DBT In The Treatment of Adolescent Eating Disorders

Contributor: Staff at Timberline Knolls Residential Treatment Center

Dad talking to Teenage daughter about using DBT in treating adolescent eating disorders

Eating disorders often occur during adolescence. If caught early, the prognosis is good for complete recovery.  An important tool in the treatment of adolescent eating disorders is DBT. 

Eating disorders cross all cultural, ethnic, racial, and social lines. In the United States, eating disorders have impacted many lives and in the UK, approximately 1.6 million people are affected by an eating disorder.

DBT in Treating Adolescent Eating Disorders

Dialectical Behavior Therapy (DBT) was initially developed to help people struggling with borderline personality disorder and suicidal behaviors, but it has now been proven to be a key component in treating eating disorders.

DBT is premised upon the concept of dialectics. In a nutshell, dialectics propose that two seemingly opposite truths can be held together as valid at the same time, involving some sort of contradictory process between opposing sides. Black-and-white thinking is the diametric opposite of the philosophy found in DBT.

You Can Accept Yourself and Still Change Yourself

The dialectic inherent to DBT is that acceptance and change can exist simultaneously.

This means that an individual accepts life as it truly is with all its successes and failures, positive and negative aspects. Yet, at the same time, she embraces the concept of change and desires every day to live a more meaningful life.

Similarly, the patients are encouraged to accept the reality of their eating disorder and simultaneously work toward combating the challenge and living their best life. The goal of DBT is ultimately to live a meaningful life, a life of value.

The Internal Dialogue and DBT

For an adolescent with anorexia, the internal dialogue could sound something like this: “I don’t want to eat. If I eat I will get fat. Everyone will hate me. I won’t have any friends.”

But, if asked to describe what a meaningful life might look like, the same person might say: “I want to be happy. I want to get a puppy. I don’t want to worry all the time. I want to be married someday.”

Utilizing DBT skills, the therapeutic goal for the patient is to recognize that their present lifestyle stands incompatible with their concept of a meaningful life. Even though the patient may feel a certain way today, change can occur, and she can ultimately live a life worth living.

Using DBT in treating adolescent eating disorders offers a skill-based approach toward healthier ways of coping with emotional triggers that might trigger eating disorder symptoms.

The four primary aspects of DBT skills training include:

  • Mindfulness. Learning to control your mind so it does not control you.
  • Distress Tolerance. Learning how to make it through crisis situations without engaging in negative or unhealthy behaviors.
  • Emotion Regulation. Learning how to tolerate and regulate emotions in productive ways.
  • Interpersonal Effectiveness. Learning how to be more effective in communicating with others, and being aware of your own limits in relationships while also observing the limits of others.

Effectiveness of DBT in Treating Adolescent Eating Disorders

Father counseling daughterA 2001 study enlisted participants with binge eating disorder for dialectical behavioral therapy, and this group underwent a significant decrease in symptoms, with 89 percent symptom-free when the study concluded and 56 percent symptom-free six months later.

In a similar study, results based on bulimic participants showed a considerable reduction in symptoms following treatment with DBT.

More recently, researchers also assessed the use of DBT with a population diagnosed with anorexia nervosa.

Encouraging associations were discovered between DBT and increased BMI, apparent even at six and 12-month follow-ups. DBT was also observed to be linked with greater emotion regulation and meaningful reductions in eating disorder symptoms.

Another recent study assessed the combined effect of DBT with Family-Based Treatment in adolescents with bulimia. Results depicted this combined treatment to lead to significant reductions in binge/purge episodes.


Mindfulness is possibly the most important component in the DBT equation. It is the basic human ability to live in the present, being aware of where one is and what one is doing.

It is a particularly critical skill for young people who often place an undue emphasis on their own thoughts. The act of mindfulness encourages one to avoid being overly reactive or overwhelmed by situational influences.

Instead of recognizing thoughts as innocent mental musings, they perceive thoughts as literal truths or directives, and they act on them accordingly and persistently. This is referred to as overlearned automatic thinking, which leads to overlearned automatic response.

Growing research shows that when the brain is trained to be mindful, the person is actually remodeling the physical structure of the brain. The inner workings of our mental, emotional and physical processes are revitalized.

A Break Between Thought and Action

A teen might think, “I’m fat.” Instead of questioning or evaluating the veracity of the thought in any regard, she automatically comes up with the most straight-forward solution: she stops eating.

The skill of mindfulness provides a much-needed break between thought and action; the skill teaches her to stop and evaluate the thought to determine if it is actually true and if it has value.

This pause allows her to consider a whole new reaction to the thought. She might conclude correctly that it was just a random thought, like millions of others that come and go, and not allow it to dictate her actions toward destructive behavior.

DBT in Treating Adolescent Population

Young adolescent using DBT in treating adolescent eating disordersIn treatment, adolescents are taught the same skills as adults.

However, more time is spent on the gradual development of essential skill sets through the incorporation of activities to keep the sessions engaging.

There are many qualities that define adolescent girls; one is that they often strongly gravitate toward the black-and-white thinking that is antithetical to DBT.

Something is either good or bad, right or wrong; gray is not a huge aspect of their thought processes.

Therefore, it is extremely important to ground them in the dialectic philosophy of DBT. Explaining that everything does not have to be either/or; instead, they can be both/and.

Early Intervention Can Help

Today, millions of adolescents throughout the world are struggling with an eating disorder. Although this is highly distressing, what is important to remember is that with early intervention, recovery is absolutely possible.


1. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061-1065.

2. Chen, E. Y., Segal, K., Weissman, J., Zeffiro, T. A., Gallop, R., Linehan, M. M., Lynch, T. R. (2014, October 27). Adapting dialectical behavior therapy for outpatient adult anorexia nervosa-A pilot study – Chen – 2015 – International Journal of Eating Disorders – Wiley Online Library.

3. Getting Started with Mindfulness. (n.d.). Retrieved from https://www.mindful.org/meditation/mindfulness-getting-started/

About Our Sponsor:

Timberline Knolls Residential Treatment Center provides quality, holistic care to women and adolescent girls ages 12 and older. We treat individuals struggling to overcome eating disorders.

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 a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Reviewed & Updated on April 11, 2024, by Jacquelyn Ekern, MS, LPC
Originally Published January 29, 2015, on EatingDisorderHope.com
Current version updated with statistics, recent research & video.