Perspectives on psychedelic treatment and research in eating disorders: a web-based questionnaire study of people with eating disorders

Eating disorders affect an estimated 1.25 million people in the UK and carry high morbidity and mortality, with lifetime anorexia nervosa (AN) showing particularly poor outcomes and a tendency toward chronicity. Standard care typically consists of psychological programmes (for example, CBT, MANTRA, SSCM, FPT) and pharmacotherapies such as selective serotonin reuptake inhibitors, but systematic reviews and meta-analyses indicate limited efficacy for anorexia nervosa and substantial barriers to pharmacological trials in this population, including patients' reluctance to take medications perceived to induce weight gain. Treatment-resistant cases, which carry a poor long-term prognosis, motivate the search for novel therapeutic approaches. Harding and colleagues frame psychedelic drugs as a candidate avenue because of promising findings in other psychiatric disorders (depression, anxiety, OCD, substance use) and the neurobiological mechanisms implicated in psychedelics (principally 5-HT2A receptor agonism). The authors note a paucity of evidence specific to eating disorders—no randomised controlled trials at the time of data collection—and argue that patient views are an important preliminary step for designing ethical, acceptable clinical trials. To that end, they conducted a web-based survey to assess perspectives among people with eating disorders regarding complementary therapies and psychedelic research and treatment.

This cross-sectional, web-based survey ran from 24 April 2020 to 27 June 2020. Recruitment targeted adults (≥18 years) living in the UK who self-reported an eating disorder diagnosis; participants were invited through social media channels including an eating disorder charity (BEAT), The Psychedelic Society, and academic accounts. Of 332 people who consented, 200 met eligibility criteria and completed the survey. Ethical approval was obtained from King's College London. The questionnaire was co-developed with eating disorder clinicians and three patients (two with prior psychedelic experience) who piloted the items. The survey took up to 15 minutes to complete via Qualtrics and comprised six components: demographics, clinical information, current use of complementary/alternative treatments, views on psychedelics as a treatment option, the Brief Illness Perception Scale (adapted to replace "illness" with "eating disorder symptoms"), and free-text questions about concerns and perspectives. Quantitative items included categorical and Likert-style responses and visual analog sliding scales (0–100) for some attitude measures. Participants rated their level of concern about specific issues (safety, side effects, stigma, long-term effects, negative experiences, weight gain, addiction, loss of control) using a four-point categorical scale. They were also asked which factors would make participation in psychedelic research more appealing (for example, a safe monitored environment, regular follow-up, more information). Analysis separated quantitative and qualitative data. Descriptive statistics (frequencies, percentages, means, standard deviations) were generated using R. For some analyses participants were grouped into categories such as "minimal concern" versus "extreme concern" and "open to participate" versus "would never participate." Qualitative responses were analysed by two independent researchers using thematic analysis; themes were discussed with the wider team and illustrative participant quotes were included.

Two hundred participants completed the survey and formed the analytic sample. The cohort was predominantly female (94.5%, n = 189) with a mean age of 28.9 years (SD = 8.9). Over half had tertiary education (54.5%, n = 109) and around half were in full- or part-time employment (51.5%, n = 103). Anorexia nervosa was the most frequent diagnosis (52.5%, n = 105); more than a quarter reported multiple eating-disorder diagnoses. Mean age at first diagnosis was 21.0 years (SD = 7.2), with an average five-year gap between symptom onset and diagnosis. Comorbidity was common: 72.5% reported depression (n = 145) and 71% reported anxiety (n = 142). Most participants (81%, n = 162) had received or were receiving psychological therapy, chiefly CBT (n = 152). Seventy-one percent (n = 142) had current or past prescribed medication, primarily antidepressants (n = 138). On the adapted Brief Illness Perception Scale, respondents were ambivalent about whether current treatments were helping (mean = 49.2, SD = 27.2). Perceived chronicity was high (expected duration mean = 79.3, SD = 21.7), and participants reported substantial emotional and life impact from their eating-disorder symptoms (means ≈ 76 and 74 respectively). Understanding of symptoms scored relatively high (mean = 70.5), while perceived control (mean = 47.2), symptom severity (mean = 55.4) and concern (mean = 51.8) were moderate. Nearly 70% (n = 139) had used complementary treatments to manage their eating disorder; common choices included yoga, meditation, relaxation techniques and hypnosis. Legal psychoactive substances had been used by 52% (n = 104) to help with symptoms (caffeine most commonly), while 13.5% (n = 27) reported using illegal substances for symptom management, cannabis being most frequent. Attitudes toward psychedelic research were cautiously positive: about half of participants indicated they would consider taking part in psychedelic research and 29.5% (n = 59) stated they would never participate. Over 60% considered psychedelic research a worthwhile area to pursue, but many reported concerns. Weight gain was the most commonly reported concern that would stop participation (74%, n = 146), followed by addiction (61%, n = 121), long-term psychological effects (61%, n = 119), negative psychedelic experiences (60%, n = 118), long-term physical effects (55%, n = 107) and side effects (54%, n = 104). Nearly half (46%, n = 90) were not concerned about stigma. Learning that esketamine is licensed for depression reduced concern for 54.3% (n = 107). When asked which measures would increase willingness to participate, the highest-ranked options were a safe monitored environment with medical staff present (n = 127), regular follow-up and support (n = 114), expectation of long-term psychological benefit (n = 112), more information about psychedelics (n = 109) and trust in the research team (n = 100). Thematic analysis of free-text responses yielded themes of factors that exacerbate or ameliorate eating-disorder symptoms. Positive influences included lifestyle strategies, complementary therapies and engagement with mental health services; negative influences included social pressures, comorbid psychological symptoms, negative self-thoughts and poor self-care. Psychological therapy was the most frequently mentioned helpful treatment (n = 65), while 45 participants felt current treatment met their needs and 28 explicitly expressed openness to novel treatments. Free-text concerns echoed the quantitative findings but showed variability: 54 participants reported no concerns about psychedelic research, 14 were opposed, and others raised worries about side effects, "bad trips", dependence, stigma and insufficient information. Several respondents suggested mitigations such as detailed information, medical supervision and trust in therapists; illustrative quotes included concise statements such as "I would not be concerned as long as I trusted the therapist I was working with."

Harding and colleagues present this survey as the first to directly assess views of people with eating disorders about psychedelics as potential treatments. The study found moderate endorsement for psychedelic research—over 60% thought it worthwhile—and about half of respondents indicated they might take part in research, though a substantive minority (29.5%) would never participate. The authors emphasise that participants expressed notable concerns, principally weight gain, addiction, long-term psychological and physical effects, and the risk of negative psychedelic experiences, and they identify concrete strategies respondents felt would reduce anxiety about participation, especially a safe, medically supervised environment and trust in the research team. The discussion situates these results relative to prior literature: the authors note that reported weight-gain concerns may stem from associations with substances such as cannabis rather than with classical psychedelics, and they contrast the relatively high concern about weight gain here with prior surveys about psychopharmacology. They also point out that clinical evidence to date indicates low dependence potential for many psychedelics and mostly transient physiological or psychological adverse effects when administered in controlled settings. The importance of "set" and "setting"—participants' mindset and the treatment context—in determining experience quality is emphasised, and the authors note recommendations to exclude individuals with a personal or family history of psychosis from psychedelic trials. Several practical implications for trial design are drawn from respondents' views: co-designing information materials and trials with patients, providing comprehensive pre-enrolment education, ensuring medical supervision and follow-up, and building rapport to improve recruitment and retention. The authors recommend incorporating patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) into future RCTs to align trial endpoints with outcomes that matter to patients; they explain briefly that PROMs and PREMs capture effectiveness, safety and care experience from the patient's perspective. The authors also argue for multidisciplinary delivery of psychedelic-assisted therapy—combining psychotherapy, dietetic input and medical monitoring—and for drug-specific monitoring instruments to capture particular hazards such as dissociation or suicidal ideation. Limitations acknowledged include recruitment bias from social media channels likely to attract people interested in psychedelics, an online survey format that may exclude those without internet access, and the possibility that visual analogue items were not optimally presented. The sample was predominantly female and highly educated, AN was over-represented, comorbidity with anxiety and depression was common, and illness severity was not assessed. Timing during the COVID-19 pandemic may have affected responses, and ethical constraints prevented analysis of partial responders, all of which may limit generalisability.

The authors conclude that there is evidence of support within the eating-disorder community for research into psychedelic treatments, albeit alongside multiple concerns that should be addressed. They recommend co-designing trials with patients, providing comprehensive pre-trial information, and delivering interventions in controlled, medically supervised environments to encourage participation and improve retention among this complex patient group.