This post was co-authored by Michelle Kim and Robert T. Muller, Ph.D.
Treating an eating disorder can become tricky when combined with other co-occurring conditions like depression, anxiety, PTSD, and/or substance abuse. Anorexia nervosa is one of the most difficult eating disorders to treat having the highest mortality rate of any mental health condition. However, other than various medications that largely target symptoms for the comorbid conditions above, there are no approved drugs that directly treat eating disorders, anorexia in particular. In the absence of tailored treatment options, perhaps it’s no surprise that a growing interest in Psychedelic-Assisted Therapy (PAT) for eating disorders is slowly gaining traction.
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Although increasingly understood as having a biological basis, the precise root causes of eating disorders like anorexia are still unclear, as is our understanding of how and why PAT may work in this context. As Natalie Gukasyan, Medical Director at the John Hopkins Center for Psychedelic and Consciousness Research emphasizes, “…it’s a lot of speculation at this point and a lot of additional research that needs to be done.”
With FDA approval of psilocybin for depression and MDMA for PTSD potentially around the corner, the idea of PAT for eating disorders appears to be encouraging. This, coupled with the lasting clinical improvements demonstrated for other difficult-to-treat conditions like major depressive disorder, PTSD, substance use, and obsessive–compulsive disorder, treating eating disorders with PAT could be promising due to certain overlapping features and shared thought patterns with other related conditions. At the same time, however, there are still more questions than answers at the moment.
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Gukasyan further explains how certain factors are preventing our ability to draw any hard conclusions about how PAT could be an effective treatment for eating disorders. To date, we still don’t understand its pathophysiology well enough to show or conclude exactly how PAT is effectively helping those suffering from eating disorders. Although certain mystical or transcendent aspects of psychedelic experiences can be linked to positive behaviour changes, it’s hard to test, experiment, and measure. Studies on this are still ongoing, much of which remains to be published.
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Research conducted by Gukasyan regarding classic psychedelics like psilocybin, LSD, and mescaline for treating eating disorders have shown promise, but the studies were shown to have methodological issues and lacking in concrete conclusions. Non-classic psychedelics like ketamine and MDMA are also showing potential, however early published research is still limited to case reports and small sample sizes, also making it difficult to draw firm conclusions just yet.
In spite of limited research, success stories are still underway. Why this might be the case is perhaps better understood through the lens of experts like Sabina Pillai, Director of Psychotherapy Services at Field Trip Health for the US & Canada, who currently offers ketamine-assisted therapy. As Pillai explains, although research has demonstrated certain psychedelic substances to be effective in and of themselves, “these medicines are really a catalyst for the process of healing, change, and growth rather than a treatment itself.”
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From Pillai’s perspective, determining whether psychedelic-assisted therapy will be beneficial for someone struggling with an eating disorder can depend on a few important factors, particularly client intrinsic motivation for self understanding. Their desire to heal, grow, and willingness to go on a “hero’s journey” (a quintessential description of a psychedelic trip), along with all the ups and downs that come with it, can play such an important role in the success of their treatment. Facing one’s traumatic past can be a complex process that tends to come with a lot of shame. Confronting a person’s family issues and relationship challenges not only with others but with themselves and their body can be difficult. This often requires courage from the client, and for the therapist to not only be supportive but “radically be with the client in their most vulnerable moment.”
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Beyond the potential ability to efficiently tackle an eating disorder and co-occurring conditions simultaneously, psychedelic assistance can make therapy feel more profound and meaningful. Often with transcendent experiences come emotional breakthroughs felt at a visceral level. This can allow clients to engage in therapy more fully. Often, with this shared transformative experience comes a deepening of the therapeutic bond between client and therapist. As a result, greater meaning becomes attached to not only the client’s life-altering experience but also the therapeutic relationship itself.
