How DBT Skills Help Manage Eating Disorders

Over 28.8 million Americans will have an eating disorder in their lifetime. Eating disorders are generally classified as a type of mental illness characterized by harmful behaviors related to food. Those with eating disorders (such as bulimia, anorexia, binge eating, ad more) usually struggle with impulsivity, compulsive behaviors, negative body image, and even coexisting conditions like depression, anxiety, and more. 

Eating disorders are the second most deadly mental illness (the first is opioid overdose), and so are critical to treat proactively and effectively. One form of treatment for the management of eating disorders is Dialectical Behavior Therapy, more commonly known as DBT. 

While DBT was originally created for the management and treatment of Borderline Personality Disorder (BPD), this therapy technique has grown in popularity over recent years for its success with both substance abuse and eating disorder conditions as both behavior patterns usually indicate underlying stressors and disregulated emotional states. Since the goal of DBT is to create both acceptance and change through management of stressors and emotions, it makes sense that this type of therapy has been helpful to those managing eating disorders. 

As awareness of DBT has grown, it’s been increasingly used to help individuals who struggle with all kinds of mental health conditions, including anxiety, personality disorders, PTSD, and more. The skills taught throughout DBT treatment are universally helpful, and can be broken down into four main categories of skill sets which are usually taught over the course of a year through both individual and group therapy sessions: 

  • Mindfulness: This skill set helps patients to be aware of their feelings and present in every moment. It can help them to notice their emotions and impulses without acting on them, which is particularly helpful for those struggling with eating disorders. 
  • Distress Tolerance: This skill module covers the ability to process and manage upsetting emotions. Difficult feelings often drive patients to find ways to “cope” or distract themselves from those feelings, which can lead to disordered eating habits. 
  • Emotional Regulation: This skill module is an easy one to relate to for those struggling with disordered eating. Since big emotions like sadness, anger, and fear often drive disordered eating habits, learning to recognize, accept, and manage these emotions is critical to creating healthier habits. 
  • Interpersonal Effectiveness: In this portion of DBT skills training patients will learn how relationship stressors can create BIG, challenging emotions, and will discover how to communicate in healthier ways to reduce the stress caused by interpersonal conflict. Since tension and distress in relationships often drives those with eating disorders to binge, purge, etc., this module can be helpful in teaching them to manage heir reactions in positive ways instead. 

While there are many types of recognized therapies for the treatment of eating disorders, DBT’s evidence-based approach as a subset of Cognitive Behavioral Therapy (CBT) makes it an enticing one. By learning to address the root causes/emotions/distress that drive impulsive behaviors like binging and purging, a significant amount of relief can be introduced into the lives of those struggling with eating disorders. 

One specific, specialized form of DBT has been incredibly successful in the treatment of eating disorders. This is called Radically-Open Dialectical Behavior Therapy (RO-DBT). 

RO-DBT is a version of DBT created specifically for the treatment of bulimia, binge eating, and anorexia which targets the anxious-obsessive need to be excessively self-controlling for certain patients. RO-DBT seeks to build more openness, connectedness, and flexibility for patients struggling with this type of control factor.

The emergence of RO-DBT came about after nearly 20 years of research into those suffering from a need to exert excessive control, which is demonstrated most often through behaviors characteristic of chronic depression, OCD, and eating disorders like anorexia. According to the theory behind RO-DBT, differences in both temperament and experiences lead overcontrolling individuals to persistently engage in behaviors that isolate them from others and create feelings of loneliness and distress. 

RO-DBT treatment focuses on adjusting social signaling for these types of patients to that their emotional expression builds trust and community/connectedness instead, thereby diminishing their symptoms and breaking the cycle of control, isolation, and disordered eating. 

The process of RO-DBT therapy covers three specific components, in addition to traditional DBT modules: 

  1. Acknowledging distressing and unwanted emotions that patients would usually explain, defend, or deny in order to feel better. 
  2. Improving self-inquiry processes, i.e. the practice of asking yourself questions in order to understand your environment and emotions. 
  3. Increasing flexibility in the moment in order to account for your needs and the needs of others in an effective and respectful way. 

If you’re looking for a solution to manage the symptoms of an eating disorder that may be impacting your life in an ongoing and disruptive way, get started with DBT therapy today. 


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