Treating Extreme State of Body Dissatisfaction with Psychedelics
Janika Ruuska
JANIKA RUUSKA (FI)
Neuroscientist (MSc) / Biotech Engineer (BEng) / Sexologist / YouTuber / Founder @TheChangingBody
Janika Ruuska is world based Neuroscientist, who has put her hands (and brain) into the dirt in Australia, Hong Kong, Finland, and who knows where next. She has impacted science thoroughly in the neurobiology of eating disorders, psychedelics, anxiety disorders, and breast cancer research. She completed her thesis under the first Australian government-funded pre-clinical study focusing on psilocybin and has co-authored in Nature Communications. Beyond her official career path, she has completed her “PhD” in eating disorders, and 10 years after recovery she intends to support people in understanding their brain and body through changes to live fulfilling lives.
Janika Ruuska explores how extreme body dissatisfaction, like anorexia nervosa, involves
Could it be beneficial to get this loved feeling while processing the things that could get you better? There is an enhanced feeling of self-compassion, love, and gratitude.
Summary
- Anorexia nervosa is a psychiatric disorder with one of the highest mortality rates and no approved pharmacological treatment, characterized by a profound lack of cognitive flexibility.
- The condition is linked to disruptions in serotonin signaling within the medial prefrontal cortex, specifically involving increased 1A and decreased 2A receptor activity.
- Psilocybin is a potential treatment because it binds to serotonin 1A and 2A receptors and can improve cognitive flexibility, addressing the rigid thinking patterns seen in anorexia.
- Research using an Activity-Based Anorexia (ABA) animal model demonstrates that anorectic behavior causes a significant downregulation of serotonin 2A receptors in the medial prefrontal cortex.
- While clinical studies show promising results for using psilocybin to treat anorexia, outcomes are highly variable, suggesting that treatment may not be equally effective for all individuals.
Article
Treating Extreme State Of Body Dissatisfaction: Psilocybin, Serotonin Receptors, And The Long Search For Relief In Anorexia
At Biohacker Summit 2023 Amsterdam, Janika Ruuska Mapped The Fragile Border Between Self-Care And Self-Destruction
At Biohacker Summit 2023 Amsterdam, held in Amsterdam, Netherlands on 14 to 15 October 2023, neuroscientist Janika Ruuska delivered a presentation that was at once clinical, personal, and unsettlingly familiar. Titled *Treating Extreme State of Body Dissatisfaction with Psychedelics*, the talk examined anorexia nervosa through the lens of neuroscience, serotonin signaling, and the emerging promise of psilocybin.
Ruuska, whose background spans neuroscience, biotech engineering, sexology, and public education, did not begin with receptors or lab models. She began with the ordinary rituals of modern wellness culture: eating lighter after indulgence, starting a healthier life on Monday, exercising to offset calories or sculpt the body. These choices, she suggested, are often socially rewarded, even admired. But in some lives, that language of health hardens into something ruthless.
“Anorexia nervosa starts from innocent decisions to take care of your health,” Ruuska said, “but at some point you think you can stop and it just continues.”
How A Pursuit Of Health Can Become A Closed Circuit Of Punishment
The moral force of Ruuska’s talk lay in her insistence that anorexia is not merely a disorder of food. It is also a disorder of rigidity, reward, fear, and emotional avoidance. She described a pattern familiar to many who work in eating disorder research and care: perfectionism, hurtful experiences, a need to please others, weak boundaries, and the absence of safe channels for emotion.
What begins as discipline can become dependency. A first goal of losing “just a little” is often met with praise from the outside world and a dangerous sense of competence within. Then the terms change. Restriction deepens. Activity intensifies. The reward curdles into punishment.
“You can think that you can stop this at any point you want,” Ruuska said, “but it is a really addictive thought.”
That framing mattered. It shifted anorexia away from stereotype and toward mechanism: not vanity, not choice in any simple sense, but a tightening loop in which the mind increasingly loses its capacity to adapt.
A Disorder With One Of Psychiatry’s Highest Death Rates
Anorexia nervosa remains one of the deadliest psychiatric disorders, yet it still has no approved pharmacological treatment. Ruuska underscored that gap with precision. The illness is marked by restricted energy intake, low body weight, and an intense fear of weight gain, but one of its defining cognitive signatures may be something less visible: impaired cognitive flexibility.
That inability to adapt, to shift behaviour even when the body is in danger, is increasingly understood as central to the condition. Ruuska linked it to disrupted serotonin signaling in the medial prefrontal cortex, a brain region involved in decision-making, emotional regulation, and flexible thought.
Her working hypothesis drew on a specific receptor imbalance: increased serotonin 1A receptor activity and decreased serotonin 2A receptor activity. Those opposing effects, she argued, may help explain why individuals with anorexia can remain trapped in severe restriction and compulsive exercise even when the body’s alarms are blaring.
Why Psilocybin Entered The Conversation
Psilocybin has in recent years been pulled from the cultural margins into serious scientific debate, particularly in depression research. Ruuska’s case for studying it in anorexia rested not on fashion, but on pharmacology.
Psilocybin, once metabolised into psilocin, binds to serotonin receptors including 1A and 2A, the very pathways implicated in anorexia. It has also been associated with improvements in cognitive flexibility, a point Ruuska returned to repeatedly.
“Psilocybin has a positive impact on cognitive flexibility, which is a major hallmark of the struggle with anorexia,” she said.
That did not amount to a claim of cure. It was, rather, an argument for biological plausibility. If anorexia is partly sustained by rigid cognition and altered serotonergic signaling, then a compound that affects both may deserve close attention.
Inside The Activity-Based Anorexia Model
Ruuska then turned to the work underpinning her thesis, drawing on the Activity-Based Anorexia, or ABA, animal model. It is a stark experimental setup. Animals are given free access to a running wheel, but food is available only for a narrow daily window of 90 minutes. Some choose activity over eating, lose weight, and develop behaviour that mirrors key features of anorexia.
The model is not a perfect replica of human illness. No animal model is. But it offers a way to study the molecular consequences of anorectic behaviour without the ethical and practical limits of human experimentation.
In Ruuska’s study, animals received either psilocybin or saline before being exposed to the anorectic conditions. The aim was not simply to test whether psilocybin worked, but to clarify what changes were caused by the anorectic state itself and what might later be altered by treatment.
Brain tissue from the medial prefrontal cortex was then analysed to examine expression of serotonin 1A and 2A receptors.
The Signal That Emerged Was Clear, If Partial
The findings were not dramatic in every direction. Ruuska reported no meaningful change in serotonin 1A receptor expression in the ABA model. But the serotonin 2A story was different.
Animals in the anorectic condition showed significantly lower levels of serotonin 2A receptors in the medial prefrontal cortex than control animals. In other words, the illness state itself appeared to be associated with a measurable downregulation of a receptor already suspected to matter.
That was the core scientific contribution of the talk. The result did not prove that reduced 2A signaling causes anorexia, nor did it prove that psilocybin can reverse it. But it sharpened the map. It identified a specific serotonergic mechanism that may help explain the disorder’s development and persistence.
Promise, But Also Variability
If Ruuska’s presentation had a governing virtue, it was restraint. She did not oversell psychedelics. She stressed uncertainty at nearly every important turn.
Her study did not show a treatment effect from psilocybin under the conditions tested. That, she suggested, may be a matter of timing, dose, or design. In the experiment, psilocybin was administered before the anorectic behaviour developed. In clinical reality, treatment would more likely be given after the illness had taken hold.
That distinction matters. Future work, she argued, should examine psilocybin during the acute anorectic phase, as well as the short and longer-term effects of treatment and its potential role alongside psychotherapy.
She also pointed to recent clinical work in people with anorexia that showed encouraging signs but highly variable outcomes. This variability may be the central truth of psychedelic medicine in eating disorders: not every patient is likely to benefit, and not every biology will respond in the same way.
“Some individuals with anorexia nervosa may benefit from serotonergic psychedelics as a treatment, and we should study further who this treatment can help,” Ruuska said.
The Radical Idea Of Combining Psilocybin With MDMA
Perhaps the most provocative section of the talk looked ahead to combination therapies. Ruuska cited emerging work involving MDMA and psilocybin together, not in anorexia specifically, but in ways that raised serious questions for the field.
For patients whose illness is entangled with shame, self-denial, and an inability to receive pleasure or compassion, the idea is not frivolous. If psilocybin can loosen rigid patterns and MDMA can enhance feelings of love, gratitude, and emotional safety, a combined approach might help some patients process the emotional architecture beneath the disorder.
Still, Ruuska was careful to emphasise risk. People with severe anorexia are often medically fragile. Cardiovascular strain, malnutrition, and multisystem stress mean that any pharmacological intervention must be approached with exceptional caution.
This was not advocacy for reckless experimentation. It was a call for disciplined research.
A Talk That Refused Easy Hope
The enduring force of Janika Ruuska’s presentation at Biohacker Summit 2023 Amsterdam was that it refused both despair and hype. It acknowledged the brutality of anorexia nervosa, the absence of approved drug treatments, and the severe limits of current knowledge. But it also offered a scientifically grounded reason to keep looking.
“We are trying to balance in this world,” Ruuska said, “but we must ask what happens when this balance is not maintained anymore.”
That question lingered long after the session ended. In a culture that praises control, reduction, optimisation, and bodily discipline, anorexia can begin in habits that seem almost virtuous. Ruuska’s talk illuminated how those habits can become a trap, and how the path out may require not only compassion and therapy, but a more precise understanding of the brain itself.
The science remains early. The outcomes remain uneven. Yet in the downregulated serotonin 2A receptor, in the rigid circuitry of cognitive inflexibility, and in the careful exploration of psychedelics as treatment, there was the outline of something rare in this field: not a breakthrough, not yet, but a credible direction.
Part of Biohacker Summit 2023 Amsterdam