Clinical Research Spotlight: Brain Circuitry in Anorexia Nervosa

Anorexia nervosa—commonly known simply as “anorexia”—is a serious mental illness likely caused by a combination of biological, genetic, psychological and social factors. The hallmark feature of the illness is extreme restriction of food intake leading to significantly low body weight, which can cause devastating medical and psychological effects. Anorexia currently has the second highest mortality rate of all psychiatric disorders, and its mortality rate is six times that expected for young women. These statistics highlight the need for improved treatments.

Columbia psychologist Alexandra Muratore, PhD, studies the neuroscience underlying anorexia nervosa and other eating disorders, with the goal of improving treatment outcomes.

“After witnessing the chronic course and the devastating effects anorexia nervosa can have on patients and their families, I was inspired to focus my research on combining neuroimaging and brain stimulation methods to inform the development of more effective treatments,” says Muratore, an assistant professor of clinical medical psychology in the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons.

Muratore received the GFED Young Investigator Award, a grant funded by the National Eating Disorders Association, to study the neurobiology of the illness and help develop new, brain-based treatments for anorexia nervosa.

We spoke to Muratore about her research and the promise of a novel treatment.

Tell us about the research into anorexia that this award will fund.

Research by our group has suggested that specific brain circuitry may be involved in restrictive eating behavior, a symptom of anorexia nervosa that both patients and doctors find extremely difficult to change with existing treatments.

With a safe, non-invasive, brain stimulation procedure called repetitive transcranial magnetic stimulation (rTMS), we will test whether changing activity within that circuitry leads to changes in symptoms among patients with anorexia nervosa.

Our findings will help us to learn more about the parts of the brain responsible for the illness and will help contribute to the development of novel treatments targeting these regions.

What exactly is rTMS?

rTMS is a non-invasive form of brain stimulation delivered via a magnetic coil placed near the scalp. It was first developed as a treatment for major depressive disorder, and the FDA approved it for that use in 2008. Since then, the FDA has approved rTMS for migraines, smoking cessation, and obsessive-compulsive disorder, which often coexists with anorexia nervosa.

Now there’s evidence from our group and others to suggest rTMS may also be helpful in treating symptoms of anorexia nervosa.

How does rTMS work?

To receive rTMS, a person remains seated while the coil is placed near their scalp, over the area of the brain we want to target. The coil generates rapidly changing magnetic pulses—the intensity of these pulses delivered is specific to each individual person being treated.

The pulses induce small electric currents which can change brain activity in the targeted region of the brain and, as a result, influence behavior. Throughout the session, individuals receiving TMS will hear a clicking sound and may feel a tapping sensation on their head.

How will you use rTMS to learn more about anorexia nervosa?

rTMS is most effective as a treatment when we know where in the brain we want to target. Before testing the effects of a full course of rTMS treatment, our group is using rTMS to more definitively test whether brain activity within a particular circuit contributes to restrictive eating behavior.

Our findings will lay the groundwork for a novel, mechanism-based treatment specifically tailored to the neurobiology of anorexia nervosa. If successful, this would be a huge breakthrough and the first step towards the development of an effective treatment.