Psilocybin & Body Image
58%
In a 2023 Columbia-affiliated pilot, a single 25mg dose of psilocybin produced a clinically meaningful symptom drop in 7 of 12 adults with SRI-resistant body dysmorphic disorder at 12 weeks. There was no control group.
Schneier et al., Journal of Psychiatric Research, 2023
22 patients
the total number of people in the entire published body-image literature
25mg
the single psilocybin dose used in both the BDD pilot and the anorexia study
0 trials
randomized or placebo-controlled trials published in either condition
Schneier et al., Journal of Psychiatric Research, 2023
As of 2025, three peer-reviewed papers have directly examined psilocybin for conditions where body image distortion is a defining feature of the diagnosis. One is a clinical pilot for body dysmorphic disorder. One is a Phase 1 feasibility study for anorexia nervosa. One is a brain imaging analysis that looked inside the brains of BDD patients after psilocybin and found neural changes that tracked how much each patient improved.
Three papers, however, is not three studies. The imaging analysis was performed on eight of the same twelve patients enrolled in the BDD pilot — the same trial, the same registration number, an overlapping author list. Counted honestly, the published literature rests on two trials and 22 people. Neither trial had a placebo group. Neither was randomized.
That distinction matters, because "three studies pointing the same way" sounds like convergence, and convergence is what turns a hypothesis into a finding. What actually exists here is one small BDD pilot, one small anorexia safety study, and a mechanistic sub-analysis of the first. This article maps that evidence precisely: what each paper did, what it found, where the numbers came from, who paid for them, and what would have to happen before any of it could be called a treatment.
For a broader look at psilocybin research across anxiety-related conditions, the data on psilocybin for existential anxiety in cancer patients offers a point of comparison where larger and better-controlled trials already exist.
Key Takeaways
- The published literature on psilocybin and body image consists of three papers covering two trials and 22 total patients — 12 with body dysmorphic disorder, 10 with anorexia nervosa. No randomized or placebo-controlled trial has been published in either condition.
- In the Schneier 2023 pilot, a single 25mg dose reduced BDD symptoms by at least 30% in 7 of 12 SRI-resistant patients (58%) at week 12, with a large within-group effect (partial η² = 0.54) and significant change from baseline as early as week 1.
- The Peck 2023 study in Nature Medicine found a single 25mg dose safe and tolerable in 10 women with anorexia nervosa. Two participants developed asymptomatic hypoglycemia after dosing, which resolved within 24 hours; all adverse events were mild and transient.
- The Zhu 2025 imaging paper analyzed 8 of the same 12 BDD patients. Increased connectivity within the Executive Control Network, and between that network and both the Default Mode and Salience Networks, predicted week-1 symptom improvement.
- Compass Pathways — which is developing a proprietary synthetic psilocybin — funded the anorexia study outright and appears in the disclosure statements of the BDD authors as well.
- Contrary to a common claim, psilocybin research in the related condition of OCD has not yet reached randomized trials. The most-cited 2025 OCD study was an explicitly non-randomized challenge study whose effect faded within three weeks.
The Evidence as of 2025: Two Trials, Two Conditions, 22 Patients
Before examining each paper in detail, it helps to see how little of it there is. The three publications used the same dose and studied treatment-resistant populations, and their results do point the same direction. But the sample overlap is the first thing an informed reader should register.
Counting the Evidence Correctly
Three Papers, Two Patient Samples, 22 People
Two of the three published papers draw on the same trial (NCT04656301). The imaging paper is a sub-study of the pilot, not an independent replication of it.
Sources: Schneier et al., J Psychiatr Res 2023 (NCT04656301); Zhu et al., Psychedelics 2025 (NCT04656301, n = 8 of the same pilot cohort); Peck et al., Nat Med 2023 (NCT04661514). Because Schneier and Zhu report on one trial, agreement between them is internal consistency — not independent replication.
Here is what each paper reported:
| Paper | Condition | Design | n | Dose | Key Finding | Trial |
|---|---|---|---|---|---|---|
| Schneier et al., 2023[1] | Body Dysmorphic Disorder | Open-label pilot, no control | 12 | 25mg oral | 7 of 12 (58%) showed ≥30% BDD-YBOCS reduction at 12 weeks | NCT04656301 |
| Peck et al., 2023[2] | Anorexia Nervosa | Phase 1 open-label feasibility | 10 | 25mg oral | Safe and tolerable; 2 cases of asymptomatic hypoglycemia | NCT04661514 |
| Zhu et al., 2025[3] | Body Dysmorphic Disorder | fMRI sub-study of the pilot | 8 | 25mg oral | Executive Control Network connectivity change predicted week-1 improvement | NCT04656301 |
All of this work is open-label: patients knew they received psilocybin, which can produce expectancy effects that inflate reported outcomes. All of it involves small samples. And two-thirds of the papers describe the same dozen people.
A 2024 systematic review and meta-analysis of psychedelics across mental disorders found the largest pooled effect for psilocybin (Hedges' g = −1.49, 95% CI [−1.67, −1.30]) and noted that a small amount of evidence also supports psychedelics in obsessive-compulsive disorder and body dysmorphic disorder specifically.[5] That pooled figure is dominated by depression trials, not body image trials, so it provides context rather than support — but it explains why researchers considered these conditions worth testing.
The BDD Pilot: 58% Responded When Standard Antidepressants Had Failed
Body dysmorphic disorder is characterized by persistent, intrusive preoccupation with a perceived flaw in physical appearance that others either cannot see or consider minor. The preoccupation consumes time, produces significant distress, and impairs functioning. In the DSM-5, BDD sits in the OCD-related disorders category because of its symptomatic and serotonergic overlap with OCD.
Only two treatments have demonstrated efficacy for BDD in randomized controlled trials: serotonin reuptake inhibitors and cognitive behavioral therapy.[1] Both work for many patients, but a substantial minority do not respond adequately to an SRI trial — and for that group the options narrow sharply. This is the population the psilocybin pilot targeted.
Franklin Schneier and colleagues at the New York State Psychiatric Institute and Columbia University designed the first psilocybin trial specifically for BDD.[1] The trial enrolled 12 adults — 8 women and 4 men — with moderate-to-severe non-delusional BDD that had not responded to at least one adequate SRI trial. Each received a single 25mg oral dose of psilocybin with psychological support before, during, and after the session, and was followed for 12 weeks. There was no control group.
Schneier et al. (2023) · Journal of Psychiatric Research
- Population
- 12 adults (8 women, 4 men) with moderate-to-severe non-delusional BDD unresponsive to at least one SRI trial
- Intervention
- Single 25mg oral dose of psilocybin with psychological support; 12 weeks of follow-up
- Comparator
- None — open-label, no control group
- Finding
- BDD-YBOCS scores fell significantly over 12 weeks (p < .001, partial η² = 0.54). Change from baseline was significant at week 1 and persisted to week 12. At week 12, 7 of 12 participants (58%) met the ≥30% reduction threshold for response. No serious adverse events occurred.
preliminary Promising signal, but a 12-patient uncontrolled pilot cannot establish efficacy. The authors themselves call for controlled studies.
Schneier et al., J Psychiatr Res 2023;161:364-370 (PMID 37004409)
The outcome measure was the BDD-YBOCS, a clinical rating scale adapted from the Yale-Brown Obsessive Compulsive Scale. Responders were defined as patients showing a drop of at least 30% — the threshold treated as clinically meaningful for BDD.
Secondary measures of BDD symptoms, conviction of belief, negative affect, and disability also improved significantly, and no serious adverse events occurred. Every participant completed dosing and all follow-up assessments — a meaningful feasibility result in itself.
What patients described qualitatively was an increased capacity to observe appearance-related thoughts from a distance rather than being consumed by them. That is worth noting given that BDD's signature feature is precisely the inability to dismiss or reframe these thoughts, even when patients recognize they may be disproportionate.
The finding does not establish that psilocybin works for BDD, and the authors do not claim it does; their stated conclusion is that the results provide "promising preliminary support" that warrants future controlled studies. The 58% response rate in an SRI-resistant population is the number that justified the imaging analysis that followed.
For context on why researchers reached for psilocybin specifically in BDD, see why researchers are interested in psilocybin for BDD, which traces the mechanistic logic from OCD research to the BDD pilot.
The Anorexia Study: A Safety Result, Not an Efficacy Result
In the same year as the BDD trial, Stephanie Knatz Peck and colleagues at UC San Diego published a Phase 1 feasibility study of psilocybin for anorexia nervosa in Nature Medicine.[2]
Anorexia nervosa involves persistent restriction of food intake, intense fear of gaining weight, and distorted perception of body size and shape. That last feature is the clearest overlap with BDD: in both conditions, the gap between how patients perceive their bodies and what is objectively there is central to the disorder rather than peripheral to it.
The study enrolled 10 adult women (mean BMI 19.7, s.d. 3.7) meeting DSM-5 criteria for anorexia nervosa or partial remission, and gave each a single 25mg dose of synthetic psilocybin with psychological support. The primary aim was explicitly safety, tolerability, and feasibility — assessed through adverse events, ECG, laboratory tests, vital signs, and suicidality. That is what a Phase 1 study is designed to establish, and it is the correct frame for reading the result.
Anorexia carries particular safety concerns: severe cases involve cardiac complications from malnutrition, and the physiological safety of psilocybin in this population needed demonstrating before efficacy testing could be justified. On that question the study delivered. No clinically significant changes were observed in ECG, vital signs, or suicidality. All adverse events were mild and transient.
Adverse Events
ModerateTwo of ten anorexia patients developed asymptomatic hypoglycemia after dosing
Concern
In the Peck 2023 feasibility study, 2 of 10 participants developed asymptomatic hypoglycemia at post-treatment. It resolved within 24 hours and produced no symptoms, but it was the one clinically significant laboratory finding in the trial — and it appeared in a population already physiologically vulnerable from malnutrition.
What the research says
The authors reported it transparently and it did not change their overall safety conclusion. It does mean that psilocybin dosing in underweight patients warrants metabolic monitoring, and that 'safe and tolerable' in a 10-person Phase 1 study is a statement about the absence of obvious harm, not a guarantee of none.
Particularly relevant for: Adults with anorexia nervosa or partial remission; low body weight
What to do
Psilocybin is a Schedule I controlled substance in the United States and is not an approved treatment for any eating disorder or body image condition. Nothing here is medical advice — these doses were given under medical supervision in a research setting.
Peck et al., Nature Medicine 2023;29(8):1947-1953 (PMID 37488291)
Where the study is often over-read is on efficacy. Its reported outcome is that psilocybin therapy is "safe, tolerable and acceptable" for women with anorexia nervosa, with participants' qualitative perceptions suggesting the treatment was acceptable to most of them. Improvements in weight and shape concerns are exploratory secondary observations from a 10-person uncontrolled study designed and powered for safety — not demonstrated treatment effects. A Phase 1 feasibility study is not built to show that psilocybin produces lasting recovery from anorexia, and this one does not.
The sustained changes in eating behavior, weight restoration, and illness chronicity that define anorexia recovery require far longer follow-up and much larger samples. What the study genuinely established is that giving psilocybin to adults with anorexia nervosa under supervision did not produce serious safety signals — enough to justify proceeding to a larger study.
For an analysis of how BDD and anorexia relate conceptually, including what the two 2023 studies suggest about shared body image distortion mechanisms, see the BDD-anorexia connection in psilocybin research.
The Brain Imaging Data: What Changed Inside Eight Patients' Brains
The clinical pilots showed that something changed for some patients after psilocybin. The imaging analysis asked what changed at the neural level, and whether it explained the clinical improvement.
Zhu and colleagues published an fMRI analysis of BDD patients who had received psilocybin — the first report of subacute brain effects of psilocybin in this population.[3] Eight adults with moderate-to-severe non-delusional BDD underwent resting-state functional MRI one day before and one day after dosing. These were participants in the same trial the Schneier paper reported.
Zhu et al. (2025) · Psychedelics
- Population
- 8 adults with moderate-to-severe non-delusional BDD — a sub-study of the 12-patient Schneier pilot (NCT04656301)
- Intervention
- Single 25mg oral psilocybin with psychological support; resting-state fMRI one day before and one day after dosing
- Comparator
- None — uncontrolled, within-subject pre/post design
- Finding
- Multivariate pattern analysis showed increased resting-state connectivity within the Executive Control Network at day 1. Increased connectivity within the ECN (dlPFC–superior parietal lobule), between the ECN and the Default Mode Network (dlPFC–precuneus), and between the ECN and the Salience Network (dlPFC–insula) each predicted BDD symptom improvement at week 1.
preliminary n = 8, uncontrolled, and published in the first issue of a new journal. The authors state that larger controlled studies are necessary to validate the observations.
Zhu et al., Psychedelics 2025;1(1):25-31 (PMID 40458078)
The findings centered on three networks. The Executive Control Network (ECN) manages attention and cognitive resources, including the ability to redirect attention away from distressing stimuli. The Default Mode Network (DMN) is most active during self-referential thinking. The Salience Network (SN) determines which stimuli get flagged for conscious attention.
After psilocybin, patients showed increased connectivity within the ECN and increased connectivity between the ECN and both the DMN and the SN. In functional terms: the network responsible for controlling where attention goes became more internally coordinated and more connected to the networks it needs to influence.
It is worth being precise about which measures predicted improvement, because this is often reported too narrowly. All three connectivity changes — within-ECN, ECN-to-DMN, and ECN-to-SN — predicted BDD symptom reduction at week 1. The ECN-to-DMN link is the most theoretically interesting, but it was not the only predictor.
That theoretical interest comes from a broader literature. A 2023 systematic review of DMN modulation across classical psychedelics found consistent acute disruption of resting-state connectivity within the DMN, alongside increased connectivity between canonical resting-state networks, across LSD, psilocybin, and ayahuasca.[4] In BDD, self-referential loops center on appearance. The imaging data extends that general pattern to a specific clinical population and identifies a connectivity signature that tracked who improved.
This is a mechanistic hypothesis, not a proof. The sample is eight people, the design is uncontrolled and within-subject, the follow-up window for the prediction is one week, and the finding needs replication in an independent cohort. But it offers a candidate biological explanation for the clinical signal: psilocybin may temporarily reorganize the relationship between self-focused rumination circuits and the circuits that regulate cognitive control.
For a deeper look at how psilocybin changes functional connectivity across conditions, see functional connectivity changes under psilocybin: fMRI evidence.
Who Funded This Work
None of the above is complete without the disclosures. The company developing a proprietary synthetic psilocybin formulation appears in the funding or conflict-of-interest statement of every paper discussed here.
Who Paid for the Evidence
One Company Appears in All Three Disclosure Statements
Compass Pathways develops a proprietary synthetic psilocybin formulation and has a commercial interest in these indications. Every quotation below is drawn from the papers' own published disclosures.
Peck 2023 — anorexia nervosa
Sponsor-fundedDirectly funded by Compass Pathways
Compass Pathways funded the study. The first author is a paid senior clinical consultant to Compass and a lead therapist on Compass-sponsored trials. The senior author has consulted and advised for Compass and received financial support for this study.
Schneier 2023 — body dysmorphic disorder
Author-level tiesNIMH-funded; authors hold industry ties
Grant support came from the NIMH (R01 MH121520, R21 MH128815). Separately, the first author discloses research support from Compass Pathways, Otsuka, and Vistagen; a co-author discloses research support from Compass Pathways and several other companies.
Zhu 2025 — fMRI sub-study
Author-level tiesAnalysis of the Schneier cohort
Shares the Schneier trial, cohort, and much of its author list, so the same disclosures apply to the data being analyzed.
Sources: conflict-of-interest and funding statements published with Peck et al., Nature Medicine 2023, and Schneier et al., Journal of Psychiatric Research 2023. Disclosed industry involvement does not invalidate a finding; it is one more reason uncontrolled results need independent replication.
Industry funding is normal in early psychedelic research and does not by itself invalidate anything. Both papers disclosed their ties clearly, which is exactly what disclosure is for. But it is one more reason why a 22-patient, uncontrolled, unblinded evidence base needs independent replication before anyone treats it as settled.
What "Preliminary" Actually Means Here
The 58% response rate from Schneier, the safety data from Peck, and the neural mechanism from Zhu are legitimate starting points. They are also genuinely insufficient to conclude that psilocybin is an effective treatment for body image disorders. Here is what "preliminary" means in practice.
No control group. Both trials were open-label. People who believe they are receiving an active treatment often report improvement independent of any pharmacological effect. This expectancy problem is particularly acute in psychedelic research because the drug's subjective effects are unmistakable — there is no credible way for a patient to remain uncertain about whether they received psilocybin. Controlling for it requires an active comparator, not just an inert pill.
Small samples that overlap. Twelve BDD patients and ten anorexia patients. The true response rate in the broader SRI-resistant BDD population could be substantially higher or lower than 58% and remain entirely consistent with what a 12-person pilot observed. And because the imaging paper re-analyzes eight of those same twelve, it cannot serve as independent corroboration.
Short follow-up. The BDD trial followed patients for 12 weeks. Whether benefits persist beyond that, whether they require repeat sessions, or whether periodic re-dosing is needed is unknown.
Unknown dose and session parameters. Both trials used a single 25mg dose. Whether that is optimal, whether multiple sessions improve outcomes, and whether lower doses produce meaningful effects are open questions.
The OCD comparison is often misstated. Psilocybin research in OCD — the closest well-studied relative of BDD — began with a 2006 open-label study in which all nine participants showed acute symptom reduction under at least one dose condition.[7] It has since produced a 2025 study of 19 adults comparing 1mg and 10mg doses. That study is frequently described as a randomized controlled trial. It was not. Participants received both doses in fixed order, four weeks apart, with participants and raters blinded only to the order. The authors describe it as a pharmacological challenge study explicitly limited by "the absence of randomisation." The 10mg dose produced a moderate-to-large advantage on the Y-BOCS one week after dosing (Cohen's d = 0.82, p = 0.002), driven mainly by the compulsion subscale — but the effect diminished over the following three weeks, and no effect appeared on depression scores.[6] The OCD field has not reached randomized trials either. For more, see psilocybin for OCD: breaking the loop.
Unknown who benefits. The pilot data does not identify which characteristics predicted response beyond the broad criterion of SRI resistance. Whether the connectivity changes Zhu identified could predict responders in advance — which would be clinically useful — remains untested.
These limitations are not reasons to dismiss the research. They are the normal condition of a field at its earliest stage. The appropriate framing is that a signal exists, a mechanism is plausible, and what the field needs next is a trial designed to actually test the hypothesis.
What Comes Next: The Registry Reality
A widespread claim about this literature is that the registered trials behind it represent a forward pipeline moving toward Phase 2. The registry does not support that reading.
What the Registry Actually Says
Every Registered Trial Behind This Evidence Base Is Already Finished
These NCT numbers are sometimes cited as the field's forward pipeline. They are not. All three are marked Completed on ClinicalTrials.gov, and two have already produced the papers this article reviews.
NCT04656301
CompletedSponsor: New York State Psychiatric Institute / Columbia
Condition: Body dysmorphic disorder · Design: Open-label, no control group · n = 12
Published as: Schneier 2023 (clinical) · Zhu 2025 (fMRI sub-study)
NCT04661514
CompletedSponsor: University of California, San Diego
Condition: Anorexia nervosa · Design: Phase 1, open-label feasibility · n = 10
Published as: Peck 2023, Nature Medicine
NCT04505189
CompletedSponsor: Academic pilot (Phase 1/2)
Condition: Anorexia nervosa · Design: Pilot study · n = Not reported here
Published as: No primary results paper identified
Source: ClinicalTrials.gov registry records for NCT04656301, NCT04661514, and NCT04505189. As of this article's review date, no randomized, placebo-controlled psilocybin trial for body dysmorphic disorder or anorexia nervosa has published results.
All three registered trials associated with this work are marked completed. NCT04656301 is the Schneier BDD pilot, which produced both the clinical paper and the imaging sub-study. NCT04661514 is the UC San Diego anorexia trial — that is the Peck study itself, already published in Nature Medicine, not a separate trial still to come. NCT04505189 is a completed academic anorexia pilot for which no primary results paper was identified.
From Signal to Evidence
What would it take?
What would it take to know whether psilocybin actually treats body dysmorphic disorder?
A randomized trial with an active comparator
Both published trials were open-label and single-arm. Because psilocybin's subjective effects are unmistakable, an inert placebo is not sufficient — a psychoactive comparator or a dose-comparison design is needed to control for expectancy.
An independent BDD cohort
All published BDD data comes from one 12-person trial at one site. Replication requires a different team dosing different patients.
Adequate sample size
A Phase 2 trial would typically need roughly 50-200 participants to detect a real effect with reasonable confidence. The current total across both conditions is 22.
Follow-up beyond 12 weeks
Durability, the need for repeat sessions, and re-dosing intervals are all unknown past the 12-week window the pilot observed.
Prospective test of the connectivity biomarker
Zhu's connectivity measures predicted improvement retrospectively in 8 patients. Establishing them as a biomarker requires predicting response in advance, in a new sample.
Demonstrated short-term safety in both populations
Both trials reported no serious adverse events, and completion rates were high. But the samples are tiny, and the anorexia study surfaced two cases of asymptomatic hypoglycemia that warrant monitoring in larger trials.
Synthesized from Schneier et al. 2023, Peck et al. 2023, Zhu et al. 2025, and ClinicalTrials.gov registry records
If the connectivity changes Zhu identified prove reliable, they could eventually function as a biomarker — a brain measurement taken shortly after a session that indicates which patients are likely to benefit. That would change how trials are designed and how a therapy might be targeted, if one ever reaches approval. For now it is an eight-person retrospective correlation.
The honest summary is that the body image work sits earlier in the pipeline than psychedelic research for depression or PTSD, where randomized trials have already produced published results. Two small uncontrolled trials and a sub-analysis are a reason to run the next study. They are not a reason to believe the answer yet.
For a broader look at how the BDD-specific evidence is developing, see the emerging research overview on psilocybin and body dysmorphic disorder and how psychedelics may alter body image perception.
The Bottom Line
As of 2025, psilocybin has been examined in three published papers covering body image disorders — but those papers rest on just two trials and 22 patients. The Schneier 2023 BDD pilot found 7 of 12 SRI-resistant patients (58%) met the response threshold at 12 weeks, with no control group. The Peck 2023 anorexia study in Nature Medicine established short-term safety and tolerability in 10 women, with two cases of asymptomatic hypoglycemia. The Zhu 2025 imaging paper re-analyzed 8 of the same 12 BDD patients and found executive-control network connectivity changes that predicted week-1 improvement. Compass Pathways funded or appears in the disclosures of all of this work. No randomized or placebo-controlled trial has been published in either condition, and every associated registry entry is already marked completed. The signal is real enough to justify controlled trials; it is not evidence of efficacy.
Frequently Asked Questions
Sources & References
- 1RTHM-01783·Schneier, Franklin R et al. (2023). “Pilot study of single-dose psilocybin for serotonin reuptake inhibitor-resistant body dysmorphic disorder..” Journal of psychiatric research.Study breakdown →PubMed →↩
- 2RTHM-01762·Peck, Stephanie Knatz et al. (2023). “Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study..” Nature medicine.Study breakdown →PubMed →↩
- 3RTHM-02220·Zhu, Xi et al. (2025). “Single-dose psilocybin alters resting state functional networks in patients with body dysmorphic disorder..” Psychedelics.Study breakdown →PubMed →↩
- 4RTHM-01697·Gattuso, James J et al. (2023). “Default Mode Network Modulation by Psychedelics: A Systematic Review..” The international journal of neuropsychopharmacology.Study breakdown →PubMed →↩
- 5RTHM-02028·Yao, Yuan et al. (2024). “Efficacy and safety of psychedelics for the treatment of mental disorders: A systematic review and meta-analysis..” Psychiatry research.Study breakdown →PubMed →↩
- 6RTHM-02161·Pellegrini, Luca et al. (2025). “Single-dose (10 mg) psilocybin reduces symptoms in adults with obsessive-compulsive disorder: A pharmacological challenge study..” Comprehensive psychiatry.Study breakdown →PubMed →↩
- 7RTHM-00195·Moreno, Francisco A et al. (2006). “Safety, tolerability, and efficacy of psilocybin in 9 patients with obsessive-compulsive disorder..” The Journal of clinical psychiatry.Study breakdown →PubMed →↩