Non-invasive brain stimulation as an experimental treatment approach for bulimia nervosa and binge eating disorders: A meta-analysis and systematic review of literature.

BACKGROUND

Bulimia nervosa (BN) is characterized by recurrent binge eating episodes followed by compensatory behaviours, whereas binge eating disorder (BED) involves similar binge episodes without purging. Recent advances in aetiology and functional pathways in the brain have opened the gateway for assessing brainfocused interventions.

AIM: This systematic review and meta-analysis explored the therapeutic benefits of non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in BN and BED.

METHODS

Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Electronic databases were searched using relevant keywords. This study included articles published in English until April 2025. The data extracted from the studies included study design, stimulation methods, sessions, outcomes, and comorbid symptoms.

RESULTS

The Meta-analysis revealed a significant reduction in food craving questionnaire-state scores following rTMS/tDCS (FCQ-S: standardized mean difference [SMD] = 0.69, P = 0.02). However, this two study meta-analysis was heavily influenced by an experimental study that assessed food craving 24 hours following a single-session rTMS. No significant reduction was observed in binge episodes, vomiting episodes, eating disorder (ED) pathology, or urge to eat. A trend toward improvement in depressive symptoms were noted but not statistical significance.

CONCLUSION

rTMS may reduce food cravings in BN and BED but shows limited impact on binge or purging behaviours. Current evidence does not support a clinically meaningful benefit of neuromodulation for core BN or BED symptoms, and its use should be considered investigational rather than therapeutic. Experimental findings indicating the reduction in food cravings need to be confirmed in larger, well-designed clinical trials.