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Dialectical behavior therapy (DBT) for eating disorders

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Dialectical behavior therapy (DBT) is a type of “talk” therapy which can help people with a number of mental health conditions, including eating disorders. The goal of DBT is to help patients identify and change self-destructive behaviors while simultaneously pushing for positive change.

If you or a loved one are struggling with an eating disorder, dialectical behavioral therapy may be able to help you better manage your emotions and reactions to potential triggers for eating disorder behavior.

10
 minute read
Last updated on 
March 31, 2025
March 31, 2025
Dialectical behavior therapy for eating disorders
In this article

What is dialectical behavior therapy?

DBT was originally developed to help patients with borderline personality disorder, a condition where people experience very intense emotions and have trouble managing their emotional reactions. The technique has since been adapted to help with other conditions, including eating disorders.

The framework of DBT is based on another type of psychotherapy called cognitive behavioral therapy (CBT). CBT uses a structured format to help patients learn to identify unhelpful thought and behavioral patterns and eventually replace them with healthier coping mechanisms.

Dialectical behavioral therapy also helps patients identify and change unhelpful patterns in this way, but it addresses some additional emotional components that may interfere with positive change. The “dia-” in “dialectical" comes from a Latin prefix that often stands for “two.” In dialectical behavioral therapy, this describes the idea that two opposing things can be true at once. 

DBT programs helps you learn the importance of both change and acceptance.

Patients in DBT programs learn the importance of not just change, but acceptance—that they can be at peace in the present moment, even as they need to change certain thoughts or behaviors. While the two are seemingly opposing therapeutic strategies, in DBT, they’re presented in a balanced way, to help patients make a positive, lasting change.

DBT and eating disorders

When used to treat eating disorders, dialectical behavior therapy operates off the idea that disordered behaviors such as binging, purging, or extreme food restriction are used to help patients relieve intense and unpleasant emotions.2

The goal of DBT is to help patients recognize, understand, and change these patterns and associations. The treatment focuses on helping patients gain more awareness and control over their emotional reactions, which can help them choose healthier behaviors when dealing with intense or overwhelming feelings.3

During DBT sessions, the therapist uses a combination of acceptance and change techniques to help a patient embrace this new behavior.6

Acceptance techniques
Change techniques

What to expect in dialectical behavior therapy

Dialectical behavior therapy is a structured type of therapy. That means sessions follow a pre-set course, including certain modules meant to help patients focus on learning specific skills or addressing other aspects of therapy. 

Generally, patients are asked at intake to describe what they’re struggling with and choose certain goals they hope to accomplish over the course of treatment. Treatment is then directed toward helping patients achieve those goals, while instilling the lessons of change and acceptance central to DBT.

There are three basic phases of dialectical behavior therapy that most patients go through:3

  • Individual therapy
  • Group therapy sessions or skills training
  • Telephone crisis coaching
Individual therapy
Group skills training
Telephone crisis coaching

How effective is DBT in treating eating disorders?

Dialectical behavioral therapy is an evidence-based treatment, or one that has been thoroughly tested through peer-reviewed studies, and is generally considered effective for patients struggling with eating disorders.

Several studies have shown the treatment is especially helpful for relieving binge eating behavior, and as such, DBT has become a popular choice for both binge eating disorder and bulimia nervosa.1 Fewer studies have been conducted with patients with anorexia nervosa, though what reports have been done show promising results.1,7

Analyses have also shown DBT can be effective regardless of a person’s sex, gender identity, sexual orientation, age, race, and/or ethnicity.5

Regardless, DBT is not for everyone. A patient who is not willing or able to participate in group treatment may not benefit from or feel comfortable with this approach. Other patients may want or benefit from more intensive individual therapy or other techniques. As with all medical issues, each case is entirely individual, and the best possible treatment depends on a patient’s specific needs and background.

Benefits of DBT

The overwhelming emotions felt by many people with eating disorders can have a significant impact not just on their physical health, but on their emotional health and overall quality of life. Skills like distress tolerance and emotional regulation can help them manage and gain control over these potentially destructive feelings.

Acceptance is also a key part of moving forward and improving quality of life. DBT encourages patients not only to make positive changes, but to find acceptance in a given moment or situation. This can help create a healthy balance, where actions and reactions are intentional, and hopefully made with a generally positive outlook.

The skills taught during a DBT course not only improve the symptoms of people living with an eating disorder but can also be applied to many other areas of life too, including at work, home, and play.

With a focus on group sessions, DBT can provide patients with a solid support network, even as they receive individual psychological help. The skills learned in DBT can also help patients form healthy relationships, based on respect, trust, and boundaries, which can be beneficial in treatment and beyond. 

Limitations of DBT

As with all forms of therapy, DBT is generally not effective on its own as an eating disorder treatment. These conditions are complex and often require a multidisciplinary treatment approach, which includes nutrition education, meal support and counseling, and medical interventions if necessary.

Completing a course of dialectical behavioral therapy also requires a significant amount of time and energy to be dedicated to this cause. There are usually multiple sessions per week and patients are expected to complete homework on a regular basis. 

Remote DBT is available
Learn more >

Dialectical behavior therapy at Within

Our clinical care team at Within believes DBT is an effective way to treat patients with eating disorders, particularly those struggling with interpersonal relationships or emotional dysregulation. 

We incorporate DBT into our virtual treatment programs, with specific DBT sessions and groups. We offer a DBT skills group that teaches the four categories of skills aimed to enhance the regulation of emotion and improve relationships. We also use a trauma-informed approach to treatment, as we understand the significant role trauma can play in the development of an eating disorder. 

Get treatment from home

If you are looking for a DBT approach to your eating disorder treatment, or are interested in learning more about our virtual treatment modalities, call our clinical care team today. We will work with you to craft the right program for your specific needs.

Call (866) 293-0041

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Wisniewski, L., Ben-Porath, D. D. (2015). Dialectical Behavior Therapy and Eating Disorders: The Use of Contingency Management Procedures to Manage Dialectical Dilemmas. American Journal of Psychotherapy, 69(2), 129-40.
  2. Linehan, M. M., Chen, E. Y. (2005). Dialectical Behavior Therapy for Eating Disorders. In: Freeman, A., Felgoise, S. H., Nezu, C. M., Nezu, A. M., Reinecke, M. A. (eds) Encyclopedia of Cognitive Behavior Therapy. Springer, Boston, MA. 
  3. Pisetsky, E. M., Schaefer, L. M., Wonderlich, S. A., Peterson, C. B. (2019). Emerging Psychological Treatments in Eating Disorders. Psychiatric Clinics of North America, 42(2), 219-229. 
  4. Distress Tolerance: DBT Skills. (n.d.) Therapist Aid. Accessed October 2024. 
  5. Van Dijk, S., Jeffrey, J., Katz, M. R. (2013). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders, 145(3), 386-393.
  6. Radical Acceptance. (n.d.) Dialectical Behavioral Therapy. Accessed October 2024. 
  7. Kröger, C., Schweiger, U., Sipos, V., Kliem, S., Arnold, R., Schunert, T., Reinecker, H. (2010). Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up. Journal of Behavioral Therapy in Experimental Psychiatry, 41(4), 381-388.

FAQs

How are eating disorders treated with dialectical behavior therapy?

Dialectical behavioral therapy can help patients with eating disorders learn how to better recognize and understand the unhelpful thoughts that drive their disordered behaviors. Once these patterns are understood, patients work on changing them.

Through a combination of individual therapy, group therapy, and telephone coaching, patients learn and practice new skills and strategies for better managing their emotions. The thought is that this can help them move away from disordered behavior which was previously used to deal with overwhelming emotions.

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