Bulimia Nervosa

Why Psychedelics Could be the Future of Anorexia Treatment

Bulimia Nervosa | Johns Hopkins Medicine
Illustration: Théophile Bartz

In early September, the burgeoning field of psychedelic research got a long-sought-after dose of legitimacy: Johns Hopkins Medicine received $17 million in funding to launch the Center for Psychedelic and Consciousness Research.

A first-of-its-kind facility for the United States, the center will study the efficacy of psychedelics — namely psilocybin (otherwise known as psychedelic mushrooms) — as a treatment for a range of mental health disorders.

While much of the existing research around psychedelics and mental health focuses on the drugs’ ability to treat PTSD, depression, and addiction, the launch of the center brings a new and less-expected line of research: psychedelics as a treatment for anorexia nervosa.

Anorexia, as it’s more commonly known, is a mental illness affecting some 30 million Americans that manifests as an eating disorder, characterized by abnormally low body weight, body image distortion, and a fear of gaining weight. People with the condition often go to extreme measures to control their weight and eating habits, which can be dangerous: Complications from the disease can include heart problems, bone loss, anemia, and even death.

In fact, anorexia nervosa is responsible for more deaths than any other mental illness.

This is due, in part, to the physically degrading nature of the illness, but it’s also attributable to the fact that medical professionals have yet to find an effective treatment for the disorder.

As of now, the accepted treatment consists of supervised weight gain coupled with cognitive behavioral therapy (CBT), which aims to challenge and change the thinking and behaviors behind the issue. The relapse rate for the treatment is up to 52%, according to a 2017 review.

Given psilocybin’s track record of treating people with other treatment-resistant mental health disorders, researchers at Johns Hopkins are cautiously hopeful that it could be the answer, and the team is in the recruiting phase of a landmark clinical trial to explore the possibility. The study will ly take two to three years to complete, from recruitment to analysis, but the trial itself will take about eight months.

In structure, the trial will look similar to the psilocybin trials Johns Hopkins has completed in the past for other disorders. After a month-long prep period, people in the study will have two psilocybin sessions two weeks apart, lasting six to eight hours each.

The dose for the first session will be 20 milligrams (considered a typical dose for inducing a psychedelic experience) and the second dose will be either 20 or 25 milligrams, depending on the experience of the first session.Though counselors are present, these sessions aren’t therapy-.

Instead, people are encouraged to “go inside” their minds and “be with their internal experience,” says Natalie Gukasyan, a post-doctoral research fellow at Johns Hopkins’ psychedelic research unit.

“It’s really a complicated illness, and we really don’t know what’s going to happen in the laboratory when we give folks this psilocybin. But we’re hoping it can be helpful.”

The sessions are followed by a next-day follow-up, then another follow-up a week later to discuss the experience. After the second session, people in the study will have a month-long “integration period,” where counselors help them integrate their psilocybin experiences into their understanding of their disease.

The therapy will be motivational interviewing, a counseling method that aims to help people find the internal motivation to change behaviors by resolving insecurities. Finally, the people in the study will have a follow-up six months later to determine the effectiveness of the intervention on the eating disorder.

Though this is the first study that will examine psilocybin as a treatment for anorexia, early research with other psychedelics has suggested promise.

A 2017 study interviewed 16 people with eating disorders who had participated in an ayahuasca ceremony, which involves drinking a psychedelic brew from the Amazon.

Eleven of the people reported that the experience led to reductions in their symptoms, and 14 said the drug made them better able to regulate their emotional state. There are also several first-person accounts of people using psychedelics to help heal eating disorders.

In a 2013 review examining the failure of treatment options for eating disorders, researchers concluded that the resistance to treatment stemmed from the “ego-syntonic” nature of the illness, meaning many of the behaviors, values, and feelings behind the symptoms of the disease stem from the needs and goals of the ego. Dissolving the ego happens to be a hallmark of the psychedelic experience: In this altered state, people are often able to gain a new perspective on themselves in the world. If psilocybin works for eating disorders, researchers believe this may be the reason.

More often than not, people diagnosed with anorexia have other mental health conditions, according to Gukasyan, which means even if the psilocybin treatments don’t treat the disease directly, the experience could still be effective for the person’s overall mental health. “It tends to be more the rule than the exception that someone with anorexia is also struggling with anxiety, depression, OCD, or have some sort of trauma-related problems,” she says.

Though anorexia nervosa is classified as a mental illness, research is increasingly showing that there are physiological components to the disease as well, which, according to Gukasyan, means that “there are things that happen in the body chemically” that keep people stuck in the patterns of starvation and excessive exercise. This includes hormone changes and potentially even genetics, as anorexia is often hereditary. Gukasyan is unsure of whether the psilocybin intervention can help address these physical aspects, but believes the trial is still worth a shot.

“It’s really a complicated illness,” she says. “And we really don’t know what’s going to happen in the laboratory when we give folks this psilocybin. But we’re hoping it can be helpful.”

You can find more information on the Johns Hopkins trial, including an online screening form to participate, here.

“,”author”:”Tessa Love”,”date_published”:”2019-11-06T20:00:04.759Z”,”lead_image_url”:”https://miro.medium.com/focal/1200/632/50/42/1*NQG-CRkSMPaCd31hjTE_pA.png”,”dek”:null,”next_page_url”:null,”url”:”https://elemental.medium.com/psychedelics-for-anorexia-b7f6b2bc59fa”,”domain”:”elemental.medium.com”,”excerpt”:”A new trial by Johns Hopkins Medicine will study the effectiveness of psilocybin for eating disorder treatment”,”word_count”:963,”direction”:”ltr”,”total_pages”:1,”rendered_pages”:1}

Source: https://elemental.medium.com/psychedelics-for-anorexia-b7f6b2bc59fa

Bulimia Nervosa in Adolescents

Bulimia Nervosa | Johns Hopkins Medicine

Linkedin Pinterest Eating Disorders

Bulimia nervosa is an eating disorder. It’s also called bulimia. A child with bulimia overeats or binges uncontrollably. This overeating may be followed by self-induced throwing up (purging).

A child who binges eats much larger amounts of food than would normally be eaten within a short period of time (often less than 2 hours). The binges happen at least twice a week for 3 months. They may happen as often as several times a day.

Bulimia has two types:

  • Purging type. A child with this type regularly binges and then causes himself or herself to throw up. Or the child may misuse laxatives, diuretics, enemas, or other medicines that clear the bowels.
  • Nonpurging type. Instead of purging after binging, a child with this type uses other inappropriate behaviors to control weight. He or she may fast or exercise too much.

What causes bulimia nervosa in a child?

Researchers don’t know what causes bulimia. Some things that may lead to it are:

  • Cultural ideals and social attitudes about body appearance
  • Self-evaluation body weight and shape
  • Family problems

Which children are at risk for bulimia nervosa?

Most children with bulimia are girls in their teens. They tend to be from a high socioeconomic group. They may have other mental health problems, such as an anxiety or mood disorders.

Children with bulimia are more ly to come from families with a history of:

  • Eating disorders
  • Physical illness
  • Other mental health problems, such as mood disorders or substance abuse

What are the symptoms of bulimia nervosa in a child?

Each child may have different symptoms. But the most common symptoms of bulimia are:

  • Usually a normal or low body weight but sees him or herself as weighing too much
  • Repeated episodes of binge eating, often in secret
  • Fear of not being able to stop eating while bingeing
  • Self-induced throwing up, often in secret
  • Excessive exercise or fasting
  • Strange eating habits or rituals
  • Improper use of laxatives, diuretics, or other medicines to clear the bowels
  • In girls, irregular periods, or no period at all
  • Anxiety
  • Discouragement because he or she is not satisfied with his or her appearance
  • Depression
  • Obsession with food, weight, and body shape
  • Scarring on the back of the fingers from self-induced throwing up
  • Overachieving behaviors

The symptoms of bulimia nervosa may look other health problems. Make your child sees his or her healthcare provider for a diagnosis.

How is bulimia nervosa diagnosed in a child?

Parents, teachers, and coaches may be able to spot a child with bulimia. But many children with it first keep their illness hidden. If you notice symptoms of bulimia in your child, you can help by seeking a diagnosis and treatment early. Early treatment can often prevent future problems.

A child psychiatrist or a mental health expert can diagnose bulimia. He or she will talk with you, your partner, and teachers about your child’s behavior. Your child may need psychological testing.

How is bulimia nervosa treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment often involves a mix of the following:

  • Individual therapy
  • Family therapy
  • Behavior changes
  • Nutritional rehabilitation
  • Medicine for depression or anxiety, if needed

What are the possible complications of bulimia nervosa in a child?

Bulimia can lead to malnutrition. It can harm nearly every organ system in the body. That’s why early diagnosis and treatment is important. Some health problems it may cause are:

  • Damage to the throat, stomach, and bowels
  • Dehydration
  • Tooth decay

Health complications may happen during treatment. Because of this, both your child’s healthcare provider and a registered dietitian nutritionist (RDN) must be part of the care team. You as a parent play a vital role in treatment.

How can I help prevent bulimia nervosa in my child?

Experts don’t know how to prevent bulimia. But early detection and treatment can lessen symptoms. They can also help your child’s normal development. It can also improve his or her quality of life. Encouraging your child to have healthy eating habits and realistic attitudes toward weight and diet may also help.

How can I help my child live with bulimia nervosa?

Here are things you can do to help your child:

  • Keep all appointments with your child’s healthcare provider.
  • Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, psychiatrists, and registered dietitian nutritionists. Your child’s care team will depend on your child’s needs and how serious the bulimia is.
  • Tell others about your child’s bulimia. Work with your child’s healthcare provider and schools to develop a treatment plan.
  • Reach out for support from local community services. Being in touch with other parents who have a child with bulimia may be helpful.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms

Key points about bulimia nervosa in children

  • Bulimia nervosa is an eating disorder.
  • A child with this eating problem overeats or binges uncontrollably. He or she may also engage in other activities to control weight.

    He or she may cause himself or herself to throw up or exercise too much.

  • Social attitudes toward body appearance and family problems may lead to bulimia.
  • A mental health expert can diagnose this eating problem.

  • A child may need therapy and nutritional rehab.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa-in-adolescents