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

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 disoder. 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.& COPY; 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license

Automated summary

Eating disorders are serious illnesses with high mortality rates and comorbidity with other mental health problems. Psychedelic-assisted therapy has shown potential in treating comorbidities of eating disorders, such as mood disorders, PTSD, and substance use disorders. This review summarizes preliminary data on the efficacy of psychedelic-assisted therapy in anorexia nervosa, bulimia nervosa, and binge eating disorder, and discusses potential therapeutic mechanisms. It suggests that psychedelic-assisted therapy may be effective in treating anorexia nervosa and bulimia nervosa, while data on binge eating disorder is limited. The therapy may improve body image beliefs, normalize reward processing, promote cognitive flexibility, and facilitate trauma processing, as well as addressing common therapeutic factors. Safety concerns and future research recommendations are also discussed.