What you need to know
Clinicians have proven few pharmacological and psychotherapeutic treatments effective for body dysmorphic disorder (BDD) and eating disorders (ED). However, researchers are exploring new treatment options for those with EDs and BDD including psychedelic-assisted therapies. This systematic review collected and evaluated evidence related to the therapeutic impact psychedelics have on patients diagnosed with EDs and BDD.
What is this research about?
EDs and BDD are mental health disorders where individuals are excessively concerned with their physical appearance leading to distress and functional impairment. EDs are behaviour conditions where a person experiences severe and persistent disturbance in eating with associated distressing thoughts and emotions, whereas BDD is a body-image disorder characterized by ongoing and intrusive preoccupations with the way one looks.
Previous studies have explored new treatment options for individuals with EDs or BDD including classic psychedelics. Classic psychedelics, such as psilocybin, lysergic acid diethylamide (LSD) and ayahuasca, are hallucinogenic drugs that affect the serotonergic system (a collection of neurons located on the brainstem) in the human body. Psychedelics activate serotonin receptors located in the cortical and subcortical structures of the brain. These receptors can treat the symptoms associated with EDs and BDD. The effects of psychedelics make one feel that they can better control and regulate emotions related to their body image. These feelings can lead to positive thinking when it comes to identity.
In this study, researchers conducted a systematic review looking at the therapeutic impact psychedelics have on patients diagnosed with EDs and BDD.
What did the researchers do?
The researchers conducted a systematic review that looked at studies on the effect of psychedelics on ED and BDD symptom severity published up until February 2022. The researchers searched relevant studies from multiple databases and through grey literature. The inclusion criteria included:
- English studies
- classic psychedelic drug that functions through the activation of the serotonin 5-HT2A receptor
- all study designs (e.g., case reports, observational studies, randomized controlled trials) that reported on the use of psychedelic drugs in patients with EDs and/or BDD.
The researchers excluded articles not published in English and studies that were conducted on animals.
What did the researchers find?
The researchers identified a total of 372 studies for data evaluation. However, only five articles met the eligibility criteria. Four of the reviewed articles described a reduction in ED or BDD symptoms following ingestion of ayahuasca or psilocybin. Two of the reviewed articles looked at ED and found that participants could identify what caused their ED and experienced changes in how they viewed themselves focusing more on self-love and self-forgiveness. Only one case report was found that reviewed a patient with BDD. In this report, the participant reported changes in their perception of their body and was no longer convinced that the perceived bodily deformations were real. Another case study was unclear on the diagnosis and the effects of psilocybin on the participant’s symptoms.
Overall, the literature was limited and few available studies were identified that showed promising results on the use of psychedelics to treat BDD and ED symptoms. The researchers believe that concrete conclusions cannot be made without rigorous scientific methodology.
Limitations of the research
The researchers note that their study had several limitations. The search was conducted in English and many articles were missed that might have been published in other languages. They were unable to draw any concrete conclusions due to limited data. Another limitation was that the studies included had small sample sizes and there were no randomized controlled trials identified.
How can you use this research?
The researchers suggest that more research is needed to determine the safety and effectiveness of psychedelics in the treatment of BDD and EDs. They suggest having larger sample sizes representing the treatment population. Furthermore, there is a need for more transparency and thorough reporting of results and adverse events that will help with understanding the therapeutic use of psychedelics in patients with BDD and EDs.
About the researchers
Nicole Ledwos1, Justyne D. Rodas1,2, M. Ishrat Husain3,4, Jamie D. Feusner2,3,4,5 and David J. Castle1,4
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden