Should Psychedelic Therapy For Eating Disorders Be Considered in FDA Approvals?

Understanding success stories and treatment potential.

Treating an eating disorder can become tricky when combined with other co-occurring conditions like depression, anxiety, PTSD, and/or substance abuse. Anorexia nervosa being the most difficult eating disorder to treat has the highest rate of death of any mental health condition. However, other than various medications that largely target symptoms of comorbid conditions above, there are no approved drugs that treat the core issue at hand. In the absence of tailored treatment options, perhaps it’s no surprise that psychedelic-assisted therapy (PAT) for anorexia is gaining traction.

Although increasingly understood as having a biological basis, body dysmorphia implications aside, of which psilocybin (hallucinogenic compound in "magic mushrooms") has shown to help, the precise mechanisms and root causes of anorexia are still unclear. 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."

Nonetheless, with FDA approval of psilocybin for depression (and possible reconsideration of MDMA for PTSD) potentially around the corner, the idea of PAT for eating disorders appears to be encouraging. This coupled with lasting clinical improvements demonstrated for other difficult-to-treat conditions like major depressive disorder, PTSD, substance use, and obsessive–compulsive disorder, suggests promise given several overlapping features and shared thought patterns .

However, Gukasyan further explains how certain factors are preventing our ability to draw any hard conclusions about how PAT could be an effective treatment. To date, we still don’t understand anorexia's pathophysiology well enough to show or conclude exactly how this is effectively helping those suffering. Although certain mystical or transcendent aspects of psychedelic experiences can be linked to positive behaviour changes, it’s hard to test, experiment, and measure. 

Prior research conducted by Gukasyan regarding classic psychedelics like psilocybin, LSD, and mescaline for treating eating disorders have shown promise, but studies were shown to have methodological issues. 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 any hard conclusions just yet.

That said, 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 currently offering 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.”

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. A client's intrinsic motivation for self-understanding for example is pivotal. Their desire to heal, grow, and willingness to go on a quintessential “hero’s journey”, 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,” according to Pillai.

Beyond the ability to efficiently treat 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. With this shared transformative experience comes a deepening of the therapeutic bond between client and therapist. As a result, greater meaning can become attached to not only the client’s life-altering experience but also the therapeutic relationship itself.

This updated post was initially co-authored by Michelle Kim and Robert T. Muller, Ph.D. originally published November 26, 2023