Dialectical Behavior Therapy for Eating Disorders: Overview and Application

Dialectical behavior therapy (DBT) has been shown to be effective in the treatment of complex, comorbid eating disorders. There is significant evidence that emotion dysregulation is involved with the development and maintenance of eating disorders. Since DBT was developed specifically to teach effective emotion regulation and target the reduction of maladaptive coping behaviors, it can be a good fit for eating disorders. DBT has been adapted for use with this population in several distinct ways, and this chapter will review these adaptations, as well as the empirical literature for each. The Stanford DBT model focuses on teaching patients to use skills to reduce or eliminate binging behavior. The multi-diagnostic eating disorder-DBT model is comprehensive DBT for individuals with complex eating disorders and is often delivered in a higher level of care setting. Radically open DBT is a variation of DBT meant for individuals with both an eating disorder and an overcontrolled personality style and teaches skills to increase openness, flexibility, and social connectedness. Finally, DBT has also been adapted for adolescents with eating disorders and incorporates families into skills groups and therapy sessions. Since family-based therapy (FBT) is considered the first-line treatment for adolescents with eating disorders, treatment programs often incorporate and evaluate an integrated approach that includes both FBT and DBT. In addition to briefly reviewing the various adaptations of DBT, this chapter also presents case examples with a discussion of which model might be the most appropriate fit for each.