional side of an eating disorder is just as important as addressing physical symptoms.
Some eating disorders can be life-threatening. For example, anorexia nervosa has the highest mortality rate of any mental illness. But recovery is possible with timely, compassionate care.
What causes eating disorders?
Eating disorders are complex and there’s rarely a single cause. Instead, they often develop through a combination of emotional, psychological, environmental, and biological factors such as:
- Personality traits: Certain characteristics, like low self-esteem, perfectionism, high sensitivity, or being overly self-critical, may increase the risk of developing an eating disorder.
- Life experiences: Traumatic or stressful events, such as bullying, abuse, grief, or major life transitions, can play a role.
- Family dynamics: Family environments marked by high expectations, criticism, or rigid rules may contribute to disordered eating patterns.
- Sociocultural pressures: While not a direct cause, societal messages around body image, diet culture, and beauty standards can shape how an individual views themselves and their eating habits.
- Mental health conditions: Anxiety, major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and other mental health conditions often appear alongside or can contribute to eating disorders.
- Biological and genetic factors: Genetics and brain chemistry may influence how someone responds to stress, processes emotions, or regulates hunger and satiety, all of which can impact eating behavior.
It’s important to remember that eating disorders are not a choice. They’re serious mental health conditions that deserve understanding and proper care. No single cause can explain why someone develops an eating disorder, which is why an individualized approach to treatment is so important.
Signs and symptoms of eating disorders
Below are the primary emotional, behavioral, and physical signs and symptoms of eating disorders. These symptoms can appear in varying combinations and intensities, depending on the individual and the specific disorder.
Emotional and behavioral symptoms include:
- Preoccupation with weight, dieting, and control of food
- Obsessive focus on body shape and size
- Intense fear of gaining weight or being perceived as ‘fat’
- Rigid food rituals, such as cutting food into tiny pieces or excessive chewing
- Strict tracking of calories, fat, or carbohydrates
- Refusing certain foods or skipping meals entirely
- Extreme discomfort eating in front of others
- Strong desire to feel or look thin
- Mood swings, irritability, or anger
- Withdrawing from social situations, family, or favorite activities
- Disrupted sleep (i.e. too much or too little).
Physical symptoms include:
- Binge eating
- Purging behaviors (e.g. self-induced vomiting or misusing laxatives)
- Significant weight fluctuations
- Persistent dizziness or fainting
- Muscle weakness and fatigue
- Digestive issues, such as nausea or stomach pain
- Feeling cold all the time
- Dry skin, brittle nails, and hair thinning
- Yellowish skin tone or fine hair growth on the body
- Missed or irregular menstrual periods
- Poor wound healing or frequent illness
- Dental issues, such as cavities or erosion caused by purging
- Calluses or cuts on knuckles or fingers from self-induced vomiting.
How are eating disorders treated?
Treating an eating disorder often involves a combination of therapies and medical support. It can be complex and won’t always work the same way for everyone. The standard treatment protocol for eating disorders typically includes:
- Psychotherapy: Specifically, evidence-based therapies like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT), which help individuals address distorted thoughts and build healthy coping skills.
- Family therapy: Involving loved ones in treatment can be crucial, especially for adolescents. Family therapy can foster support and address family dynamics that can help aid recovery.
- Nutritional counseling: Registered dietitians help create balanced meal plans, correct nutritional deficiencies, and repair an individual’s relationship with food.
- Medical monitoring: Because eating disorders can cause serious physical complications, ongoing medical check-ups are essential to ensure physical health and safety.
- Psychiatric support: Medication management and regular evaluation by a licensed therapist can be helpful, particularly when there are co-occurring conditions like anxiety, OCD, or depressive symptoms.
While this integrated approach helps many people recover, nearly 30% of individuals with clinically diagnosed eating disorders do not respond fully to traditional treatments. This is known as treatment resistance. For these individuals, symptoms may persist despite months – or even years – of therapy and support.
In these situations, transcranial magnetic stimulation (TMS) is offering a new path forward for those who don’t respond to traditional treatments.
What is transcranial magnetic stimulation (TMS)?
Transcranial magnetic stimulation (TMS) is an innovative, non-invasive brain stimulation therapy that uses gentle magnetic pulses to stimulate specific areas of the brain. This targeted stimulation can lead to meaningful changes in mood, thought patterns, and behavior – particularly in people whose symptoms haven’t improved with conventional treatments.
TMS was first approved by the U.S. Food and Drug Administration (FDA) in 2008 for treatment-resistant depression. Since then, research has shown it may also help treat other mental health conditions, including anxiety, OCD, post-traumatic stress disorder (PTSD), substance use disorders, and more recently, eating disorders.
The benefits of TMS include:
- Painless and medication-free
- Free from systemic side effects (unlike some medications)
- Non-surgical, with no need for anesthesia or downtime
- Compatible with daily life – patients can drive themselves to and from sessions and resume normal activities afterwards.
A typical TMS treatment plan includes daily sessions over a span of 6 to 9 weeks. Each session takes place in an outpatient clinic, making the therapy accessible to individuals with family responsibilities or full-time jobs.
Read More: How Successful is TMS Therapy?
What is repetitive transcranial magnetic stimulation (rTMS)?
rTMS is the most commonly used form of TMS therapy in clinical practice. Unlike single-pulse TMS, rTMS delivers repetitive magnetic pulses to the brain, helping to gradually retrain neural activity over time. Because most therapeutic applications involve repetitive stimulation, the terms TMS and rTMS are often used interchangeably.
What is theta burst stimulation (TBS)?
TBS is a more recent innovation of rTMS. It delivers short bursts of magnetic pulses in specific patterns that mimic natural brain rhythms. One of the main advantages of TBS is its efficiency – treatments can take as little as 3 to 10 minutes compared to the 20 to 40 minutes required by standard rTMS.
Despite its shorter duration, research suggests that TBS may be just as effective than traditional TMS for certain conditions. For those who are looking for faster treatment, accelerated TMS is another way to receive TMS in a more condensed, intensive treatment schedule.
See: Accelerated TMS vs. Traditional TMS: Which One Makes Sense for You?
How does TMS therapy help eating disorders?
Neuroimaging studies show that certain brain circuits function differently in people with eating disorders, especially those with anorexia nervosa. Areas like the insula – which processes body perception and reward – and the dorsolateral prefrontal cortex (DLPFC) – involved in self-control, decision-making, and emotional regulation – appear underactive or overactive in individuals with eating disorders.
TMS targets these specific brain regions to help normalize activity. By doing so, TMS can help reduce distorted thoughts about food and body image, and improve emotional regulation and decision-making.
Research into TMS for eating disorders
Numerous studies have explored the efficacy of TMS for eating disorders. Let’s take a look at some of the findings for specific conditions.
TMS for anorexia nervosa
In 2013, a study found that applying rTMS over the left DLPFC reduced anxiety, feelings of fullness, and body image distortion in individuals with anorexia. In 2018, a randomized controlled trial published in the BMJ reported improvements in BMI, eating disorder symptoms, and overall quality of life after rTMS treatment.
The same study showed that four months after TMS therapy, patients with severe, enduring anorexia nervosa reported an increased willingness to eat more food, reduced self-imposed food restrictions, and greater variety in food choices – including ‘fear foods’. At 18 months post-TMS, many participants reached a BMI of 18.5 or higher, the threshold for medically healthy weight. However, individuals with extremely low BMI at the start of treatment did not respond as well, suggesting that nutritional stabilization may be necessary before beginning TMS.
Preliminary research combining TMS with concurrent antidepressant medication found a stronger response in eating disorder symptoms, but not mood, amongst those receiving both treatments. This points towards TMS’s specific effect on eating-related thoughts and behaviors.
TMS for bulimia nervosa
In several studies, including randomized controlled trials, patients with bulimia who received TMS showed reduced urges to binge and purge, decreased food cravings, and increased blood flow in brain regions associated with appetite control and emotional regulation.
TMS for binge eating disorder (BED)
One study of 28 individuals with BED found that TMS reduced binge and purge behaviors by at least 50%. Several single-case studies also reported substantial reductions in binge eating episodes and food cravings.
Overall, TMS seems to support improved impulse control and emotional regulation, both of which are often disrupted in BED.
Keep Reading: Who Qualifies for TMS Therapy? (TMS Requirements)
Is TMS therapy safe?
TMS is generally well-tolerated and considered a safe, non-invasive treatment. Like any other medical intervention, however, it can cause side effects in some individuals. Fortunately, most of these are mild, temporary, and resolve on their own as the body adjusts to treatment over time.
Common side effects of TMS include:
- Tingling or twitching in facial muscles
- Mild headaches
- Scalp discomfort or neck pain
- Dizziness or lightheadedness.
The most serious potential side effect of TMS is a seizure, but this is extremely rare with a risk of less than 0.01% per session (less than 1 in 10,000 treatments). We screen patients carefully for any risk factors before beginning treatment to ensure safety and reduce the chance of complications.
Learn More: TMS Side Effects: All You Need to Know
TMS therapy at BestMind
If you or someone you care about is struggling with an eating disorder and hasn’t responded to traditional treatment, TMS may offer a new path forward. We offer this innovative therapy at our BestMind clinics in Oregon and Colorado. Contact us today to learn more about how we can support your recovery.
