Why Eating Disorders Are So Hard to Treat
Eating disorders are not primarily about food. Food is where the symptoms live. The drivers are underneath: trauma, anxiety, shame, a nervous system that learned to use restriction, bingeing, or purging to regulate what felt unmanageable.
They also share something important with OCD: cognitive rigidity. The looping, intrusive thoughts about food, weight, and the body. The compulsive behaviors that feel impossible to interrupt even when someone desperately wants to. The inability to tolerate uncertainty or flexibility. Researchers have noted significant overlap between eating disorders and OCD-spectrum conditions in terms of neurobiology, phenomenology, and treatment response. That overlap matters for understanding why ketamine may help.
Standard treatments like CBT, DBT, and FBT have solid evidence bases and remain the foundation of eating disorder care. They also have real limits. For people with complex trauma histories, or for those who have been through multiple levels of care without lasting relief, something needs to shift at a deeper level before the behavioral and cognitive work can fully take hold.
That is where ketamine enters the conversation.
What Ketamine Does in the Brain
Ketamine works primarily on the glutamate system via NMDA receptor antagonism. Unlike most psychiatric medications, which target serotonin or dopamine, ketamine acts on the brain's learning and memory pathways. This gives it several properties that are particularly relevant for eating disorders.
Neuroplasticity: Ketamine promotes the formation of new neural connections. For people whose brains have been running the same rigid patterns for years or decades, this creates a biological window in which new learning becomes possible. The same pathways that keep someone locked in compulsive food behaviors are shaped by neurological grooves that are genuinely difficult to change. Ketamine loosens them.
Reduced cognitive rigidity: This is one of the most clinically meaningful effects for eating disorders specifically. Ketamine has shown promise in early studies on OCD, reducing obsessive thoughts and compulsive behaviors. Because eating disorders share significant features with OCD at the neurobiological level, researchers have hypothesized and begun to demonstrate that ketamine's anti-rigidity effects translate. The looping, food-centered ruminations. The black-and-white thinking about eating. The inability to tolerate a meal that doesn't follow the rules. These are not just habits. They are patterns wired into the nervous system, and ketamine creates conditions in which they can begin to loosen.
Rapid antidepressant and anxiolytic effects: Depression and anxiety are highly prevalent in eating disorders across all subtypes. Ketamine's well-established, rapid effects on both are clinically significant for this population. Not just as a treatment for comorbid conditions, but because reducing the weight of depression and anxiety can create real breathing room for the eating disorder work itself.
Quieting the default mode network: Ketamine temporarily disrupts the brain's self-referential rumination system, responsible for the relentless internal commentary about food, body, and self-worth that so many people with eating disorders describe. When that noise quiets, even briefly, something different becomes accessible.
What the Research on Ketamine Therapy for Eating Disorders Shows
It is important to be honest about where the research stands. While the evidence base is not yet at the level we have for depression or PTSD, what we have is promising, and the research is growing quickly.
Mills et al. (1998) published one of the earliest studies on ketamine and eating disorders in QJM, treating 15 patients with chronic, treatment-resistant eating disorders using intermittent ketamine infusions. 9 of the 15 showed prolonged remission, with significant reductions in compulsion scores. The researchers framed eating disorders as a compulsive behavior condition driven by pathological memory recall. It was a remarkably forward-looking framework that anticipated much of where the field has since arrived.
Robison et al. (2022) conducted a case series of five patients in residential eating disorder treatment who received group-based ketamine-assisted therapy with intramuscular ketamine over four weeks. Four of the five showed clinically significant improvements in depression scores. The authors noted that participation in concurrent residential treatment programming may have contributed to sustaining ketamine's effects, suggesting the combination of ketamine with active therapeutic support produces more durable results than either alone.
Martinotti et al. (2025) published a case series of eight patients with treatment-resistant anorexia nervosa who received ketamine alongside usual care. Six of the eight showed significant BMI improvement. Notably, improvements in cognitive rigidity, food-related ruminations, and OCD-like symptoms emerged from the fourth or fifth session onward. This suggests that sustained treatment within a therapeutic framework matters, not just a single infusion.
A 2025 case study (Journal of Eating Disorders) documented the first structured ketamine-assisted therapy case for anorexia nervosa showing both rapid and sustained symptom remission at five-month follow-up. The study noted a meaningful symptom increase during the therapy-free interval between the final ketamine session and the first booster dose. This finding directly supports the importance of ongoing therapeutic support rather than ketamine as a standalone intervention.
The broader psychedelic-assisted therapy literature is also relevant. A
2023 review in the European Neuropsychopharmacology examined psychedelic-assisted therapy across anorexia nervosa, bulimia nervosa, and binge eating disorder, including ketamine, psilocybin, MDMA, and ayahuasca. The review identified shared mechanisms: neuroplasticity, reduced cognitive rigidity, increased emotional flexibility, and improved capacity for self-compassion. UCSF is currently running an active
clinical trial (the KETTLE study) specifically investigating ketamine's effects on cognitive flexibility in hospitalized adolescents and young adults with anorexia nervosa.
The picture that emerges across this literature is consistent: ketamine does not cure eating disorders. It creates conditions, neurological and psychological, in which the deeper work of recovery becomes more accessible.
Ketamine-Assisted Therapy Versus Ketamine Infusions
Most of what people picture when they hear "ketamine" is an infusion clinic. You go in, receive the medicine, someone monitors your vitals, and you leave. That model has its place, particularly for acute depression.
For eating disorders, the therapeutic container matters more, not less.
Eating disorders are relational conditions. They are maintained by shame, secrecy, and disconnection. They are driven by trauma that shapes the nervous system in ways that are genuinely difficult to reach through behavioral intervention alone. They involve parts of the self that are deeply protective and do not give ground easily. Ketamine can open a neurological window. What you do inside that window, with a trained therapist and preparation and integration built around the medicine, is what determines whether that opening translates into lasting change.
The 2025 case study showing symptom relapse during the therapy-free window makes this point directly. The medicine created access. Therapy is what sustained it.
That also means the therapist matters. Ketamine therapy and integration from a provider who understands both ketamine experiences and eating disorder recovery gives the work a much better chance of holding.
At Houston Healing Collective, our approach to ketamine-assisted therapy for eating disorders includes thorough preparation before each session, a trained ketamine therapist present throughout, and integration work after. We draw on EMDR, IFS-informed therapy, somatic approaches, and trauma-informed yoga depending on what each person needs.
Is Ketamine Therapy Right for Me?
Ketamine-assisted therapy for eating disorders is not a first-line treatment. It is most appropriate for people who have engaged seriously with eating disorder treatment and continue to struggle, particularly those with complex trauma histories, treatment-resistant presentations, or significant comorbid depression, anxiety, or OCD.
It may be worth exploring if you have engaged seriously with treatment and are still stuck in the same patterns. If depression or anxiety is making it difficult to engage with the eating disorder work. If the cognitive rigidity feels immovable despite genuine effort. If you have the insight to understand what is driving the eating disorder and still find it impossible to shift.
A medical evaluation is part of every intake. Ketamine is not appropriate for everyone, and we assess carefully before recommending it.
Our Approach to Ketamine Therapy for Eating Disorders in Houston
At Houston Healing Collective, we specialize in the intersection of trauma and eating disorders. We understand that recovery rarely happens in a straight line and almost never happens through any single intervention.
We work from a Health at Every Size framework. Weight is never a treatment goal. Your relationship with yourself is.
We offer ketamine-assisted therapy alongside sublingual, intramuscular, and IV ketamine overseen by a trained physician partner. We also offer ketamine-assisted EMDR, a specialized protocol that pairs low-dose sublingual ketamine with EMDR reprocessing, for clients where trauma is a significant driver of the eating disorder.
If you are in Houston and want to talk through whether ketamine-assisted therapy might be right for your situation, we offer a free 15-minute consultation.
Schedule one here or
contact us here first.
Serving clients in-person in Houston, Bellaire, West University, River Oaks, The Heights, and Sugar Land, and virtually across Texas.
References
Martinotti, G., Chiappini, S., Pettorruso, M., Mosca, A., Miuli, A., Di Carlo, F., D'Andrea, G., Collevecchio, R., Di Muzio, I., Sensi, S. L., & Di Giannantonio, M. (2021). Therapeutic potentials of ketamine and esketamine in obsessive-compulsive disorder, substance use disorders, and eating disorders: A review of the current literature. Brain Sciences, 11(7), 856.
https://doi.org/10.3390/brainsci11070856
Mills, I. H., Park, G. R., Manara, A. R., & Merriman, R. J. (1998). Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions. QJM: An International Journal of Medicine, 91(7), 493–503.
https://doi.org/10.1093/qjmed/91.7.493
Robison, R., Lafrance, A., Brendle, M., Smith, M., Moore, C., Ahuja, S., & Robison, R. (2022). A case series of group-based ketamine-assisted psychotherapy for patients in residential treatment for eating disorders with comorbid depression and anxiety disorders. Journal of Eating Disorders, 10, 68.
https://doi.org/10.1186/s40337-022-00588-9
Scolnick, B., Zupec-Kania, B., Calabrese, L., Aoki, C., & Hildebrandt, T. (2020). Remission from chronic anorexia nervosa with ketogenic diet and ketamine: Case report. Frontiers in Psychiatry, 11, 763.
https://doi.org/10.3389/fpsyt.2020.00763
Timek, A., Daniels-Brady, C., & Ferrando, S. (2024). Improvement in depressive symptoms in a patient with severe and enduring anorexia nervosa and comorbid major depressive disorder using psychotherapy-assisted IV ketamine: A case report. Journal of Eating Disorders, 12, 82.
https://doi.org/10.1186/s40337-024-01039-3
Tortora, C., et al. (2025). Reconnecting through dissociation: A 5-month follow-up case study on ketamine-assisted psychotherapy for anorexia nervosa. Journal of Eating Disorders.
https://doi.org/10.1186/s40337-025-01313-y
Martinotti, G., et al. (2025). Ketamine as adjuvant treatment in eating disorders: An exploratory study of a case series and retrospective analysis. Journal of Eating Disorders.
https://doi.org/10.1186/s40337-025-01232-y
