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-image disturbances central to the disorder. In this double-blind, placebo-controlled, randomized 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 or sham TMS combined with body perception training, while a treatment-as-usual group and a healthy control group served as comparators. Active TMS produced significant improvement on the primary outcome measure, the Body Shape Questionnaire, relative to both control groups. Moreover, active stimulation normalized EBA responses to self- versus non-self touch, aligning neural activity patterns more closely with those of healthy individuals.These findings demonstrate that individualized neuromodulation targeting a disorder-relevant neural substrate can effectively recalibrate disturbed body perception. By integrating brain stimulation with behavioral retraining, this study exemplifies a precision psychiatry approach that links neurobiological mechanisms to personalized therapeutic interventions in anorexia nervosa.