Effectiveness of DBT in the Treatment of Binge Eating Disorder

Binge eating disorder (BED) is one of the newest additions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the record of all officially recognized mental health conditions.

But by some counts, the condition already represents the most common eating disorder in the United States, impacting an estimated 3.5% of adult biological women, 2% of adult biological men, and 1.6% of adolescents. All told, that comes to nearly 3 million people.^1,2

Still, the dysfunctional behaviors associated with the condition have been noted, in some form, for many years, and a number of therapies have been adapted to help treat BED, including dialectical behavior therapy (DBT).

What is Binge Eating Disorder?

As its name may imply, binge eating disorder is characterized by binge eating episodes.

These scenarios happen when someone consumes an amount of food that is larger than what is widely considered to be normal in a certain period of time. Many experts consider two hours to be a reasonable window for determining the progress of a binging episode.

These events are also characterized by a number of other traits, including:³

• The lack of a sense of control over how much or what is being eaten
• Eating more rapidly than normal
• Eating despite not feeling hungry
• Eating until feeling uncomfortably full, or beyond that point

Generally, these episodes are marked by a sense of distress, and many people with BED express regret after a binging period.

Binge eating disorder symptoms are similar to those experienced by people with bulimia nervosa, though people with BED do not participate in compensatory behavior afterward, such as self-induced purging.

To be officially considered binge eating disorder, someone must experience these episodes at least once a week over the course of three months.³

What Causes Binge Eating Disorder?

While there is no one direct cause of BED, the condition can be brought on or sustained by a number of different factors.

Psychological Risk Factors

Like virtually all other types of eating disorders, BED commonly co-occurs with a number of other mental health concerns, including depression and anxiety disorders.

Low self-esteem, negative self-image, and poor body image are also common traits that work to develop or sustain this condition.

Behavioral Risk Factors

Consistent attempts at dieting are common among people who struggle with BED. By some estimates, as many as 30% of people looking into weight loss programs or treatments are thought to exhibit binge eating disorder symptoms.²

A history of trauma and experience with criticism related to body weight, shape, or size has also been linked to BED.¹

Biological Risk Factors

Like many eating disorder behaviors, binge eating has been found to have genetic influences, and BED has been shown to run in families.¹Diabetes—particularly Type 2 diabetes—also has a specific relationship with BED. The focus on food and diet needed to helpfully manage diabetes can potentially lead to a fixation, which can result in BED. The disordered eating behaviors associated with BED can also lead to the development of Type 2 diabetes.¹

DBT and Binge Eating Disorder

While eating disorders often take a heavy social and physical toll, the conditions are, first and foremost, mental health disorders. As such, there are several different therapies designed to help encourage recovery by helping patients develop and focus on more positive thought patterns.

While dialectical behavior therapy was first developed to help people with borderline personality disorder, it has since been adapted for treating eating disorders, including BED.

How Does Dialectical Behavior Therapy Work?

Dialectical behavior therapy is an offshoot of cognitive behavior therapy (CBT), another form of psychotherapy that is widely recommended for most types of eating disorders.

CBT is based on the idea that disordered behaviors stem from disordered thoughts. Through a rigorously structured course of treatment, patients are taught how to identify these unhelpful thoughts and their connection to unhelpful behavioral patterns. Therapists will then introduce healthier coping mechanisms for patients to utilize during stress.

The ultimate goal of CBT is for a patient to first recognize, then be able to stop, and then all-together eliminate these unhelpful thoughts and behaviors.

DBT shares these core philosophies and goals, but this form of therapy also introduces the idea that two things can be true at once. For people struggling with BED, that includes understanding that change is necessary while simultaneously learning to accept and love themselves.

How Does DBT Help with Binge Eating Disorder?

The dual focus in dialectical behavior therapy can help address not just the disordered thoughts and behaviors someone with BED is experiencing but also some of the underlying psychological factors, including low self-esteem and poor self-image.

The combination can be powerful, with one study showing as many as 69.9% of patients showing a “clinically significant change” in behavior at the end of DBT treatment.⁴

DBT therapists focus on four critical concepts to help encourage recovery.

Mindfulness

One of the core DBT skills is mindfulness. This concept encourages patients to focus on the present moment and all the sensations, feelings, and emotions they’re experiencing.

Mindfulness skills help build awareness of both internal feelings and external actions. This can help curb binge eating by helping patients recognize potential triggers, slow down, and utilize healthier coping mechanisms before they become drawn into an unhelpful thought or behavioral pattern.

Distress Tolerance

Recognizing emotions and actions is one thing. Coping with them is another.

Distress tolerance is a combination of coping skills that help patients more helpfully manage unpleasant thoughts or negative emotions that tend to trigger binging episodes. These skills can include techniques such as distraction, self-soothing, or “improving the moment,” which teaches patients to look for more positive perspectives.

Managing Interpersonal Relationships

Also known as interpersonal effectiveness, this aspect of dialectical behavior therapy helps patients become more assertive in their personal relationships while keeping those relationships positive and healthy.

This skill set can help someone develop confidence, self-respect, and a sense of agency over their words and actions while giving them a communication boost.

Emotion Regulation

Emotion regulation is the phase of DBT where patients learn how to identify and, eventually, control the powerful emotions that may contribute to their condition.

Assessing feelings and then using the new tools taught in therapy to help control them can help release someone from disordered patterns. It also generally helps someone cope with their emotions better and welcome more positive experiences and outcomes.

Other Types of Binge Eating Disorder Treatment

While dialectical behavior therapy helps many patients deal with binge eating disorder and other mental health conditions, it’s not the only thing that can help with eating disorder recovery.

Support Groups

Finding a support system is an integral part of sustained recovery. Many people who struggle with BED find this type of community through group therapy for binge eating.

These meetings allow patients to meet other people who are experiencing or have experienced similar struggles. Support, advice, and care are often provided here.

Medication

While generally not the first line of treatment, different types of medication have been shown to help people manage their disordered thoughts and behaviors.

In general, medications of all types have been found to be most effective when used in tandem with other types of treatment, namely therapy. The severity of the disorder typically determines the recommended course of action.

Finding Help for Binge Eating Disorder

If you or a loved one are struggling with binge eating disorder, you should seek help. Allowing the condition to continue untreated could lead to a number of mental and physical health complications.

You should start by speaking with your primary care doctor or therapist. These medical professionals can often offer advice about the type of care that may be most beneficial for you or where to start looking for treatment programs.

The most important thing to remember is that help is always available, no matter how difficult recovery may seem.