A Conversation on Eating Disorders, the impacts of COVID, and new treatments
Warning: this article contains discussions of the onset, diagnosis and treatment of eating disorders.
In the 1970s, Dr. Allan Kaplan was a medical student looking for a calling within his field. He found it in an unexpected place as he passed a hospital room where an emaciated woman was being treated for anorexia. Over the next four decades, his work in the diagnosis and treatment of eating disorders would lead him to the very frontier of the human mind. Recently, we had the privilege to sit down with Dr Kaplan, MD MSc FRCP(C), to discuss his work and vision for his field of study.
While Dr. Kaplan’s specialty is the treatment of anorexia nervosa, the field of eating disorders recognizes three main types, namely anorexia, bulimia and binge-eating disorder. The latter two are characterized by the compulsive consumption of huge quantities of food; the former is characterized by a total aversion to eating, often leading to starvation in the name of thinness.
Anorexia bears the dubious distinction of being the most deadly of the three, with a mortality rate of one in five affected women. Yet no exact cause for anorexia is known, and the condition remains little understood. While the condition is believed to be approximately 70% genetic, Dr. Kaplan carefully highlights the fact that genes are not totally responsible: “genes load the gun”, he said, “but the environment pulls the trigger”.
In other words, as with other diseases, genes account for predisposition but not predetermination, and external influences are likely to push susceptible people towards action. Conventional wisdom points to environmental culprits such as social media, and the beauty and fashion industries’ omnipresent and pervasive beauty standards. However, Dr. Kaplan also points to a more recent trigger: the collateral effects of the pandemic on our mental health.
“COVID has dehumanized us”, he says, describing the isolation and fear of contagion that has become indistinguishable from fear of close contact with others since March of 2020. From being trapped inside and engaging with anxiety-provoking media, to the effects of being constantly on-camera in Zoom meetings, to the bodily changes resulting from being less physically active, the pandemic has been “the antithesis of a mentally healthy environment”, and has exacerbated poor mental health for many people – anorexia patients among them.
Many people had to get used to new lifestyles and even new bodies during the pandemic, and this led to poor mental health outcomes for some. Even certain mental health treatment had to change to an online setting; Dr Kaplan cited patients’ reluctance to turn on their cameras as a symptom of struggle with body image and food. “The only real drug for anorexia – and I’m not trying to be facetious”, said Dr. Kaplan, “– is food.” The real question is how to get anorexic patients to eat, and how to override the pathological fear of weight gain. Dr. Kaplan’s research has taken him to an unlikely ally: psychedelics.
If for you, the very word “psychedelics” evokes a trippy 60s drug scene draped in tie-dye and defined by free love and communal living, you’re not alone; this shared association is a major reason that psychedelics fell out of favor in medical circles in the 1970s and even became a cultural taboo. For decades, this stigma stifled a field of study which has only recently re-emerged and which is presently developing largely thanks to private philanthropic funding.
The greatest strides to-date have been made in the field of post-traumatic stress disorder (PTSD) treatment. Today, the study of treatment through psychedelics is “in its infancy”, according to Dr. Kaplan. There is no approved drug for anorexia, though there have been many attempts to use other treatments; Dr. Kaplan cited antidepressants in particular, stating that “just about any drug that you can think of has been tried” to treat the condition.
Three key parameters must be present in the development of all new treatments and medications: safety, feasibility, and efficacy. These three key factors must be proven before a treatment can become widely available, and in the budding field of anorexia treatment, psychedelics are making their very first strides. The first studies have been conducted on palliative care patients, for whom other treatments have so far been ineffective.
While little understood, psychedelic drugs are believed to fundamentally alter the chemical composure of the brain, and it is believed that this is where their potential efficacy could come from; this process is sometimes described colloquially as a neural “rewiring”. Near the end of our conversation, Dr. Kaplan summarized the present and future of his field matter-of-factly: “We don’t have any answers, there’s no studies ever published on anorexia nervosa and psychedelics, so we’re into a new space here, this is really thinking out of the box, it’s somewhat theoretical.”
If psychiatric treatment with psychedelics has been highly stigmatized, Dr. Kaplan mentioned, so has anorexia itself. The condition is even more stigmatized than schizophrenia, and yet is paradoxically often romanticized in pop culture and media. Stigma is an isolating factor for many who grapple with the condition, and as with most stigmatization, Dr. Kaplan believes the solution is educating the public. This, he said, would go a long way towards reducing the suffering of those experiencing the potent cocktail of internal and external factors.
“These are deadly illnesses”, said Dr. Kaplan, “and we need to be educated about them, and we need to protect our young [from exposure] to influences which could exacerbate the risk for them of developing these disorders. They destroy people’s lives, I don’t know how else to put it.”
Dr. Allan Kaplan is a Senior Scientist at the Center for Addiction and Mental Health in Toronto, as well as a professor in the University of Toronto’s Department of Psychiatry.
Allan S Kaplan - MSc MD FRCP(C)
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