The potential use of N-methyl-3,4-methylenedioxyamphetamine (MDMA) assisted psychotherapy in the treatment of eating disorders comorbid with PTSD.
Timothy D Brewerton, Adele Lafrance, Michael C Mithoefer
Medical Hypotheses 2021 DOI: 10.1016/j.mehy.2020.110367 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Intervention | MDMA-assisted psychotherapy |
| Topics | PTSD MDMA Psychedelic-assisted therapy |
| Keywords | Eating disorders MDMA-Assisted Psychotherapy Posttraumatic stress disorder Eating disorder symptoms Comorbidity treatment: comorbidity Complex comorbidity Transformative treatment Improved well-being Challenge |
| Citations | 28 |
| Key points | Proposes that MDMA-assisted psychotherapy may be efficacious for both eating disorder and PTSD symptoms in the comorbid ED-PTSD population. |
Abstract
Despite advances in the field, eating disorders (EDs) remain very challenging disorders to treat, especially when comorbid with posttraumatic stress disorder (PTSD). N-methyl-3,4-methylenedioxyamphetamine (MDMA)-assisted psychotherapy for treatment refractory PTSD shows great promise, with two-thirds of participants achieving full remission at 1 year or more at follow-up. PTSD is a common comorbidity associated with EDs, and patients with EDs and PTSD (ED-PTSD) are reported to have higher severities of illness, greater comorbidities, higher treatment dropouts, and poorer outcomes. We hypothesize that MDMA-assisted psychotherapy will be efficacious in the ED-PTSD population for both ED and PTSD symptoms. The rationales for and proposed mechanisms of MDMA-assisted psychotherapy for ED-PTSD are considered from neurobiological, psychological and social perspectives. MDMA is associated with unique psychopharmacological effects, including: 1) reduced fear, 2) enhanced wellbeing, 3) increased sociability/extroversion, 4) reduced self-criticism, 5) increased compassion for self/others, 6) increased interpersonal trust, and 7) alert state of consciousness. These anxiolytic and prosocial effects may counteract avoidance and hyperarousal in the context of psychotherapy for those with ED-PTSD. Other clinical features of EDs that may be amenable to MDMA-assisted psychotherapy include body image distortion, cognitive rigidity, and socio-emotional processing difficulties. To illustrate its potential, personal accounts of individuals with ED-PTSD symptoms reporting benefit from MDMA adjunctive to psychotherapy are described. In addition, the possible risks and challenges in conducting this work are addressed, and future implications of this proposal are discussed.
Comparable studies
Other theoretical and historical papers on MDMA and psychedelic-assisted therapy, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations. Adolescents with PTSD | 2024 | Theoretical or philosophical paper | |
| Couple Therapy With MDMA-Proposed Pathways of Action. | 2021 | Theoretical or philosophical paper | |
| Informed Consent in Psychedelic-Assisted Therapy. | 2024 | Theoretical or philosophical paper | |
| The “Third” Eye: Ethics of Video Recording in the Context of Psychedelic-Assisted Therapy | 2023 | Theoretical or philosophical paper | |
| MDMA-assisted therapy: challenges, clinical trials, and the future of MDMA in treating behavioral disorders. | 2025 | Theoretical or philosophical paper |
Citations in the library
Cited by 21
- MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD. Journal of Psychiatric Research May 1, 2022
- Psychedelics in the treatment of eating disorders: Rationale and potential mechanisms European Neuropsychopharmacology June 21, 2023
- (2-Aminopropyl)benzo[β]thiophenes (APBTs) are novel monoamine transporter ligands that lack stimulant effects but display psychedelic-like activity in mice. Neuropsychopharmacology March 1, 2022
- Therapeutic emergence of dissociated traumatic memories during psilocybin treatment for anorexia nervosa Journal of Eating Disorders May 26, 2025
- Therapeutic role of psilocybin and 3,4-methylenedioxymethamphetamine in trauma: A literature review World Journal of Psychiatry May 19, 2023
and 16 more in the library
Cites 14
- The safety and efficacy of {+/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. Journal of Psychopharmacology July 19, 2010
- 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. The Lancet Psychiatry May 1, 2018
- Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. Journal of Psychopharmacology 2013
- MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology September 1, 2019
- Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. The Lancet Psychiatry April 5, 2016
and 9 more in the library