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Orthorexia Nervosa (ON); is a condition characterized by individuals being overly focused on healthy eating habits, constantly checking and classifying the foods they will consume. ON has not yet been clinically defined as an eating disorder or in a different category, and has not been included in DSM-5. Cognitive flexibility can be defined as a person's ability to quickly change their thinking and behaviors to adapt to different situations and changing conditions. It has been reported that cognitive flexibility skills are impaired in ON. There is evidence that tDCS, a neuromodulation method, increases cognitive flexibility skills. On the other hand, although there are EEG studies on eating disorders, there is no EEG study directly studying ON, and there is no information on the EEG profiles of individuals with high ON scores. For this reason, EEG studies on eating disorders and obsessive behaviors are generally generalized to orthorexia nervosa and are interpreted. This study aims to compare the EEG oscillations and cognitive flexibility skills of individuals with high ON scores with a control group and to examine the effects of anodal tDCS application on these two variables. For this purpose, a total of 48 individuals, 24 healthy and 24 high ON scores, will be included in the study. Participants will be randomly assigned to tDCS experimental and control groups. Therefore, 48 participants will be divided into 4 different subgroups of 12 people each. Data collection tools will be Informed Consent Form, Demographic Information Form, Beck Depression Inventory, Orthorexia Nervosa Test (TON-17), Cognitive flexibility task. First, participants will be subjected to a cognitive flexibility task by taking simultaneous EEG recordings, then tDCS stimulation will be initiated (active or sham) and after stimulation, a cognitive flexibility task will be performed by taking simultaneous EEG recordings again. EEG analyses will be performed using the Brain-Vision Analyzer program. Repeated Measures Analysis of Variance (within-group and between-groups) will be used in statistical analyses.
Measurement instruments:
Informed Voluntary Consent Form Demographic Information Form Edinburgh Hand Preference Survey Beck Depression Scale Test of Orthorexia Nervosa (TON-17) Cognitive Flexibility Task EEG and tDCS devices Statistics: Statistical analyses will be conducted using SPSS 25.0 (Statistical Package for Social Sciences) for Windows, and EEG data will be analyzed using the Brain-Vision Analyzer software.
Descriptive statistics for group variables such as age and education will be presented as means and standard deviations, while gender will be reported as frequency and percentage.
The normality of the distribution of variables will be assessed using the Kolmogorov-Smirnov test, and appropriate parametric or non-parametric tests will be applied based on the results.
To evaluate pre-test and post-test data for cognitive flexibility and EEG measures in the experimental and control groups, Repeated Measures Analysis of Variance (within- and between-subjects) or its non-parametric equivalent, the Friedman Test, will be used.
For all statistical tests, a significance level of p < 0.05 will be considered as the threshold for statistical significance.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental group | Active Comparator | Participants will take active tDCS stimulation |
|
| Control group | Sham Comparator | Participants will take sham tDCS stimulation |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Active tDCS | Device | 20 min, 2 milliampere (mA), Anodal tDCS in left DLPFC |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Change in EEG Oscillations in individuals with Orthorexia Nervosa for active vs. sham stimulation | The EEG oscillations recording the event brain oscillations during the cognitive flexibility task from pre and post measurements. There are the five frequencies band which are Delta (0.5-3,5 Hz), Theta (4-7 Hz), Alpha (8-13 Hz), Beta (15-30 Hz) and Gamma (30-100 Hz). Data will be record simultaneously and analyzed. The analysis will be done with the BrainVisionAnalyzer program and power analysis will be made in Delta, Theta, Alpha, Beta, Gamma bands and the averages will be compared. Oscillations will be evaluated in terms of averages changing as an indicator of the effect of the neuromodulation preceding it. | Baseline, 5 minutes after completion of the active/sham stimulation |
| Change in Cognitive Flexibility Task score in individuals with Orthorexia Nervosa for active vs. sham stimulation | A structured task-switching paradigm will be used to measure cognitive flexibility skills from pre and post test score in individuals with Orthorexia Nervosa * The paradigm consists of two conditions: trials with a task switch and trials without a task switch. The experiment will include two blocks, with a total of 320 trials. Each block will contain 160 phases, consisting of 80 trials with a task switch and 80 trials without a task switch. Score averages will compare between pre and post test. Data will be record Excel by Psychopy program simultaneously. Performance will be evaluated for accuracy as an indicator of the effect of the neuromodulation preceding it. | Baseline, 20 minutes after completion of the active/sham stimulation |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Saliha Şahintürk Şentürk, PhD | Contact | +90 531 566 03 22 | salihasahinturk@gmail.com | |
| Melek Özden, PhD | Contact | +90 5079771646 | melekozden1@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istanbul Medipol University | Recruiting | Istanbul | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32594475 | Result | Emek Savas DD, Yerlikaya D, G Yener G, Oktem Tanor O. Validity, Reliability and Normative Data of the Stroop Test Capa Version. Turk Psikiyatri Derg. 2020 Spring;31(1):9-21. doi: 10.5080/u23549. English, Turkish. | |
| 35331781 | Result | Du M, Peng Y, Li Y, Zhu Y, Yang S, Li J, Zou F, Wang Y, Wu X, Zhang Y, Zhang M. Effect of trait anxiety on cognitive flexibility: Evidence from event-related potentials and resting-state EEG. Biol Psychol. 2022 Apr;170:108319. doi: 10.1016/j.biopsycho.2022.108319. Epub 2022 Mar 22. |
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| ID | Term |
|---|---|
| D000088102 | Orthorexia Nervosa |
| ID | Term |
|---|---|
| D001068 | Feeding and Eating Disorders |
| D001523 | Mental Disorders |
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It is an experimental, randomised controlled trial. The data will be collected with the convenience sampling method from volunteer healthy people and individuals with orthorexia nervosa. The matched-group design method will be used.
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Participants will not know that which group they will be in
| Sham tDCS |
| Device |
20 min, left DLPFC Sham tDCS |
|
| 32006627 | Result | Dong G, Wang Y, Chen X. Anodal occipital tDCS enhances spontaneous alpha activity. Neurosci Lett. 2020 Mar 16;721:134796. doi: 10.1016/j.neulet.2020.134796. Epub 2020 Jan 30. |
| 31461371 | Result | Donaldson PH, Kirkovski M, Yang JS, Bekkali S, Enticott PG. High-definition tDCS to the right temporoparietal junction modulates slow-wave resting state power and coherence in healthy adults. J Neurophysiol. 2019 Oct 1;122(4):1735-1744. doi: 10.1152/jn.00338.2019. Epub 2019 Aug 28. |
| 40620518 | Result | Darna M, Stolz C, Jauch HS, Strumpf H, Hopf JM, Seidenbecher CI, Schott BH, Richter A. Frontal theta oscillations and cognitive flexibility: Age-related modulations in EEG activity. Aging Brain. 2025 Jun 24;8:100142. doi: 10.1016/j.nbas.2025.100142. eCollection 2025. |
| 23894253 | Result | Chrysikou EG, Hamilton RH, Coslett HB, Datta A, Bikson M, Thompson-Schill SL. Noninvasive transcranial direct current stimulation over the left prefrontal cortex facilitates cognitive flexibility in tool use. Cogn Neurosci. 2013;4(2):81-9. doi: 10.1080/17588928.2013.768221. |
| 30580246 | Result | Cavinato M, Genna C, Formaggio E, Gregorio C, Storti SF, Manganotti P, Casanova E, Piperno R, Piccione F. Behavioural and electrophysiological effects of tDCS to prefrontal cortex in patients with disorders of consciousness. Clin Neurophysiol. 2019 Feb;130(2):231-238. doi: 10.1016/j.clinph.2018.10.018. Epub 2018 Nov 29. |
| 31494070 | Result | Borwick C, Lal R, Lim LW, Stagg CJ, Aquili L. Dopamine depletion effects on cognitive flexibility as modulated by tDCS of the dlPFC. Brain Stimul. 2020 Jan-Feb;13(1):105-108. doi: 10.1016/j.brs.2019.08.016. Epub 2019 Aug 31. |
| 36683346 | Result | Berchio C, Annen LC, Bouamoud Y, Micali N. Temporal dynamics of cognitive flexibility in adolescents with anorexia nervosa: A high-density EEG study. Eur J Neurosci. 2023 Mar;57(6):962-980. doi: 10.1111/ejn.15921. Epub 2023 Feb 7. |
| 32289681 | Result | Alizadehgoradel J, Nejati V, Sadeghi Movahed F, Imani S, Taherifard M, Mosayebi-Samani M, Vicario CM, Nitsche MA, Salehinejad MA. Repeated stimulation of the dorsolateral-prefrontal cortex improves executive dysfunctions and craving in drug addiction: A randomized, double-blind, parallel-group study. Brain Stimul. 2020 May-Jun;13(3):582-593. doi: 10.1016/j.brs.2019.12.028. Epub 2020 Jan 3. |
| 27039163 | Result | Aboulafia-Brakha T, Manuel AL, Ptak R. Prefrontal transcranial direct current stimulation facilitates affective flexibility. Neuropsychologia. 2016 Jun;86:13-8. doi: 10.1016/j.neuropsychologia.2016.03.030. Epub 2016 Mar 30. |