The Healing Potential of Psychedelic-Assisted Therapy for Eating Disorders

Eating disorders affect millions of people worldwide, presenting complex challenges that often require comprehensive and innovative approaches to treatment. In recent years, there has been growing interest in the potential of psychedelic-assisted therapy as a transformative tool in the realm of mental health. This blog post explores the emerging field of psychedelic-assisted therapy for eating disorders, shedding light on its promising benefits and the implications it may have for the future of treatment.

Introduction

Eating disorders affect at least 9% of the population, or 70 million people, worldwide[8], and this number is increasing. A review of worldwide data found that eating disorder diagnoses more than doubled from 2000-2018, with the trend was consistent across regions, age groups, and genders.[10]

These conditions are also serious, falling among the deadliest mental illnesses, second only to opioid overdose.[8] Every year, 10,200 deaths occur as the direct result of an eating disorder—that’s one death every 52 minutes.[9]

 

Understanding Eating Disorders

“Eating disorders are a window into the struggle of the soul.”

People don’t choose eating disorders. Nobody wakes up one day and says “I’d like to have anorexia”—If they do, they’re seriously misinformed. Eating disorders aren’t choices, but rather serious multi-faceted and biologically influenced illnesses. An individual may consciously decide to purge or over-exercise at first, but before long, this disordered relationship with food and one’s body can become a deeply-ingrained subconscious pattern that takes on a life of its own. When left untreated, eating disorders can lead to serious, and sometimes life-threatening, physical and psychological consequences, underscoring the urgent need for effective therapeutic interventions.

Thankfully, eating disorder behaviors are learned behaviors and can be unlearned—but it takes time. Everyone has the capacity for full recovery. Part of the work in recovery is to uncover the meaning or purpose behind the symptoms.

 

The Limitations of Traditional Treatments

Conventional treatment approaches, including cognitive-behavioral therapy and medication, have demonstrated some effectiveness in managing eating disorders. However, there are currently no FDA-approved treatment options for anorexia nervosa and only one for bulimia nervosa and binge-eating disorder respectively. While depression commonly occurs with most eating disorders, traditional antidepressants (i.e. SSRIs) often lack efficacy in patients with anorexia. Even when patients are able to take advantage of available treatments, many continue to struggle with symptoms, and relapse rates remain high.

Studies have found that over a third of all patients treated for anorexia or bulimia end up relapsing within the first few years of completing treatment. The highest risk for relapse from anorexia occurs in the first 18 months (about 1 and a half years) after treatment, with 35% falling back into eating disordered behaviors.[1]

While the onset of bulimia usually occurs during adolescence or early adulthood, it tends to persist for several years, either chronically or intermittently. Treatment does help most people with bulimia achieve long-lasting recovery, but relapse still is a significant concern, with rates of up to 41% of former patients resuming bulimic behaviors within 2 years.[2]

Recognizing these challenges, researchers and clinicians have continued to search for new and improved ways to help individuals with eating disorders find more long-lasting and complete healing, including the use of psychedelic-assisted therapy as a potential alternative or complementary treatment modality.

 

The Role of Psychedelics in Healing

Psychedelic substances like psilocybin, MDMA, and LSD have shown promise in facilitating profound psychological healing in individuals dealing with depression, PTSD, substance abuse, eating disorders, and other mental health conditions. Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points suggest that psychedelics create desirable brain states that can accelerate therapeutic processes and make eating disorder interventions easier to receive. The desirable brain states in

 

Research Studies

Group Ketamine-Assisted Therapy for Eating Disorders [3]

This pilot study, led by Dr. Reid Robison, Chief Clinical Officer of Numinus, explored the use of group ketamine-assisted psychotherapy (KAP) in a residential eating disorder treatment facility. 5 individuals with eating disorder diagnoses and comorbid mood and anxiety disorders received weekly intramuscular ketamine injections in a group setting followed by non-drug psychotherapy over 4 weeks.

Regarding the outcomes, the study found promising results. Group KAP was feasible and well-tolerated, with high patient satisfaction and treatment adherence rates. Participants experienced reduced symptoms of depression, anxiety and showed significant improvements in eating eating symptoms and quality of life, with effects persisting at a 6-month follow-up.

Participant quote:

“Trying ketamine allowed me to see the possibility of a life I could have. While the effects did not last, my very first experience snapped me out of a state of life-long, deep disconnection that I didn't even know I had been experiencing. Suddenly, I was able to live in the world in the way people had always described it. Though I am still trying to figure out how to attain that level of connection after catching a glimpse, that one experience was so essential. I could finally feel hunger and fullness cues. I felt what it's like to live in a body, instead of living a short distance from it. I felt connected to others and genuinely cared about their well-being. I felt human for the first time in a long time.”

 

Psilocybin-Assisted Therapy for Anorexia [4]

This study being conducted by Compass Pathways in collaboration with University of California San Diego,  is exploring the safety, tolerability, and efficacy of psilocybin-assisted therapy for patients with anorexia. Preliminary results from 10 participants who received a single 25 mg dose of synthetic psilocybin (~3.5 grams of dried psilocybin) shows:

 

Psilocybin-Assisted Therapy for Binge-Eating Disorder [5]

This Phase II study is currently underway at the University of Florida in collaboration with Tryp Therapeutics and happens to be the first ever psilocybin-assisted therapy study addressing binge-eating disorder. Interim analysis of five early participants has found:

MDMA-Assisted Therapy for Eating Disorder Symptoms [6]

This study investigated the effects of MDMA-assisted therapy on adults with severe PTSD, specifically exploring its impact on eating disorder symptoms. A total of 90 participants with severe PTSD received treatment in a double-blind, placebo-controlled trial. At baseline, 13 participants had EAT-26 scores in the clinical range, and 28 had scores in the high-risk range, despite the absence of active purging or low weight. After finishing the study, there was a significant reduction in total EAT-26 scores in the entire PTSD group following MDMA-assisted therapy compared to placebo. Moreover, significant reductions in total EAT-26 scores were observed in women with high EAT-26 scores (≥11 and ≥20) following the study protocol.

 

Other studies:

 

GROUP PHASE INDICATION STATUS
MAPS Phase II MDMA for anorexia and BED Anticipated start date in 2023
Johns Hopkins Phase I Psilocybin for anorexia Enrollment complete
Imperial College Phase I/II Psilocybin for anorexia Enrollment complete
TRYP Phase II Psilocybin for BED Enrolling
XPIRA Phase II Psilocybin for Anorexia Anticipated start date in 2023
COMPASS Phase II Psilocybin for Anorexia Enrolling

 

 

Integrating Psychedelics with Conventional Models

Integration of psychedelic-assisted therapy with conventional eating disorder treatment requires careful consideration of medical and safety factors, as well as the crucial involvement of specialized eating disorder clinicians. These clinicians have the expertise to navigate the unique challenges and triggers associated with eating disorders, helping patients access and integrate psychedelics in a safe and therapeutic manner. Their involvement ensures a comprehensive treatment approach that combines the benefits of psychedelic therapy with the tailored support required for individuals with eating disorders, leading to more effective and sustainable outcomes. We view the role of psychedelics as an adjunctive to traditional treatments, not a “replacement.”

 

Conclusion

Psychedelic-assisted therapy represents a promising frontier in the treatment of eating disorders, offering new possibilities for deep healing and transformation. While further research is needed to fully understand its effectiveness and establish appropriate guidelines, preliminary studies and anecdotal evidence suggest that this approach holds tremendous potential. As the field progresses, it is essential to strike a balance between innovation and responsible practice, ultimately providing individuals with hope and a path toward recovery from their eating disorders.

 

References

  1. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
  2. BMC Psychiatry. 2019; 19: 134. Published online 2019 May 6. doi: 10.1186/s12888-019-2112-9
  3. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00588-9
  4. https://compasspathways.com/comp360-psilocybin-therapy-shows-potential-in-exploratory-open-label-studies-for-anorexia-nervosa-and-severe-treatment-resistant-depression/
  5. https://tryptherapeutics.com/updates/tryp-therapeutics-announces-interim-results-for-its-phase-ii-clinical-trial-for-the-treatment-of-binge-eating-disorder-with-psilocybin-assisted-psychotherapy
  6. https://www.sciencedirect.com/science/article/pii/S0022395622001303
  7. https://pubmed.ncbi.nlm.nih.gov/9797933/
  8. (Ghaderi et al., 2018, Ward et al., 2019)
  9. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
  10. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342

Motivation To Heal: How Ketamine Has Helped One Woman Deal With an Eating Disorder

By Greg Ferenstein

Joan was desperate to overcome an eating disorder, which she had been struggling with since adolescence.

The disorder was unfortunately more than dangerously low weight; she didn’t have the energy to live her life and do what she loved most like hiking or traveling.

This spiralled into depression, anxiety and suicidal ideation.

Eating disorders are a major mental health challenge. According to the National Association of Anorexia Nervosa and Associated Disorders, a staggering 9% of the global population struggles with some form of eating disorder. Consistent with Joan’s experience, an estimated 26% with the condition attempt suicide.

The pandemic has been especially challenging for those suffering from mental health conditions and may have exacerbated the incidences of those struggling with eating disorders.

Joan tried many treatments, including a longer term residential program. But the coercive nature of being committed in a facility left her fearful to try more intensive, traditional medical services.

So, like many people, she turned to less traditional services in the psychedelics underground with facilitators who could help her cope with mental illness using unapproved drugs.

“I've done psilocybin to LSD,” she says.

Given that there is no regulation or oversight, the psychedelics underground can be a precarious place.

After an underground session with MDMA, a synthetic compound currently in final stages of FDA clinical trials, Joan said she developed some important sense of self-acceptance.

“It's the first time I was able to look at myself in a mirror,” she recalls. Previously she had so much self-loathing for her appearance.

The psychedelic experiences convinced her that she could focus on her health.

Eventually, Joan met someone from Cedar by Novamind and decided to go for a few sessions of their Emotion Focused Ketamine-Assisted Psychotherapy (EF-KAP).

Novamind recently published a case series of patients undergoing ketamine-assisted therapy for eating disorders and found promising results. “The seemingly rapid response in mood to ketamine treatments observed in some cases is congruent with previous studies of ketamine for depression,” concluded the report.

Joan’s experience seems consistent with the report’s results. In total, she had two sessions.

“Something shifted in me,” she says.

Sometimes people experience intense visualizations in a ketamine experience, but not always. After one of the sessions, Joan remembers calling her mother and being more open to new ideas.

“I was able to think about things more rationally and just hold ideas that I couldn't have held otherwise.”

Since those sessions, Joan says that she gets less “freaked out” about eating more calories per day. Previously that sort of idea frightened her, but less so after the ketamine sessions.

And she is currently becoming more comfortable with the idea of gaining weight.

“I don't have to gain a ton of weight. But I want to have a little bit more energy to do some of the things I used to do, like hiking and traveling.”

*Joan is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.