# Deciphering the Neural Mechanisms of Restrictive Eating in Anorexia Nervosa Using Repetitive Transcranial Magnetic Stimulation

> **NIH NIH K23** · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · 2022 · $195,475

## Abstract

PROJECT SUMMARY
Anorexia nervosa (AN) is a devastating illness with morbidity and mortality rates among the highest associated
with any psychiatric disorder. Treatments for adults with AN have limited efficacy due to an inadequate
understanding of the mechanisms underlying AN's core symptoms. The salient feature of AN is extreme
restriction of food, particularly dietary fat intake, a behavior both highly resistant to change and central to
relapse. There is a pressing need to understand the neural bases of restrictive eating and use this knowledge
to develop novel, mechanism-based treatments. Neuroimaging research of food restriction in AN has found
that compared to healthy controls, patients with AN exhibit greater choice-related dorsal striatum activation,
suggesting that activity in this region may underlie maladaptive eating behavior. To confirm the significance of
these brain regions, a critical next step is to extend correlational findings by directly probing this region using
repetitive transcranial magnetic stimulation (rTMS) and evaluating its effects on brain and behavior. TMS is a
non-invasive form of neuromodulation that delivers an electromagnetic pulse to the cortex and modulates
neuronal activity of both targeted cortical regions and subcortical regions within related circuits. Previous
research indicates the DLPFC may be a cortical TMS target through which to engage the dorsal striatum.
Preliminary data from our group shows that compared to sham, high-frequency rTMS (HF-rTMS) to a specific
region of the right DLPFC previously implicated in AN significantly increases selection of high-fat foods among
inpatients with AN. The goal of this Mentored Patient-Oriented Research Career Development Award is to
examine the neural mechanisms underlying restrictive food choice in AN using HF-rTMS as an experimental
manipulation of neural activation. The proposed study will combine neuronavigation-guided rTMS,
individualized functional TMS targets, fMRI and a computerized food-choice task to test the effects of HF-rTMS
on brain and behavior. The study will utilize a double-blinded randomized parallel design: adult inpatients with
AN will receive either HF-rTMS (n=36) or sham (n=36) to the DLPFC. We will compare group changes in brain
and behavior to test whether activity in the dorsal striatum underlies restrictive eating behavior in AN (Aim 1)
and test the effects of HF-rTMS to the DLPFC on restrictive eating behavior (Aim 2). Our use of individualized
TMS targets will enable us to identify whether resting-state functional connectivity predicts neural or behavioral
response to HF-rTMS (Exploratory Aim). Data yielded from the proposed study will enable the field to generate
causal inferences about the role of brain regions underlying maladaptive eating behavior in AN, and will
support the preparation of an R01 application to develop novel treatments for this disorder. Together, the
expertise developed through this K23 award will support the appl...

## Key facts

- **NIH application ID:** 10525743
- **Project number:** 1K23MH128530-01A1
- **Recipient organization:** NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
- **Principal Investigator:** Alexandra Felicia Muratore
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $195,475
- **Award type:** 1
- **Project period:** 2022-09-15 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10525743

## Citation

> US National Institutes of Health, RePORTER application 10525743, Deciphering the Neural Mechanisms of Restrictive Eating in Anorexia Nervosa Using Repetitive Transcranial Magnetic Stimulation (1K23MH128530-01A1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10525743. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*