Classic Serotonergic Psychedelics in the Treatment of Eating Disorders: A Scoping Review
Abstract
Background: Eating disorders (EDs), including Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), and Other Specified Feeding or Eating Disorders (OSFED), are severe psychiatric conditions characterized by high mortality, treatment resistance, and profound functional impairment. AN carries the highest mortality rate of any psychiatric disorder, and long-term remission rates remain poor across all ED diagnoses despite decades of research. Classic serotonergic psychedelics — compounds acting as agonists at the 5-HT2A serotonin receptor, including psilocybin, lysergic acid diethylamide (LSD), ayahuasca/DMT, mescaline, and 5-MeO-DMT — have recently attracted significant scientific interest as potential treatments for treatment-resistant psychiatric conditions, with mechanisms that overlap substantially with ED pathophysiology. Rationale: A recent systematic review (Bevione et al., 2025) examined psilocybin specifically in EDs and identified only two eligible published primary studies. No comprehensive, protocol-registered, multi-agent, and multi-diagnosis evidence map currently exists for classic serotonergic psychedelics across the full spectrum of EDs. Objectives: This scoping review aims to systematically map the available evidence on the use of all classic serotonergic psychedelics across all ED diagnoses; characterize the volume, nature, and distribution of evidence by agent, diagnosis, and study design; and identify knowledge gaps to inform future research priorities. Methods: The review follows JBI methodology for scoping reviews and is reported according to PRISMA-ScR. The PCC framework guides eligibility. Three databases are searched from inception: PubMed, Europe PMC, and the Cochrane Library. An additional manual search of ClinicalTrials.gov is conducted. Any study design reporting original human data on the use of classic serotonergic psychedelics in individuals with a DSM-5/ICD-11 ED diagnosis, across any setting with therapeutic intent, is eligible. Reviews, editorials, conference abstracts, and preclinical studies are excluded. Expected outcomes: A PRISMA-ScR compliant evidence map; structured characterization of evidence by agent, diagnosis, study design, and outcomes; identification of knowledge gaps; and a peer-reviewed manuscript submitted to a high-impact specialist journal.
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