Trauma and Eating Disorder Treatment: Is DBT-PE Right for You?

Extensive research validates that trauma and eating disorders frequently co-occur.  A 2012 study illuminated that “the vast majority of women and men with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma.”  The study estimates that in the female population* approximately 30% with diagnosis of bulimia and 20% with diagnosis of binge eating disorder meet criteria for lifetime incidence of Post-Traumatic Stress Disorder (PTSD) (*co-morbidity between eating disorder and PTSD in males has been understudied).

There are different kinds of trauma that can be factors in the development of eating disorders.  These traumas include emotional or physical neglect, sexual harassment, physical or sexual abuse and assault, witnessing a traumatic event, emotional abuse, teasing, and bullying. Trauma can lead to a significant and enduring disruption in one’s nervous system which can make it harder for that individual to process and cope with emotions.  Eating disorder behaviors can be a method that trauma sufferers use to escape or avoid difficult or uncomfortable emotions or memories.

It’s natural to want to prevent feeling painful emotions or have painful reminders intrude on your thoughts, so individuals with untreated trauma and/or PTSD may go through great lengths to avoid them.  Unfortunately, the methods often used to avoid this emotional pain in the short term (e.g. suicidal behavior, self-injury, severe dissociation, eating disorders, substance abuse), are not effective in the long term and are actually getting in the way of creating a more fulfilling life.

What is DBT PE?

Dialectical Behavior Therapy Prolonged Exposure (DBT PE) is an evidenced-based treatment for trauma based on exposure therapy and cognitive behavior therapy principles.  PE works by changing post-traumatic thoughts and feelings through experiential learning, rather than trying to “logic your way out.”  The protocol is designed for people suffering from PTSD and trying to escape from that suffering in ways that negatively impact their lives.

Developed by Melanie Harned, DBT PE combines standard DBT with Prolonged Exposure. Combining DBT and PE together allows for emotional and/or behavioral stabilization before focused trauma treatment begins. So, in other words, the protocol first helps participants build strength and coping capabilities so that they can then be ready to tackle the trauma work most effectively.  The protocol is broken down into three stages. The first stage is standard DBT treatment which will help the individual learn coping skills in order to control behaviors that would interfere with the effectiveness of the trauma treatment. Once an individual is capable of experiencing difficult emotions without engaging in those escape behaviors, Stage 2 involves engaging in the prolonged exposure piece to directly target the PTSD.  This second stage involves imaginal and in-vivo exposure.  In imaginal exposure, the patient revisits the traumatic experience, narrating out loud in the company of the therapist.  The in vivo exposure involves slowly confronting situations previously avoided in the service of escaping memories or feelings associated with the trauma. These exposures, conducted under the careful watch and support of the PE therapist, are expected to work the patient towards freedom from the confines of the oppressive thoughts, feelings and memories associated with the traumatic experience. In Stage 3, the client would resume standard DBT to build a life worth living without PTSD.

Who can benefit from DBT PE?

DBT PE is an ideal approach for individuals who attempt to manage or avoid difficult emotions in problematic or harmful ways that would likely interfere with standard PTSD treatment. For example, while remembering an aspect of their trauma, individuals might logically know that they are currently safe, but their body doesn’t get the memo, and emotions (including avoidance of emotion) take over. When the urge to escape one’s emotions is very powerful, tapping into reasoned thoughts is often not enough at first. Through DBT PE, people are taught strategies and coached through the exposure so that they can expose themselves to actually experiencing something different, which leads to much deeper learning. Especially for a person who has experiences multiple traumas, use of these strategies has often helped people to better deal with their painful emotions.


Columbus Park clinicians are superbly well-trained and prepared to deliver the DBT and DBT PE protocol.  Our DBT PE clinicians have completed both advanced training in DBT and the highly sought after intensive DBT PE training with Dr. Melanie Harned herself.  Contact us to learn more about DBT PT and if it might be right for you.




Brewerton, Timothy D. Eating disorders, trauma, and comorbidity: focus on PTSD. The Journal of Treatment & Prevention. 2007;15(4): 285-304. doi:10.1080/10640260701454311

Harned, M and Ritschel, L (2018). Training in the DBT PE Protocol for PTSD [PowerPoint slides 4-31] What is DBT PE?. Retrieved from

Mitchell KS, Mazzeo SE, Schlesinger MR, Brewerton TD, Smith BN. Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the National Comorbidity Survey-Replication Study. The International Journal of Eating Disorders. 2012;45(3):307-315. doi:10.1002/eat.20965.