Psychedelics For Eating Disorders: An Interview With Psychiatrist And Researcher Dr. Reid Robison
You may have heard of psychedelics being used to help treat PTSD or end-of-life anxiety. But a small but growing body of work suggests they could be helpful for another group of mental health conditions: using psychedelics for eating disorders.
Dr. Reid Robison is a Utah-based psychiatrist who works with patients recovering from anorexia, bulimia, and binge-eating disorder, and has witnessed firsthand how psychedelic drugs like ketamine and MDMA can aid in the recovery process.
Robison has several roles in the psychedelic space. As a clinical researcher, he currently serves as the principal investigator of at least one study of psilocybin. He has previously led over 100 clinical trials in neuropsychiatry. As the chief clinical officer at Numinus, he supervises the company’s clinical work, including its ketamine-assisted psychotherapy program. He is also the medical director at Center for Change, an eating disorder treatment facility in Utah.
Healing Maps recently sat down with Dr. Robison to discuss the increased use of psychedelics among young people, the spectrum of eating disorders, and how psychedelic-assisted therapy can bring new perspectives to patients who are suffering.
Healing Maps (HM): A recent study showed that in 2021, cannabis and psychedelics use among young people reached an all-time high. Why do you think that is?”
Reid Robison (RR): “I think it’s the result of this perfect storm of young people reclaiming their mental health, and of abandoning conventions from past generations, including the fears around psychedelics that led to them being banned. I see the psychedelic renaissance as part of this broader mental health revolution that’s happening, where the stigma is reducing.
“It’s unfortunate that mental health and addiction struggles are also increasing. The Covid-19 pandemic shined a light on that, and perhaps amplified it, but at the same time, it’s becoming more and more socially acceptable to seek help and to take care of one’s mental health. In parallel with that, you have psychedelic medicines coming into the public eye and spreading, as a way of healing and growing and raising consciousness.”
HM: Let’s jump to eating disorders. Can you describe how these complex disorders are exhibited in people?
RR: “Eating disorders encompass several different conditions that are sometimes on different ends of a spectrum in mental health. It’s estimated that here in the U.S., over 30 million Americans suffer from an eating disorder in their lifetime. They’re the most common chronic illnesses among adolescent females in the U.S. and Canada, although they do affect young and old, all economic classes and ethnicities: one percent of women suffer from anorexia sometime in their lifetime, one and a half percent suffer from bulimia, and three to four percent suffer from binge-eating disorder.”
HM: What’s happening in the mind of a person suffering from an eating disorder, and how can a psychedelic experience potentially interrupt that?
RR: “The paper by Robin-Carhart Harris and colleagues called The Entropic Brain discusses how you could plot mental health conditions on a spectrum, from entropy or chaos, to order and control. Anorexia would fall on the over-control end of the spectrum, along with anxiety or OCD, where the individual gets trapped in their own rules; for example, ‘don’t eat that, it will lead to weight gain.’
“Binge eating disorders are on the other end of the spectrum towards entropy, or disorder, where an individual can’t stop engaging in a pattern of eating, similar to substance use patterns and even mood disorders like depression, where one can’t get out of bed. With anorexia, it’s highly ordered — you can’t not get out of bed and go through one’s highly structured routine.
“The fascinating thing about psychedelics is that they do appear to treat both ends of the spectrum of over-control and rigidity, and also disorder and disorganization. There’s balance to be found in the middle, and psychedelics do restore that balance by wiping the default mode network, or dissolving the ego.
“Psychedelics in anorexia for example, give a time-out from these stuck patterns of rigidity. In a similar way but also distinct way, psychedelics can help with a blank slate in cases of binge-eating disorder or bulimia, by clearing those patterns and letting people consciously choose their path forward. I will offer a disclaimer for conditions like anorexia, where there is a lot of rigidity. It does take more psychedelic work and more dosing sessions because of the sticky nature of these patterns.”
HM: Existing treatment models for eating disorders are limited. How does psychedelic-assisted therapy compare to what is currently available to patients suffering from anorexia, bulimia, or binge-eating disorder?
RR: “That’s a good question, because eating disorders are complicated neurobiological conditions and often require intensive treatment, which involves unlearning the behaviors that show up in these conditions. Sometimes that requires getting out of the environment where these patterns have developed and become stuck, meaning intensive day treatment or overnight care, especially when conditions become life-threatening.
“Psychedelics aren’t a substitute for specialized treatment with a dietician and an eating disorder therapist — I see them as more of a catalyst or therapy accelerator, still requiring a specialized team in place. But we can hopefully accelerate the path to full recovery by giving a psychedelic medicine. In these conditions, the stakes are high, and there are not very good existing treatments, especially medication treatments.”
HM: What makes MDMA specifically a good psychedelic for eating disorders treatment?
RR: “MDMA for eating disorders is very interesting, because it has this unique ability to promote empathy towards the self and others. In eating disorders, there is often a significant lack of self-compassion towards one’s body, and oneself in general. When you give a substance like MDMA, as we’ve seen in the MAPS studies so far, there have been cases where eating disorder symptoms have been healed in parallel to healing one’s trauma.
“This is because of the unique mechanism of MDMA that helps you reconnect with yourself in a loving way, trust your treatment team, move through difficulties of the past that were previously overwhelming, and forge a new path forward with some self-compassion.”
HM: Based on your research, how effective would you say psychedelics like ketamine and MDMA are at treating people with eating disorders, or at least setting them on the path towards recovery?
RR: “Unfortunately, we don’t have as much data yet as we do for say, ketamine and psilocybin for depression, or MDMA for PTSD. Even in the eating disorder studies that I’ve done, like many others, we’re often looking at the symptoms of depression and anxiety and trauma that go along with it. Eating disorders can often co-occur with other conditions, so much of the research is focused on how we reduce the burden of those other conditions to make it more feasible to recover from an eating disorder.
“There haven’t been controlled, blinded, large-scale studies using psychedelics for eating disorders, although that work is being done. Anecdotally, and having published some case reports of doing ketamine-assisted psychotherapy for eating disorders, I do have a lot of optimism for the ability of ketamine and MDMA to accelerate the healing and recovery path — not as a quick fix and not necessarily as a standalone substitute for conventional treatments, but paired with specialized care.”
This interview has been edited for clarity and length.