rTMS for Aneroxia Nervosa in Youth

Open to people ages 14-24

1. 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;
2. YBC-EDS score≥16,
3. baseline CGI-S score ≥4,
4. English speaking (as this complement of questionnaires are available in English)
5. 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),
6. medically stable, as determined by their treating clinician, and
7. 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.
8. For women: not currently pregnant and on reliable birth control if sexually active (as the effects of rTMS on the unborn fetus are unknown).

1. a lifetime history of psychosis, mania, or seizure disorder
2. 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.
3. unstable neurological disorder,
4. metal in head/eye,
5. inability to tolerate MRI,
6. at high risk of alcohol withdrawal or substance intoxication,
7. diagnosis of pervasive development disorder,
8. 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),
9. For women: pregnant or not using a reliable form of birth control.