rTMS for Aneroxia Nervosa in Youth

Inclusion criteria

• youth aged 14-24 with DSM-5 AN-restricting (ANR) or AN-binge-eating-purging (ANBP) type as determined by the MINI-KID/MINI and clinical interview;
• YBC-EDS score≥16,
• baseline CGI-S score ≥4,
• English speaking (as this complement of questionnaires are available in English)
• on stable psychotropic medication (if any) for the preceding 4 weeks (i.e., SSRIs, atypical antipsychotics and benzodiazepines of doses <1 mg lorazepam equivalent daily),
• medically stable, as determined by their treating clinician, and
• not deemed to be at high risk of imminent suicidal behavior by initial study psychiatrist assessment and referring provider/team, and no endorsement of items 4 or 5 on the Severity of Ideation Subscale of the C-SSRS.
• For women: not currently pregnant and on reliable birth control if sexually active (as the effects of rTMS on the unborn fetus are unknown).

Exclusion criteria

• a lifetime history of psychosis, mania, or seizure disorder
• active suicidality as determined by clinical assessment by MD or PhD, and endorsement of items 4 or 5 on the Severity of Ideation Subscale of the C-SSRS.
• unstable neurological disorder,
• metal in head/eye,
• inability to tolerate MRI,
• at high risk of alcohol withdrawal or substance intoxication,
• diagnosis of pervasive development disorder,
• medical instability as determined by primary care provider and/or referring clinician (i.e., unstable electrolytes in the setting of worsening binge-eating/purging, cardiac arrhythmias requiring Holter or other intensive monitoring),
• For women: pregnant or not using a reliable form of birth control.