Theta burst stimulation of extrastriate body area for body perception in anorexia nervosa: a randomized controlled trial

Anorexia nervosa is a severe and potentially life-threatening psychiatric disorder characterized by self-starvation, intense fear of weight gain, and a distorted body perception. Treatment remains challenging, and effective interventions for adults are limited. The extrastriate body area (EBA), a cortical region involved in body representation, may contribute to the body perception disturbances. In this double-blind, placebo-controlled, randomized proof-of-concept trial, we investigated the therapeutic potential of targeted theta burst transcranial magnetic stimulation (TMS) of the EBA in patients with anorexia nervosa ( n = 40). Participants received four weeks of active ( n = 10) or sham ( n = 10) TMS combined with body perception training, while a treatment-as-usual group ( n = 20) and a healthy control group ( n = 40) served as comparators. Improvements in the primary outcome measure, the Body Shape Questionnaire, differed across groups over time, with active TMS showing faster improvement (after 4 weeks) relative to both control groups, that was sustained at 6 months follow-up. Moreover, active stimulation was associated with changes in EBA responses to self- versus non-self touch, shifting neural activity patterns more closely to those of healthy individuals. These findings provide preliminary evidence that individualized neuromodulation targeting a disorder-relevant neural substrate combined with behavioral training shows potential for effectively recalibrating disturbed body perception. By integrating brain stimulation with behavioral training, this study exemplifies a precision psychiatry approach that links neurobiological mechanisms to personalized therapeutic interventions in anorexia nervosa.