MDMA-assisted therapy reduces eating disorder symptoms in adults with severe posttraumatic stress disorder (PTSD), according to a new study published in the Journal of Psychiatric Research.
Eating disorders are serious mental illnesses that can have devastating physical and emotional consequences. Anorexia nervosa, bulimia nervosa, and binge-eating disorder are the most common types of eating disorders. The lifetime prevalence of eating disorders is estimated to be approximately 8% for women and 2% for men.
MDMA, commonly known as “molly,” has shown promise in treating various mental health conditions when combined with psychotherapeutic interventions. The U.S. Food and Drug Administration has granted breakthrough therapy designation to MDMA-assisted psychotherapy for PTSD, acknowledging that it “may demonstrate substantial improvement over existing therapies.” The authors behind the new study sought to explore whether this form of psychotherapy could provide aid to those suffering from eating disorder symptoms.
The researchers examined data from a phase 3 randomized, double-blind, placebo-controlled study during which MDMA was administered to patients with severe PTSD. During the clinical trial, treatment was administered to 90 participants over the course of 18 weeks. Patients underwent three 90-minute preparatory psychotherapy sessions, three 8-hour active MDMA or placebo sessions, and nine 90-minute integrative psychotherapy sessions.
The primary outcome measure in the trial was the Clinician-Administered PTSD Scale, a structured diagnostic interview that assesses PTSD severity. MDMA was well tolerated and there was a robust reduction in PTSD symptoms among MDMA patients compared to patients receiving a placebo combined with a similar therapy.
But the study also included a validated screening tool known as the Eating Attitudes Test 26, which assesses various symptoms characteristic of eating disorders. For example, the questionnaire asks the participants to indicate how often they feel terrified about being overweight, find themselves preoccupied with food, vomit after eating, and feel extremely guilty after eating, among other things. The patients completed the questionnaire twice — prior to treatment and at the end of treatment.
Prior to treatment, thirteen participants met the criteria for clinically significant concern about dieting, body weight or problematic eating behaviors. Another 28 patients had scores that placed them within an “at risk” range. The finding are in line with previous reports that eating disorder symptoms are associated with PTSD, the researchers said.
Reductions in eating disorder symptoms were observed in both patients who received MDMA and patients who received a placebo. However, the reductions tended to be greater among those who received MDMA. “There was an apparent gender effect in that the reduction was primarily seen in women, who not only consisted of 63% of the sample but are known to have higher rates of EDs and their symptoms,” the researchers noted.
But the specific mechanisms that account for the improvement in eating disorder symptoms following MDMA-assisted therapy are unknown. In a separate paper, published in Medical Hypotheses in 2021, the researchers proposed that MDMA might help to “facilitate an advantageous psychological state that has the capacity to augment the therapeutic process by providing the opportunity to process emotions fueling the disorder, as well offering corrective emotional experiences.”
MDMA is a psychoactive drug that produces feelings of euphoria and empathy, and when used in a therapeutic setting, it can help to reduce fear and judgmentalness, providing a safe space for patients to explore their emotions. In addition, MDMA helps to increase communication and trust, which can be helpful in resolving conflict or trauma.
The new findings are promising but preliminary. The Eating Attitudes Test 26 is commonly used in clinical settings, but it is not used to make clinical diagnoses. “A major limitation of this study was that full syndromal EDs were not exclusively studied, so the generalizability of our findings to the treatment of EDs is limited,” the researchers said. Future research should explore the safety and feasibility of MDMA-assisted therapy in patients diagnosed with eating disorders such as anorexia nervosa restricting-type.
The study, “MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD“, was authored by Timothy D. Brewerton, Julie B. Wang, Adele Lafrance, Chelsea Pamplin, Michael Mithoefer, Berra Yazar-Klosinki, Amy Emerson, and Rick Doblin.
