Psilocybin-assisted psychotherapy as a potential treatment for eating disorders: a narrative review of preliminary evidence

Eating disorders involve abnormal energy balance, cognitive inflexibility, and emotional distress, with few effective treatments and low long-term remission. Psilocybin, a serotonergic psychedelic, shows therapeutic potential for disorders marked by rigid thinking and treatment resistance. This narrative review examines the hypothesis that psilocybin-assisted psychotherapy could be an effective adjunctive treatment for eating disorders, drawing on biological plausibility, transdiagnostic evidence, and preliminary results. The authors conclude that current literature does not yet support clinical use, but preliminary evidence warrants more rigorous clinical trials.

Study at a glance

Abstract

Eating disorders (ED) are a group of potentially severe mental disorders characterized by abnormal energy balance, cognitive dysfunction, and emotional distress. Cognitive inflexibility is a major challenge to successful ED treatment and dysregulated serotonergic function has been implicated in this symptomatic dimension. Moreover, there are few effective treatment options and long-term remission of ED symptoms is difficult to achieve. There is emerging evidence for the use of psychedelic-assisted psychotherapy (PAP) for a range of mental disorders. Psilocybin is a serotonergic psychedelic that has demonstrated therapeutic benefit in a variety of psychiatric illnesses characterized by rigid thought patterns and treatment resistance. The current paper presents a narrative review of the hypothesis that psilocybin may be an effective adjunctive treatment for individuals with EDs, based on biological plausibility, transdiagnostic evidence, and preliminary results. Limitations of the PAP model and proposed future directions for its application to eating behavior are also discussed. Although the literature to date is not sufficient to propose the incorporation of psilocybin in the treatment of disordered eating behaviors, preliminary evidence supports the need for more rigorous clinical trials as an important avenue for future investigation.