MDMA: A Catalyst for ED-PTSD Treatment

MDMA supplements treatment of co-occurring trauma and eating disorders

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Eating disorders (EDs) are among the deadliest psychiatric disorders, altering cognitive function, judgment, emotional stability, and restricting the life activities of sufferers.1 Early traumatic experiences or adverse events can have a tremendous impact on eating disturbance.1 Many studies have documented an association between trauma history in those struggling with EDs, with childhood sexual abuse (CSA) being the most well-documented trauma and a significant risk factor.2

Several studies indicate that sexually assaulted women are more likely to report an ED and poor mental health than women who had not been sexually assaulted.2.History of trauma is more commonly reported for those diagnosed with bulimia nervosa (BN) in comparison to non-BN patients, and studies also find higher rates of various types of traumas among male and female patients with BN or binge eating disorders compared with the general population, especially with respect to interpersonal traumas.2 Other types of trauma reported in ED patients include physical and emotional abuse, teasing and bullying, parental separation, and loss of a family member or close friend.2 The prevalence of traumatic events in ED patients ranges from 37% to 100%, whereas exploring the full diagnosis of posttraumatic stress disorder (PTSD) in ED samples have found a prevalence range from 4% to 52%.2

It is more frequently seen for ED-PTSD patients to have experienced multiple traumas.3 Evidence compiled from national representative samples, community and clinical samples, meta-analyses, and personal patient reports have demonstrated strong links between traumatic experiences and all EDs, particularly those with the clinical features of binge eating and/or purging.3 In a representative subsample (n = 2980) from the National Comorbidity Survey Replication, the reporting rates of any trauma in men and women with bulimia nervosa (BN), anorexia nervosa (AN), and binge-eating disorder (BED) were between 90 and 100%, and most (64–100%) endorsed one or more traumas compared to less than half in the non-ED participants.3 In another study with a larger database of 36,309 men and women from the National Epidemiologic Survey on Alcohol and Related Conditions, 68% of those with any ED endorsed child maltreatment.3 In studies that asked about ages of traumas and ED onset, the majority reported traumas occurred prior to or at the same time as the onset of the ED.3 In the National Women’s Study, 78% of women with BN who reported rape indicated that their first rape predated the onset of binge eating.3

Additionally, in a community-based prospective longitudinal study of 782 mothers, the occurrence of adverse events during childhood was associated with a significantly higher risk of ED in adulthood.3 Furthermore, multiple studies confirm that approximately two-thirds of ED patients with PTSD report that their first traumatic event occurred before the onset of their ED with lifetime prevalence rates of PTSD in EDs ranging from 37 to 45% in BN and 21–26% in BED.3 Lower prevalence rates have been reported in association with AN (12–13.7%), however in one series, those with AN with binge and/or purge features had higher lifetime PTSD rates (12.4–18.4%) than those with pure AN restricting type (9.9%).3

Current Treatments for Eating Disorders

All aspects of PTSD and trauma-related symptoms such as intrusion, avoidance, hyperarousal, and dissociation have been shown to increase with the number of lifetime traumatic events.3 Those who have experienced a higher number of traumatic experiences have been linked to ED severity and comorbidities, including food addiction, substance use, and suicide.3 Trauma histories and PTSD have been reported to predict more complicated prognosis, higher treatment dropout rates, and worse outcomes following treatment.3 Individuals with ED-PTSD tend to be more impulsive, prone to revictimization, and the subsequent perpetuation of PTSD.3 Although there are several evidence-based practices for treating both EDs and PTSD individually, there are few findings on integrated treatment approaches for this common comorbidity.3

Eating disorders are often connected to traumatic experiences because the behaviors associated with these disorders develop as a coping mechanism, a means of self-protection, a means of escaping the related emotions, or reducing awareness of what they might have experienced.4 Current treatment is therefore focused on uncovering the emotions associated with the traumatic event(s) through therapeutic approaches such as dialectical behavioral therapy (DBT) and Acceptance and Commitment Therapy (ACT).4

As eating disorders are often resistant to treatment, third-wave cognitive-behavioral therapies such as DBT and ACT are often effective treatments for eating disorders, which address aspects of the eating disorder pathology beyond the behavior, such as emotion regulation, and experiential acceptance.5 It is shown that therapy in conjunction with environmental and pragmatic change strategies improve emotion regulation skills, assisting with interpersonal deficits and providing skills for coping with impulsivity to reduce both disordered eating and trauma symptomatology.5 Process groups have also been proven beneficial in treating trauma and eating disorders as individuals are able to answer the “how” and “why” relating to their experiences, and experiential therapies such as art therapy and animal therapy also allow individuals to express and release emotions in a soothing environment.4 In order to better understand disordered eating and comorbid trauma, more research is pertinent to enhance conceptualization and better treatment outcomes.5 MDMA-assisted psychotherapy offers a unique combination of approaches with great healing potential for life-threatening conditions.3

Treating Eating Disorders with MDMA

An important function of EDs can be seen as an attempt to manage difficult emotions as emotion recognition and processing deficits have been considered to play significant roles in symptom expression in the development and continuation of EDs.3 Functional magnetic resonance imaging (fMRI) studies of patients with EDs have uncovered disturbances in the neural circuits that support emotion processing (amygdala) and self-regulation, i.e., amygdala and dorsolateral prefrontal cortex, (dlPFC).3 The activation of the amygdala and dlPFC in individuals with EDs are thought to produce enhanced emotional responses in reaction to disorder-relevant stimuli and negative affective states.3 Such hypervigilance in reaction to possible threatening stimuli may lead to emotional dysregulation and/or over-control, which then furthers primary ED symptoms of restriction, binge eating, and/or purging thus, a greater capacity for emotional regulation in those with ED predicts high treatment success rates.3

MDMA operates through the release and reuptake inhibition of serotonin, dopamine, and norepinephrine, which are implicated in both the ill and recovered states EDs, as well as associated comorbidities.3 MDMA also promotes the release of affiliative neurohormones such as oxytocin (OT), cortisol, arginine vasopressin, and prolactin, which have been reported to be disrupted in EDs.3 MDMA produces unique psychopharmacological effects such as a decreased feelings of fear, an increased feeling of wellbeing, increased sociability and extroversion, reduced self-criticism, increased compassion for self and others, increased interpersonal trust, and the alert state of consciousness.3

MDMA has also aided in enhancing acceptance of self and others, increasing tolerance of emotionally upsetting matters, and the ability to address these concerns without disorientation or loss of ego boundaries.3 Additionally, MDMA alters basic emotional processes, slowing the identification of negative emotions, and increasing responses to positive emotions in others and so, MDMA has theoretical promise as a treatment for ED-related emotional processing, including dysregulation.3 MDMA reduces amygdala activation and emotional reactivity in EDs, and the anxiolytic and prosocial effects of MDMA can also counteract avoidance and hyperarousal. These factors can introduce an advantageous psychological state to allow the capacity to augment the therapeutic process by providing the opportunity to process emotions fueling the disorder and offer corrective emotional experiences.6

Current evidence suggests that this function produces some of the most powerful positive changes on PTSD and related symptomatology compared to other evidence-based treatments.3 These clinical improvements are also shown to be maintained at follow-up assessments 17–74 months after treatment, therefore proving that ongoing administration of MDMA is not required.3 Improvements have likewise been reported in other important symptoms, including depression, social anxiety, suicidality, substance use, self-esteem, as well as increased self-awareness, trust, and compassion towards others, thereby making it an ideal addition to psychotherapy for PTSD.3

Conclusion

Many current eating disorder treatment programs offer a trauma treatment track where therapists specializing in trauma help to uncover emotions associated with traumatic events in order to fully understand and treat the eating disorder at hand.4 MDMA, used in conjunction with psychotherapy to further the processing, healing, and recovery for those combatting ED-PTSD, can provide the ability to utilize a psychological state by simultaneously addressing the difficulties of both disorders, allowing these individuals the opportunity to process emotions feeding the disorders, and offer new, restorative emotional experiences. Successful treatment for EDs truly begins when the underlying trauma and the associated emotions are assessed and addressed4.

Taschauna Richards-Whyne

Taschauna Richards holds a Master of Science degree in Counseling Psychology with a concentration in Clinical Mental Health Counseling from Nova Southeastern University. She has experience providing clinical counseling services utilizing other treatment modalities such as Cognitive Behavioral Therapy (CBT), trauma-focused therapy, mindfulness, Motivational Interviewing, and psychedelic integration and coaching to treat those with co-occurring disorders and other mental health concerns. She is interested in holistic and alternative medicine, especially how psychedelics and natural substances can aid in mental health treatment.

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Mary
3 days ago

How does a person living in NY USA get mushrooms and mescaline? I have CRPS/RSD and Small Fiber Peripheral Neuropathy. Mescaline targets the small Fiber Peripheral nervous system and can literally heal me but after 8 years of searching and getting ripped off I’ve just about lost all hope.