Psychedelics in the treatment of eating disorders: Rationale and potential mechanisms

Eating disorders are serious illnesses with high mortality and comorbidity. Psychedelic-assisted therapy shows promise for common comorbidities like mood disorders, PTSD, and substance use disorders, and may also benefit eating disorders themselves. This review summarizes preliminary data on ketamine, MDMA, psilocybin, and ayahuasca for anorexia nervosa, bulimia nervosa, and binge eating disorder. Preliminary evidence suggests psychedelic-assisted therapy may be effective for anorexia and bulimia, with very little data on binge eating disorder. Potential mechanisms include improving body image beliefs, normalizing reward processing, promoting cognitive flexibility, and facilitating trauma processing, alongside general therapeutic factors. Safety concerns and future research recommendations are discussed.

Study at a glance

Abstract

Eating disorders are serious illnesses showing high rates of mortality and comorbidity with other mental health problems. Psychedelic-assisted therapy has recently shown potential in the treatment of several common comorbidities of eating disorders, including mood disorders, post-traumatic stress disorder, and substance use disorders. The theorized therapeutic mechanisms of psychedelic-assisted therapy suggest that it could be beneficial in the treatment of eating disorders as well. In this review, we summarize preliminary data on the efficacy of psychedelic-assisted therapy in people with anorexia nervosa, bulimia nervosa, and binge eating disorder, which include studies and case reports of psychedelic-assisted therapy with ketamine, MDMA, psilocybin, and ayahuasca. We then discuss the potential therapeutic mechanisms of psychedelic-assisted therapy in these three eating disorders, including both general therapeutic mechanisms and those which are relatively specific to eating disorders. We find preliminary evidence that psychedelic-assisted therapy may be effective in the treatment of anorexia nervosa and bulimia nervosa, with very little data available on binge eating disorder. Regarding mechanisms, psychedelic-assisted therapy may be able to improve beliefs about body image, normalize reward processing, promote cognitive flexibility, and facilitate trauma processing. Just as importantly, it appears to promote general therapeutic factors relevant to both eating disorders and many of their common comorbidities. Lastly, we discuss potential safety concerns which may be associated with these treatments and present recommendations for future research.