How DBT Can Help Treat Eating Disorders (Part 2)

April 27, 2020

This feature by Lucene Wisniewski is the second part in a two-part series about applying DBT to the treatment of eating disorders. In part 1, Lucene addresses some of the existing literature and basic concepts for the application of DBT to eating disorders. Part 2 shares advice for clinicians and insight on when it is appropriate to use DBT with clients diagnosed with an eating disorder.

In part 1 of “How DBT Can Help Treat Eating Disorders,” we explored the basic concepts on applying DBT to eating disorders. Start by reading Part 1 here if you have not already. Now we need to know when and how to apply it.

When is it appropriate to use DBT with clients diagnosed with an eating disorder?

Not all eating disorder clients are appropriate for comprehensive DBT and comprehensive DBT is not appropriate for all clients with eating disorder. DBT should be considered with eating disorder clients for whom standard, evidence-based treatments have not helped, for clients who have a co-morbid diagnosis, or for when emotion regulation issues are central to a client’s illness.  

Advice for clinicians

A common pitfall that DBT clinicians may experience when they begin treating eating disorders is they assume that the disorder is NOT about the food.  Clinicians must understand that it is not about the food until it is! It is not about the food until you ask a client with restrictive behaviors to eat or one with binge eating to refrain from eating.

More specifically, a patient may be using restrictive behaviors to “numb” emotions and to feel “in control,” yet when faced with a granola bar that contains more than a predetermined number of calories, the anxiety and fear are really about THAT granola bar in THAT moment (not about being in control or numbing emotions).

Also, it is standard in ED treatment for the therapist to take the individual’s weight at the start of each session.  DBT therapists without ED experience may find this uncomfortable.

My advice to any clinician: if you are going to choose to see patients who suffer from an eating disorder, get trained!  There is a heavy dose of cognitive behavioral treatment for EDs that is needed as part of the treatment.  Training and supervision in EDs is necessary to successfully and effectively treat these clients.

If you are interested to learn more about emotion regulation in DBT, read here.

Lucene Wisniewski, PhD, FAED, is the owner and founder of Lucene Wisniewski, PhD, LLC, and DBTOHIO, as well as an Adjunct Assistant Professor of Psychological Sciences at Case Western Reserve University. From 2006-2014, she served as Clinical Director and co-founder of the Cleveland Center for Eating Disorders, a comprehensive eating disorder treatment program offering evidenced based care. Read her full biography here.


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