Psilocybin for eating disorders — the Johns Hopkins study and what it means

The Eating Disorders Courage to be Seen (EDCTS) study from Hopkins (2023 published in Nature Medicine) examined psilocybin-assisted therapy in adult women with anorexia nervosa. This was a significant result: 10 participants, open-label pilot. At 1-month follow-up, 40% of participants maintained or improved their BMI and 50% showed meaningful reduction in eating disorder psychopathology scores. No serious adverse events. The study was small and unblinded — it's a proof-of-concept but the signals are strong enough to warrant larger trials.

Why this matters so much: anorexia nervosa has the highest mortality rate of any psychiatric condition — approximately 5-10% of diagnosed patients die from the illness or complications. Standard treatments (CBT, FBT, specialized programs) have limited effectiveness, particularly in severe and longstanding cases. The current treatment landscape is inadequate. Any signal of novel efficacy gets serious attention in this field.

Proposed mechanism for eating disorders: anorexia involves rigid, inflexible thinking about food and body image, similar in some ways to OCD. Psilocybin's effects on cognitive flexibility and default mode network rigidity may address these patterns. The mystical experience component may also be relevant — a profound experience of self-transcendence may disrupt the hyper-self-focused cognition that characterizes anorexia's relationship to body and food.