In a recent Journal of Eating Disorders editorial, Touyz and Hay (2022) argued for greater innovation in the field of eating disorders, calling for urgent paradigm shifts. Whilst many have benefited from existing evidenced-based therapeutics, research shows that up to 40% of individuals with anorexia nervosa (AN) will still be ill at 20 years.
AN maintains the highest mortality rate of all the mental disorders and is the leading cause of mental health related hospitalisations. Repeated hospitalisations and inpatient feeding are often the only life-saving intervention available when psychotherapy fails. The high mortality rate and costs of AN reflect a conspicuous lack of treatments, as there are no recognised or effective pharmacotherapies for AN. A variety of trials have reported notable therapeutic potential in a range of severe refractory psychiatric illnesses following 2-3 spaced exposures to psilocybin embedded within a carefully managed psychotherapeutic regime, so called psilocybin-assisted psychotherapy. Ambivalence, cognitive rigidity and amotivation are central to AN and are important predictors of treatment response and relapse prevention. These features prove extremely hard to impact with conventional therapies. Participants given psilocybin report lasting increases in open-mindedness and psychological/cognitive flexibility, readiness to try and engage in new activities, and improved ability to dismantle rigid and habitual mental templates in several psychiatric disorders that are often co-morbid with AN. Trialling psilocybin-assisted psychotherapy in AN is a logical next step and such trials are already underway in several countries including the USA, Canada, UK, and Australia. Brain circuitry dysregulation may prove to be the root cause of this devasting disorder. Neuroscience provides an almost perfect model upon the to explain why psilocybin-assisted psychotherapy may change the minds of those with persistent AN.
This article Collection will be devoted to this new frontier in better understanding the potential role of psychedelics in the treatment of eating disorders.