Effectiveness of DBT in the Treatment of Binge Eating Disorder

Historically, binge eating disorder (BED) has been the least diagnosed and unrecognized eating disorder; and yet, in the United States, 3-5% of women, about 5 million, and 2% of men, 3 million, struggle with BED1.

Those with this disorder consume an extreme amount of food, usually quite rapidly. They often conduct this behavior alone and subsequently experience a high level of guilt, knowing that the behavior is not “normal.”

Why Do People Engage in Binge Eating?

People engage in binge eating primarily because of pain, emotional pain. The extent of this pain can be as vast and diverse as the people themselves. A man may have been seriously neglected or abused by his mother as a young child; a woman may have experienced a sexual assault as a college student.

Although the event is long past, the pain lingers, possibly in the form of vivid memories, or even flashbacks. The pain is enormous; the individual feels defenseless against it. To cope and manage the experience, the person turns to food.

This type of food consumption has nothing to do with physical hunger; a person engaging in a binge does so as a solution to their pain. This behavior not only proves effective, it is addictive.

Dialectical Behavior Therapy in the Treatment of BED

Dialectical behavioral therapy (DBT) is a form of integrated treatment combining behavioral, cognitive, and supportive therapies; it emphasizes teaching each woman how to experience her emotions and create a life worth living. The driving force behind DBT is the concept that acceptance and change can exist simultaneously.

DBT is extremely effective in the treatment of BED. Binge eating is an avoidant behavior–the intent is to avoid emotional pain. DBT does not seek to fix, change or control emotions; instead this therapeutic approach helps an individual accept and cope.

DBT consists of four components; each plays a vital role in helping a person with BED. The first two components connect to the acceptance piece, while the second two are related to the change piece.

Mindfulness/Distress Tolerance

Mindfulness is concerned with the here and now. It urges the individual to be fully present in the moment; this necessitates accepting the emotions associated with that moment. Say an adolescent is very hurt by what a peer said about her on Facebook.

Controlling an Emotional Experience

A person who has BED may react by consuming an entire package of cookies to help control her emotional experience. Conversely, the mindful response is to acknowledge the feelings and experience them.

This means noticing and feeling the hurt. The degree to which she can “sit with the feelings” depends on many variables such as age, individual temperament, the length of time she has used food to cope, etc.

Distress Tolerance Techniques

The hope is that as time passes, the pain will diminish. If, however, it escalates and begins to manifest in other symptoms such as sweating or escalated heart rate, then distress tolerance techniques may be added.

This may be something like taking a walk, petting a dog or sewing. These strategies are not designed to negate or erase the emotions, but to add to the emotional experience in a way that helps make it more manageable.

Emotion Regulation/Interpersonal Effectiveness

Emotions are a very normal part of being human; throughout our day, we experience a wide variety of feelings. It is important for us to notice and have our emotions because they are like little messengers that provide information.

As an example, certain advertisements or greeting cards may cause unexpected tears. Emotion regulation means the person accepts the brief emotion, then brushes the tears away and goes on with her life. However, if an individual is emotionally deregulated, she might succumb to a crippling crying jag that lasts for hours.

Consuming Balance for Emotional Regulation

To a large degree, emotion regulation is predicated on balance. It is as simple as consuming a well-balanced diet, getting adequate sleep, maintaining a healthy exercise regimen. This idea of wellness extends to building positive daily experiences, cultivating gratitude and spending time with joyful, affirming people, while eliminating experiences and people that do not honor our values.

Whereas we can’t decide when or to what degree emotions will present themselves, we can regulate the environment into which emotion is expressed.

Interpersonal Effectiveness

In tandem with regulation, DBT fosters interpersonal effectiveness. Essentially, this is the skill of clear and concise communication. In the previous example of the hurtful Facebook post, instead of self-harming by eating excessively, the individual assertively addresses the issue with the offender.

This involves using “I” statements like “I feel” or “I need.” Verbalizing is the opposite of stuffing and is as healthy as the other is unhealthy. Interpersonal effectiveness isn’t about being right, it is about being heard.

The goal of DBT is for an individual to first define what a meaningful life looks like for her, then second, go ahead and live that life every day. An illness like BED is absolutely contrary to this notion; it will never be part of a meaningful life. Fortunately, with the proper help, a healthy relationship with food can be restored.

Community Discussion – Share your thoughts here!

What has been your experience with DBT and treating binge eating disorder, what advice do you have to share?


  1. http://www.anad.org/get-information/about-eating-disorders/binge-eating-disorder/

Contributor: Meghan Tomasek MA, LPC, DBT Program coordinator, Timberline Knolls

About the Author:

Meghan oversees the Dialectical Behavior Therapy (DBT) program. This involves supervising the DBT Specialists, providing education and training for TK staff and facilitating DBT groups for residents.

She joined Timberline Knolls in February, 2009, as a behavior health specialist. In this capacity, she provided in-the-moment skills coaching and application of DBT skills for adolescent residents.

Meghan obtained her Master’s degree in Community Counseling at St. Xavier University. She completed a one year internship with extensive training in ACT and DBT where she provided individual DBT therapy to adults and adolescents struggling with eating disorders self-harm and substance abuse. She became a part of the DBT department in March 2010, and helped facilitate the structure of the current program.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on August 8th, 2015
Published on EatingDisorderHope.com

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.