Dialectical Behavior Therapy and Eating Disorders

Eating disorders are mental illnesses that are characterized by harmful eating behaviors. People with eating disorders may also struggle with negative body image. These disorders are often compulsive, which means the disordered behaviors happen automatically or they feel very difficult to stop doing.

Eating disorders are also considered the deadliest mental illness, second only to opioid overdose. This is why it’s so important to have effective ways to treat them. There isn’t a single way to treat eating disorders. This post will cover one research-based treatment approach, dialectical behavior therapy, DBT for eating disorders.

dbt therapy session

What is DBT for Eating Disorders?

DBT is a treatment method that was originally developed for people with borderline personality disorder. However, research shows that DBT can also be helpful for people with eating disorders [1].

DBT is a therapy technique that helps people develop new coping skills and relationship skills. This can be helpful for people with eating disorders because disordered behaviors can become a way to deal with upsetting feelings or relationship stressors. DBT for binge eating, bulimia, and anorexia has been a proven tool during treatment.

DBT Skills for Eating Disorders

DBT has four categories. Each category is a core skill that clients can build. These four core skills are mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.


Mindfulness skills help someone become aware of and stay in the present moment. This can help people notice their emotions and thoughts without acting on them. This can be especially helpful for people with eating disorders. Mindfulness skills can help people with eating disorders learn to notice disordered thoughts without putting them into action.

Distress Tolerance

Distress tolerance skills help build up someone’s ability to deal with upsetting feelings. Sometimes, difficult emotions can leave people feeling desperate to find a way to cope and make the hurtful feeling go away. As mentioned earlier, eating disorder behaviors can become a way to deal with upsetting emotions. Learning other ways to cope can eliminate the need for disordered behaviors.

Interpersonal Effectiveness

Big emotions can get in the way of having healthy relationships. On the other hand, relationship stressors can be difficult to manage. Interpersonal effectiveness skills help someone learn how to communicate in a clear and healthy way.

Emotion Regulation

Emotion regulation skills are just what they sound like—skills to help you learn how to manage your feelings! This category is a bit different than distress tolerance because distress tolerance is about how to take the edge off when emotions are big.

Emotional regulation skills are about how to deal with core emotions, such as anger, sadness, or fear. Learning how to cope and handle these emotions can help prevent them from turning into bigger feelings or harmful behaviors.

For example, if someone finds it difficult to cope with sadness. In the past, the sadness might have turned into shame, which then leads them to binge eat. If someone can learn how to deal with sadness, then the cycle is interrupted and they’re emotionally better off.

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DBT is an evidence-based treatment. However, DBT isn’t the only treatment method that’s backed by research for treating eating disorders. Another popular treatment approach is cognitive behavior therapy (CBT). CBT seeks to help people stop unwanted behavior and feelings by changing the way they think.

This can be helpful for people with eating disorders because there is often a lot of unrealistic or illogical thoughts that feed into a cycle of disordered behaviors.

However, CBT doesn’t help someone build coping skills for moments when their thoughts and feelings are a realistic response to what’s going on. DBT and CBT go well together.

Types of DBT for Eating Disorders

Traditional DBT can work wonders. However, some people with eating disorders may benefit from an off-shoot of DBT called Radically-Open Dialectical Behavior Therapy (RO-DBT) [2].

RO-DBT is a form of DBT for bulimia, anorexia, and binge eating that was developed to help people who struggle with being excessively self-controlling [2]. RO-DBT aims to help people become more open, flexible, and more connected with people in their life [2].

getting help in therapy

Who Can Benefit from DBT for Anorexia, Bulimia, or Binge Eating?

DBT is used to help people who struggle with all kinds of mental illnesses, such as anxiety, eating disorders, or personality disorders. However, these skills are universally helpful. Everyone needs help coping with emotions from time to time.

People in eating disorder treatment may learn DBT skills in a DBT group or individually with a DBT therapist. Group therapy can allow people to practice these skills with other people and also learn from other people’s experiences. Learning DBT for eating disorder skills in individual therapy can help you figure out which skills are most effective for you.

[1] Healthline. (2019). Dialectical Behavior Therapy. Retrieved November 15th, 2021 from https://www.healthline.com/health/dbt

[2] Radically Open. (n.d). About RO DBT. Retrieved November 15th 2021 from https://www.radicallyopen.net/about-ro-dbt/

Author: Samantha Bothwell, LMFT
Page Last Reviewed and Approved By: Jacquelyn Ekern, MS, LPC / 12.21.21