The Neurological Basis of Eating Disorders. I: EEG Findings and the Clinical Outcome of Adding Symptom-Based, QEEG-Based, and Analog/QEEG-Based Remedial Neurofeedback Training to Traditional Treatment Plans.

Peter N. Smith, PsyD, (1) Marvin W. Sams, ND (2), Leslie Sherlin, BA (3)
(1) Mirasol, Tucson, Arizona, (2) Neurofeedback Centers of America, Dallas, Texas (3) NovaTech EEG, Scottsdale, Arizona
pns001@aol.com

Introduction
Eating disorders are associated with the highest mortality of any DSM-IV diagnosis (Fichter & Quadflieg, 1999). Despite dedicated efforts, intervention has proven only modestly effective. Because of this resistance to treatment, neurofeedback was added to the more traditional treatment modalities to determine if clinical outcomes could be improved. Previous EEG research in those with eating disorders revealed significant generalized abnormalities and unstable responses to hyperventilation (Crisp& Fenton, 1968), and inappropriate Theta activity in the right parietal region, both before and after weight gain (Grunwold &Ettrior, 2001).Our study was designed to further evaluate the EEG findings in those with eating disorders, report the clinical benefit of adding neurofeedback to traditional medical and psychological treatment modalities, and compare the initial results of three different approaches to neurofeedback training.

Method
Personality, stress indices, and attentional screening tests were administered to 120 patients being admitted to a residential treatment center. One third of the treatment group received pre-QEEG evaluation prior to neurotherapy interventions.
The neurofeedback protocols used were from one of three basic clinical approaches: (a) symptom-based, (b) QEEG-based, using traditional neurofeedback protocols, and (c) task-activated, analog/QEEG-based training using research-confirmed training protocols.

Results
In all three neurofeedback approaches, BDI scores, neuroticism scores, and EDI scores demonstrated significant change. Weight changes were in the desired direction.
EEG/QEEG findings will be reviewed, but, in summary, right brain dysfuction and significantly increased Delta slow wave activity with cognitive challenge were common.
The initially determined difference in the three neurofeedback training approaches is that the research-designed training protocols are statistically more likely to reduce or eliminate the need for medication.

Conclusion
Our study confirms that EEG abnormalities are commonly present in those with eating disorders. Importantly, adding neurofeedback to traditional treatment protocols to address these neurological issues significantly enhances treatment outcome.

References
Crisp,A. H., Fenton,G. W.,& Scotton, L. (1968). A controlled study of the EEG in anorexia nervosa. British Journal of Psychiatry, 114, 1149-1160.
Fichter,M. M.& Quadflieg, N.(1999). Six-year course of anorexia nervosa. International Journal of Eating Disorders, 26, 359-385.
Grunwald, M. et al. (2001). Deficits in haptic perception and right parietal theta power changes in patients with anorexia nervosa before and after weight gain. International Journal of Eating Disorders, 29, 417-428.