Psychedelics and eating disorder treatment might sound like an unexpected combination. However, it’s a promising strategy for a notoriously difficult condition. Eating disorders affect approximately 5 million Americans annually, often adolescents and young women. 1
Although a range of treatments exist, their effectiveness varies pretty widely—if they work at all. Evidence suggests that the most effective psychological treatments help foster a positive sense of self and change a person’s compulsive behaviors. 2
Therein lies the promise of psychedelics, which have been shown to shift a person’s thought patterns and self-image. Here’s what we know (so far) about psychedelics and eating disorder treatment.
What is an Eating Disorder?
An eating disorder refers to harmful eating behaviors and excessive concern about body weight. These behaviors and concerns impair a person’s physical, mental, or social health.
Eating disorders are mental disorders that may be rooted in anxiety, trauma, or addiction. They’re generally more common in young women, except for binge eating disorder, which is more common in men and older individuals. 1
However, eating disorders can affect anyone, regardless of age, weight, gender, cultural background, or socioeconomic group.
There are many different eating disorders, such as anorexia and bulimia. A range of factors can drive these conditions, including environmental, genetic, social, and psychological causes.
If you or someone you know are struggling with an eating disorder, reach out to Eating Disorders Helpline for information about support, resources, and treatment options in your area.
Also known as anorexia nervosa (AN), anorexia is characterized by a fear of gaining weight or an obsessive motivation to lose weight. Symptoms include the following:
- Abnormally low body weight
- Distorted perception of weight
- Excessive exercise
- Emotional reaction to gaining weight
- Preoccupation with food and eating
- Severe restriction of food intake
Anorexia is the most fatal of all psychiatric conditions. Mortality rates are 11.6 times higher than the general population. 3
The exact cause of anorexia is unclear. However, malnutrition and weight loss can reduce brain tissue and impair cognitive function. Additionally, people with anorexia often struggle with depression. 4
This eating disorder is also known as bulimia nervosa. People with bulimia habitually binge, which is consuming large amounts of food with a loss of control over eating.
After a binge, people may compensate for the amount and types of foods just eaten. Those compensatory behaviors are generally unhealthy. For example, people might self-induce vomiting, use laxatives, excessively exercise, or follow a strict diet after a binge episode.
- Fear of gaining weight
- Feeling a loss of control during a binge episode
- Preoccupation with body shape and weight
- Repeated episodes of eating large amounts of food in one sitting
- Vomiting, using laxatives, or other compensatory behaviors after bingeing
As with other eating disorders, the causes of bulimia aren’t clear. Although the mortality rate isn’t as high as anorexia, bulimia can lead to serious complications like heart problems, tooth decay, self-injury, and other mental disorders.
Binge eating disorder
Like bulimia, binge eating disorder is characterized by eating a large amount of food in a short time. People feel a loss of control over how much they eat. However, they don’t purge or compensate for eating after a bingeing episode.
- Eating large amounts of food past the point of fullness
- Feeling embarrassed by the amount of food being eaten
- Loss of control during binge-eating
- History of weight gain and loss
Binge eating disorder is the most common eating disorder, affecting about 3 percent of American adults in their lifetime. 5 It tends to occur with other conditions, such as obesity, depression, and anxiety. 6
There are several other types of eating disorders. The DSM-5 calls these categories feeding and eating disorders. Types include: 1
- Rumination: Regurgitating previously swallowed food, chewing it again, and then swallowing or spitting. Rumination may occur alongside anorexia.
- Purging disorder: Attempting to control weight by vomiting, excessively exercising, or using laxatives. Unlike bulimia, people with purging disorder do not binge-eat.
- Night eating syndrome: Waking up several times a night to eat.
- Orthorexia: An obsessive focus on healthy eating. People with orthorexia may eliminate entire food groups, such as carbohydrates or meat. (Although not every diet practice can be classified as orthorexia—there must be a psychiatric component.)
Popular Treatments for Eating Disorders
There’s a lot of variation in how providers treat eating disorders. Generally, they’re treated through a combination of psychotherapy and nutritional counseling. The goal of these therapies is to foster healthy behaviors and achieve a healthy weight.
Certain medications may also be prescribed, such as antidepressants and antiepileptics. These medications can help control symptoms and comorbid conditions like compulsive eating, depression, and anxiety.4
Cognitive-behavioral therapy is the first-line treatment for all eating disorders. Also known as CBT, this type of talk therapy helps people become more aware of negative thought patterns and practice healthier coping strategies.
Other psychotherapies for eating disorders include family-based treatment and interpersonal therapy.
How effective are treatments for eating disorders?
Eating disorders are difficult to manage. In comparison to anorexia, the prognosis is better for bulimia: The majority of people with bulimia recover within 9 to 10 years, versus 50 percent of people with anorexia.1
In three studies that evaluated the long-term outcomes of eating disorders, 64 percent of patients with anorexia, 53 percent of patients with bulimia, and 30 percent of patients with binge eating disorder still met the criteria for an eating disorder at 10–20 years follow-up. 7,89
Clinical practice guidelines state that nutritional therapy shouldn’t be the only treatment used to treat eating disorders. However, because eating disorders can have many contributing factors and comorbidities—such as environmental stressors, depression, and trauma—treating them is notoriously an uphill battle.
This difficulty begs the question: Is it time for a new therapeutic approach?
How Can Psychedelics Help Treat Eating Disorders?
Psychedelics are experimental treatments for various mental disorders, including anxiety, addiction, depression, and post-traumatic stress disorder (PTSD).
Researchers aren’t completely sure how psychedelics work yet. Early evidence suggests that psychedelics trigger changes in the brain that stimulate therapeutic states of altered consciousness. They might also trigger neuroplasticity.
Most psychedelics (such as DMT, LSD, and psilocybin) work by binding to serotonin receptors, specifically 5-HT2A. In doing so, psychedelics mimic serotonin—the neurotransmitter that plays a role in things like mood, memory, and attention. 10
These substances also stimulate secondary changes in the brain, like interacting with the default mode network—the part of your brain that deals with your sense of self. 11
One working hypothesis is that these changes help disrupt a person’s established behaviors and thoughts, which makes a person more responsive to change. These effects might help people with mental disorders (such as eating disorders) feel more receptive to treatment and more willing to alter negative thoughts and behaviors.
Said another way: Psychedelics aren’t standalone treatments for eating disorders, but they might help people manage their conditions when paired with psychotherapy.
Research is still in its early days, so it’s too early to say that psychedelics and eating disorder treatment are better than other therapies. Currently, several psychedelics clinical trials are exploring the relationship between certain psychedelics and eating disorders. Here’s an overview of several trials and preliminary studies.
Exploratory studies suggest that Ayahuasca should be explored as a potential eating disorder treatment.
Researchers interviewed people previously diagnosed with eating disorders about their experiences with Ayahuasca. 12,13 Participants shared that the experience reduced disordered thoughts and symptoms, shifted body perception, and helped to process past traumas, among other themes.
Qualitative studies such as these aren’t the same as placebo-controlled trials, but they do point to future opportunities for research.
Ketamine is a dissociative anesthetic that is oftentimes grouped with psychedelics because of its psychoactive properties. Ketamine has a rapid antidepressant effect and is a powerful tool for treatment-resistant depression.
Minimal research exists that focuses on ketamine for eating disorder treatment. However, ketamine shows promise as a way to treat depression, which often occurs with anorexia.
The drug may also promote neuroplasticity and neuroinflammation, both of which are associated with anorexia. Ketamine’s dissociative qualities can also help people detach from a rigid sense of self, making them more receptive to psychotherapy. 14
MDMA therapy has been shown to reduce eating disorder symptoms in adults with severe PTSD. 15 In the randomized, placebo-controlled trial of 90 participants, MDMA significantly reduced eating disorder symptoms compared to therapy with placebo.
In terms of clinical trials, a Phase II study will explore the safety and feasibility of MDMA-assisted psychotherapy in eating disorder treatment. The study is not yet recruiting, but if you’re interested in participating when the time comes, browse the eligibility criteria.
Currently, psilocybin is the most-studied psychedelic for eating disorder treatment.
The following clinical trials will examine psilocybin in treating eating disorders:
- Evaluation of Psilocybin (TRP-8802) in the Treatment of Binge Eating Disorder: Currently recruiting participants.
- Effects of Psilocybin in Anorexia Nervosa: Currently recruiting participants.
- Evaluation of Psilocybin in Anorexia Nervosa: Safety and Efficacy: Completed, but results have not yet been posted.
Like other psychedelics, psilocybin has shown promising results in treating mental disorders such as depression, addiction, and anxiety.
Frequently Asked Questions
Can drugs cause eating disorders?
Drugs don’t necessarily cause eating disorders. However, people who struggle with eating disorders may use substances to self-medicate and cope with depression and anxiety, leading to drug abuse.
Is serotonin associated with eating disorders?
There is evidence that people with eating disorders have dysfunctional serotonin systems. For example, abnormal serotonin receptor activity has been found in people with anorexia. 16,17
Correlation does not equal causation, but it’s possible that changes in serotonin can contribute to the negative mental effects of eating disorders.
Can microdosing therapy help with eating disorders?
Although anecdotal reports suggest that microdosing supports everything from a healthy mood to creativity, the scientific evidence is mixed. No existing research examines microdosing therapy and eating disorder treatment.
Final Thoughts on Psychedelics for Eating Disorders
Psychedelics are an emerging therapy for mental disorders, and part of the reason they’re substances of note is that they work differently than existing treatments—which is heartening for treatment-resistant disorders and difficult-to-treat conditions like eating disorders. Clinical trials will help demonstrate if, and how, psychedelic therapy can help people recover from conditions such as anorexia and bulimia.
If you or someone you know struggles with disordered eating, help is available. Reach out to the Eating Disorders Hotline.
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