Trigger Warning: This article describes the behaviors of those struggling with eating disorders.
Lauren Taus went straight for the scale. This time, not to weigh herself, but to grab the slender glass instrument from its centerplace in the bathroom, carry it outside, and haul it to the ground. In a singular gust, the shattered pieces of the scale had scattered throughout the driveway. “It was exhilarating and liberating and energizing and beautiful,” Lauren relays through a big, happy smile, over a Zoom call. It was when the 38-year-old therapist and yoga teacher had done ayahuasca that a spirit entity, which felt like a grandmother, told her to let go of her eating disorder. Immediately after the ceremony, the facilitators lent her a baseball bat and their own scale, encouraging her to smash it—then she went home, and smashed her own. “The relationship to my body has changed since then,” she says.
Lauren is one of the 28.8 million Americans (or nine percent of the population) who experience an eating disorder—including anorexia, binge eating, or bulimia nervosa—in their lifetime. Eating disorders can be lethal, second only to opioid overdose as the deadliest mental illness in the US. More than 10,000 people die each year as a direct result of an eating disorder, either by suicide or by medical complications secondary to the symptoms. That’s one death every 52 minutes.
“I was probably knocking on death’s door for a short period of time,” Lauren says. “I didn’t have my period for a number of years and my parents threatened to take me out of school if I wouldn’t gain weight.” She was 17 when she first started weighing herself obsessively and manipulating her food intake. “I would be crying over the toilet bowl because I just couldn’t purge,” so she started abusing laxatives instead. In college the situation became worse.“I was weighing myself all the time, giong to the gym a lot and dropping weight constantly,” she says. “I was a straight A-student. I was an editor of the college newspaper. I was doing community service. I was thriving from external measurements, but I was dying inside.”
Seeing a therapist and going to 12-Step meetings run by Overeaters Anonymous helped Lauren slowly return to a more healthy way of eating. “The therapist probably saved my life,” she says. But the idea of having to constantly control her weight never entirely left her mind. “Every morning my heart would start racing when I stepped on the scale,” she recalls. “And the number it showed would determine how I was feeling about myself, or if I go out or cancel a date.”
Eating disorders are among the most challenging mental disorders to treat, and long-term outcome studies show high rates of dropout from treatment and relapse rates around 30 percent and higher depending on the eating disorder and the way relapses are measured. Methods including psychotherapy, hospitalization, and medication may ease the symptoms of an eating disorder, especially for those suffering from bulimia nervosa or binge eating disorder. For anorexia nervosa, however, there is no consensus on a first-line psychotherapeutic model or treatment. And up until now, there is nothing that comes even close to a cure.
So no wonder there’s a great deal of excitement and curiosity among psychedelic researchers, who have heard about healing stories like Lauren’s, with the help of ayahuasca. Psychedelics might just hold the key to new forms of treatment, which could potentially transform the lives of eating disorder patients, in ways that have not yet been achievable.
“When it comes to eating disorders and psychedelics, we are in the beginning of a very exciting time,” says clinical psychologist Adèle Lafrance, who is a clinical psychologist and a pioneering researcher in the psychedelic field.
In 2017, Lafrance published her research on ayahuasca and eating disorders, which laid the groundwork for what’s now a slew of studies that are about to start in several universities across Canada, the USA and the UK looking at MDMA, ketamine and psilocybin as potential eating disorder treatments, as well. Her initial study looked at 14 women and two men, 10 suffering from anorexia and six from bulimia. Thirteen of the 16 participants had at some point engaged in conventional eating disorder treatment in either hospitals or other settings with various psychotherapeutic approaches. But these treatments had not led to what participants described as recovery from eating disorder thoughts and behaviors.
“All but one participant reported that the ayahuasca experiences contributed to a greater sense of wellbeing and was beneficial to them with respect to eating disorder thoughts and symptoms,” says Lafrance. Half of the interviewees also reported reductions in anxiety, depression, self-harm, suicidality, and problematic substance use that are often comorbid with an eating disorder.
Some participants reported that the preparatory dieta leading up to the ayahuasca ceremony, which includes restricting one’s intake of meat, sugar, coffee, alcohol and other drugs, was a trigger for well-known thoughts about food restrictions. But the purging (vomiting) aspect of ayahuasca—seemed to be a completely different experience. “It was mostly experienced as a purge of pain fueling the illness,” Lafrance reports, rather than being reminiscent of the purge inherent in disordered “binge-and-purge” bulimic cycles. “One woman, [however], shared that she never actually purged in an ayahuasca ceremony, because she was told by the plant spirit that she had vomited enough in her life.”
With the ayahuasca having helped the study subjects to experience deeper, more efficient healing, coupled with feelings of self-love and self-care, they were able to approach their eating disorder from a different vantage point than what traditional treatment could offer. “I think it adds a dimension that is missing [from the Western model], which is this ability to really experience in a very embodied way all of the implicit material that played a role in leading into the formulation of the eating disorder, the wounding that happened,” one participant in Lafrance’s survey explained.
Today, a new and somewhat broader study follows up on Lafrance’s previous work. At the Center for Psychedelic Research at Imperial College London, postdoc Meg J. Spriggs published a study in August looking at various psychedelics in the treatment of depression and overall well being among eating disorder patients. In conducting the study, Spriggs anonymously surveyed 27 participants reporting a lifetime diagnosis of an eating disorder, and who had taken ayahuasca, DMT, 5-MeO-DMT, LSD, 1P-LSD, shrooms, or San Pedro. The results showed improvements in both symptoms of depression, as well as in general well being two weeks after a psychedelic experience. While no firm conclusions could be drawn, Spriggs writes, the evidence shows the potential for psychedelic-assisted psychotherapy as an eating disorder treatment, and the need for more clinical trials.
“That night, I laid down after drinking the first cup [of ayahuasca],” Lauren says, describing the experience that changed her life. “My body was shaking and I remember judging the way my thighs felt shaking. Then I saw a woman in a gray dress who points at my thighs, looks at me and says: What’s your problem? I made those! So I feel a bit childlike, punished and ashamed and I am like: Oh! Sorry! I should not complain about your handiwork.” Then Lauren describes her vision of the woman going about her body, doing “house cleaning.” “I am uncomfortable with the cleaning. I don’t like it. But she’s like: Come! Come clean with me. You asked for this,” Lauren recalls. “So I would join her in the journey to clean my house. Every time I started protesting like a little girl, ‘Do you ever stop?’ she would say something like ‘That’s none of your business. I have a lot of work to do, Missy!’ So I keep cleaning with her.”
After the woman in the gray dress finished cleaning house, Lauren envisioned an obese cartoon character, who seemed like a mother, dancing in a G-string bikini. “She starts shaking her ass and thighs and arms and titts and she laughs. So joyful and happy. And there is so much beauty in it,” Lauren says. “I am almost dying in laughter. I am just having fun with that woman who loves her body which is breaking all standards of what I think I am supposed to look like. It felt like two hours of laughter.”
“It is time for you to retire your extra, extra small life!”
But then at a certain point, Lauren sits up and the grandma in the gray dress is back. “She tells me, ‘It is time for you to retire your extra, extra small life!’ I see clothes coming out of my closet that are double zero. And I am trying to purge, but I don’t know if I can do it,” she describes. It wasn’t just about the xxs size clothes, she says, but about the “mental restrictions” she had imposed upon herself.
“I was really trying to get on board with what I knew to be true, but it was so hard, so hard for me to get behind this,” Lauren remembers. “I was wailing and grieving that extra, extra small life and my pride of being tiny and thinner than other people. All that bullshit that plagued and shrank me. I managed to crawl over to the fire and I was still bargaining with her: Can I maybe keep my scale? But she was like, ‘No. You are not getting a back door. Yes or no? What do you want? If I let you keep it, your life is not going to change!’”
“Eating disorders don’t discriminate,” Lafrance explains. “They can happen to anyone and any family type. So it is really hard to pinpoint what is causing them.” They are complex and often a collision of factors and events in a person who is either neurobiologically more vulnerable or has experienced significant challenges and trauma in their life. “But there seems to be one important shared factor across eating disorders that has been shown in a number of different studies,” says Lafrance, “and that is a difficulty with processing emotions.”
These can manifest differently, she says. “Patients struggling with anorexia nervosa, for example, might have a hard time even naming emotions, never mind attending to them, labeling them, or regulating them.” So in a way eating disorders might just be a dysfunctional coping mechanism of sorts. “Starving can numb distress,” Lafrance says. “Binge eating can soothe, and purging can provide relief.”
Identifying the importance of emotional processing vis-à-vis eating disorders is huge, she adds, since classic psychedelics are well positioned for just that: To help patients target and transform their ability to process emotions. Psychedelics, says Lafrance, hold the potential to reduce fears when approaching painful memories and emotions—so while tripping, it becomes easier to tolerate emotionally upsetting topics and to address them in a healthy manner, while otherwise the person might feel disoriented, dissociate, or experience ego loss when approaching the same topic or memory.
“There seems to be one important shared factor across eating disorders that has been shown in a number of different studies, and that is a difficulty with processing emotions.”
In another qualitative study whose results have not yet been published, Lafrance and colleagues interviewed various ceremony facilitators about eating disorders and ayahuasca. “One common characteristic that was either observed or perceived in the context of eating disorders by the ceremony leaders was that of a spiritual void,” says Lafrance. “They felt that eating disorders signified that an individual was struggling with lack of self-love, lack of self-worth and a lack of spiritual connection.“ Several also mentioned similarities among eating disorder patients, and those who struggle with addiction.
Those interviewed—either indigenous facilitators themselves, or trained in an indigenous shamanic tradition—felt that the conventional treatment programs had too narrow a focus on behaviors and symptoms, Lafrance reports. They felt that emotional and spiritual deficiencies and aspects of healing were not emphasized enough.
“I strongly believe that we need to combine the wisdom from these indigenous practices with a focus on behavioral symptoms because it’s the behavioral symptoms that end up being lethal,” says Lafrance, who adds that she would like to include the benefits of both worlds into future eating disorder treatments: spiritual healing, as well as behavior therapy in an approach combining indigenous wisdom and clinical methodology.
Lafrance is now involved in not less than three clinical trials in Canada, the US, and in the UK that are about to start or have just recently begun with psilocybin, ketamine and MDMA.
She collaborates as clinical supervisor in a pilot study looking into Psilocybin as a treatment for anorexia nervosa at Imperial College in London. She will look into the potential of MDMA for anorexia nervosa and binge eating disorder in a MAPS sponsored study happening simultaneously in Denver, Toronto and Vancouver that just received FDA and ethics approval. And she will be looking at anorexia nervosa and emotion-focused ketamine-assisted psychotherapy in collaboration with Novamind, a private company sponsoring psychedelic research as well as facilitating psychedelic retreats in Costa Rica and the Netherlands. In all three study set ups, a caregiver or a loved one will be recruited together with the patient. “Eating disorders don’t only affect individuals,” she says. “They affect families in significant ways.”
Furthermore, John Hopkins University as well as the Eating Disorder Treatment and Research Center at University of California in San Diego are about to start their first clinical trials for psilocybin and anorexia nervosa.
All five studies will assess safety, feasibility and preliminary outcomes first. “We’re at the very beginning of this work. So we really need to show that it’s safe,” Lafrance explains,noting that scientists need to be sure that these psychedelic substances will be well tolerated by the patients.
Lauren knew deep down that retiring her extra, extra small life was the reason she came to ceremony, yet still she felt resistance. “But all of a sudden, I see naked men and women and children and I am focusing on those naked female bodies and the different sizes and shapes,” she recalls. “I am Jewish. And in that context I realize that I am looking at a concentration camp with these people being incarcerated. Mama Ayahuasca in her gray dress looks at me and says, ‘You spit in their face hating your body! Stop it!'” Still sobbing, Lauren managed to spin around. “Time and space disappear and all of a sudden I am looking at the stars. I see the same people that I saw in the camp and I see my ancestors and my mom and my sister and my dad and I know one day we will all be there. And finally I am in the space of discomfort that’s necessary for the shift to happen—and I can let go of my patterns and my dysfunctional behavior.”
Indeed, Lauren’s entire family struggles with eating: Her mother, she says, has trauma and used food to numb, while her father was concerned with weight, as if it were a “moral value.” Needless to say, Lauren adds, her eating disorder developed at an early age. “When I was a little girl I had this idea that I had a very ugly face, a face that nobody would ever love,” she says. “I think that some of what has happened in my family felt ugly and I took it on and wore it. So I decided that if I didn’t have a perfect body nobody would ever love me because my face felt deformed.”
“One of my goals is to bring more love into psychotherapy.”
When Lauren, who now is a therapist herself, looks back on her experience she says she was “locked out” of her own heart—as is much of the population, she surmises. “In the end it is a homecoming journey. All progress is return. It’s like an archeological dig into your authentic self. And I am incredibly proud of myself how far I came on this path.”
Lafrance’s perspective towards her future work points toward a similar direction. “One of my goals is to bring more love into psychotherapy,” she says. It’s a term that has been some sort of a taboo in the therapeutic context in the past—and maybe that’s exactly why the field of mental health, itself, could use some of the perspective offered by psychedelics.
“When I think about individuals with eating disorders, I see a real difficulty both in feeling other people’s love as well as expressing love freely to others,” says Lafrance. “The psychedelic renaissance is pointing us in a direction of being able to talk about love openly and directly, to support our patients to heal their relationship with love.”