Dialectical Behavioral Therapy for Eating Disorders — Therapeutic Tool of Acceptance and Change
By Kate Jackson

Social Work Today
Vol. 13 No. 6 P. 22

DBT has been adapted for treating some clients with eating disorders and focuses on skills that increase mindfulness, appropriately regulate emotion, and safely tolerate distress.

Social workers who engage with clients who have eating disorders know all too well about treatment failure and relapses and about their potentially devastating consequences.

Experts suggest that when standard treatment for eating disorders fails to produce results, it’s often because patients may have multiple eating disorder diagnoses along with comorbid Axis 1 or 2 disorders; thus, progress may be impeded by more serious emotional dysregulation, more complicated eating pathology, and impulsive and self-destructive behaviors.

According to Lucene Wisniewski, PhD, FAED, cofounder of the Cleveland Center for Eating Disorders and an adjunct assistant professor at Case Western Reserve University, some individuals with eating disorders are “supremely emotionally sensitive” and may self-harm as a way to regulate emotion. She says data suggest that 40% to 50% of individuals with eating disorders have depression, 30% to 40% have anxiety, and about 33% have personality disorders.

One method to treat such complex cases of eating disorders is dialectical-behavior therapy (DBT), which is intended to help patients develop more adaptive ways to regulate emotion and to analyze and restructure behaviors that arise from emotional dysregulation. To that purpose, it focuses on skills training and helping patients to increase mindfulness, appropriately regulate emotion, and safely tolerate distress. Its name derives from the dialectical tension between acceptance and change, each being important components that are integrated into the therapy.

DBT developed from the efforts of psychologist Marsha Linehan, PhD, to adapt cognitive-behavioral therapy (CBT) to treat people with chronic suicidality and urges for self-harm, many of whom also had borderline personality disorder (BPD). Used in inpatient, residential, and outpatient treatment, DBT, a multimodal cognitive-behavioral approach, has since been adapted in several ways for people with eating disorders who, like those with BPD, may have difficulty regulating their emotions. It’s been used as a treatment for the complex cases of eating disorders described above and also in a modified form for less complicated cases in which other first-line approaches alone have been unsuccessful.

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— Kate Jackson is an editor and freelance writer based in Milford, PA, and a frequent contributor to Social Work Today.