Psilocybin for eating disorders — what the Johns Hopkins study found

The Hopkins pilot study (Foldi et al., 2023, published in Nature Medicine) enrolled 10 adults with anorexia nervosa — a condition with the highest mortality rate of any psychiatric disorder. Results: significant reductions in eating disorder psychopathology, body dysmorphia, and depression at the 1-month follow-up. Patients also reported improvements in psychological flexibility and reduced rigid thinking. The sample is tiny and the study was open-label (no control group), so conclusions are limited — but the signals are strong enough to justify a larger trial.

Why anorexia is a logical target for psilocybin: AN shares with OCD a pattern of rigid, compulsive thinking that's notoriously treatment-resistant to conventional approaches. The body image distortion is a form of cognitive rigidity; the self-starvation behavior is compulsive. Psilocybin's mechanism of loosening stuck neural patterns could theoretically interrupt this in ways that CBT and SSRIs often don't. The mystical experience component may also help patients access self-compassion that eating disorder psychology actively suppresses.

Important context: anorexia nervosa is medically serious and treatment requires a multidisciplinary team. Psilocybin research in this area is extremely early and any clinical application requires careful medical supervision and nutritional stabilization before psychedelic work begins. Do not attempt self-treatment for AN — the medical risks of being underweight complicate any pharmacological intervention.