DBT for Eating Disorders (including
binge eating
and bulimia)
Approximately 2.1% of US adults struggle with eating disorders each year.
DBT is an effective approach for treating eating disorders and related issues such as emotion regulation.
Is DBT effective for this diagnosis?
Dialectical Behavioral Therapy (DBT) is shown to reduce binge eating in both Binge Eating Disorder (BED) and Bulimia Nervosa as well as the compensatory behavior in Bulimia. In many people, binging and associate behaviors are a response to emotional dysregulation. DBT specifically addresses this emotional dysregulation as well as its resulting ineffective behavior (binge eating and/or purging, for example). If Standard DBT does not fit your unique situation, we at the DBT Center of Marin also offer Informed DBT. Informed DBT integrates other evidence-based, cognitive-behavioral interventions into DBT to create a multidimensional treatment to best address your eating disorder.
What is Binge Eating Disorder? Bulimia Nervosa?
Both BED and bulimia are characterized by episodes during which an individual consumes large quantities of food, often rapidly. Bulimia, however, also includes an inappropriate compensatory behavior to prevent weight gain and self-evaluation based on weight. These behaviors are often triggered by intense emotion. BED and bulimia can generate a lot of shame and have a negative impact on your quality of life. Both can also be extremely dangerous to your health.
How does DBT support this diagnosis?
DBT can help you minimize eating disordered behaviors by improving your ability to get through distressing emotions without them. Through Mindfulness, DBT helps you connect with your body nonjudgmentally. Support for these symptoms extends beyond the therapy session through phone coaching as a crisis intervention tool in addition to individual weekly psychotherapy and skills groups. DBT provides clients with guidance on how to apply therapeutic skills to the unique situations in their lives.
Which specific modules are most relevant?
Learn how to manage BED or bulimia through the 4 components of DBT: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.
Do You Have an Eating Disorder?
Which DBT modules are most relevant for substance abuse?
Mindfulness: Learn how to be truly present.
Mindfulness skills teach you how to focus on your current situation, stopping rumination on painful past experiences or future uncertainty. These skills can help you reduce dissociation and ground you in your body. Regular mindfulness practice can help keep you grounded and increase your mental stability. This makes you better able to recognize your ineffective behaviors and vacillating emotions and to cope ahead for future stressors.
Emotion Regulation: Learn to manage, change, and accept the different emotions, so that your emotions don’t control you.
Dysregulated emotions can lead to eating disordered behaviors. DBT teaches Emotion Regulation skills to stop unwanted emotions from starting in the first place, regulate or change such emotions once they start, and learn to accept and become comfortable with unavoidable emotions. DBT prioritizes taking care of your body to stabilize your mind, helping more effective behaviors become a habit.
Distress Tolerance: Learn to tolerate painful emotions and situations that seem unbearable, and avoid behavior that can make things worse.
Emotions often seem unbearable or intolerable, which can lead you to choose the coping method that provides the fastest relief, no matter the harm it causes. Distress Tolerance offers tangible skills to use in place of ineffective behaviors that can make things worse. These techniques range from guided self-soothing skills to easy-to-use methods that activate the parasympathetic nervous system, using your own body’s chemistry to reduce distress.
Interpersonal Effectiveness: Learn to communicate with others in respectful ways while maintaining healthy boundaries and upholding positive self-respect.
The symptoms of BED and bulimia can place strain on relationships. DBT guides you in both being a good friend or partner and getting your needs met. Interpersonal effectiveness skills provide clear instruction on how to maintain relationships with others, ask for what you want, and uphold your self-respect. Interpersonal Effectiveness skills also provide tools to head off problems and resolve conflicts before they become overwhelming.
References to research that demonstrate the efficacy of the treatment for the diagnosis
1. This study found that participation in DBT focused on Emotion Regulation decreased binge/purge behaviors in patients with bulimia nervosa compared to those with bulimia on a waitlist.
Safer, D. L., Telch, C. F., Agras, W. S. Dialectical Behavior Therapy for Bulimia Nervosa. American Journal of Psychiatry 158, 632–634 (2001). https://doi.org/10.1176/appi.ajp.158.4.632
2. This article summarizes the state of research concerning DBT for eating disorders, including its benefit for those with BED or Bulimia.
Brown, T. A., Wisniewski, L., Anderson, L. K. Dialectical Behavior Therapy for Eating Disorders: State of the Research and New Directions. The Journal of Treatment & Prevention 28, 97–100(2020). https://doi.org/10.1080/10640266.2020.1728204
3. This study showed an improvement in emotion regulation and binge eating after 10 weeks of DBT.
Rahmani, M., Omidi, A., et al. The effect of dialectical behavior therapy on binge eating, difficulties in emotion regulation and BMI in overweight patients with binge-eating disorder: A randomized controlled trial. Mental Health & Prevention, 9, 13-18 (2018). https://doi.org/10.1016/j.mhp.2017.11.002