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Christian Counseling Connection
INNOVATIVE THOUGHT & PRACTICE
E
ating Disorders (ED) are complex problems having a multiplicity of
simultaneous, co-occurring issues and symptomology. Practitioners
treating eating disorders often find themselves asking what should be ad-
dressed first in the counseling process, especially when there is accom-
panying alcoholism, drug abuse, history of abuse, trauma, self-injury, depression,
anxiety, a personality disorder, etc. Wherever the therapist chooses to begin, it is
evident that a comprehensive treatment model is required. Dialectical Behavioral
Therapy (DBT) is one such modality (among others) and has been found to be an
effective evidence-based orientation in the treatment of eating disorders and co-
occurring problems.
WHAT IS DBT?
Originally developed by Marsha Linehan (1993), professor of psychology at the
University of Washington, DBT is a comprehensive treatment approach that com-
bines standard cognitive-behavioral techniques for emotion regulation and real-
ity testing with concepts of distress tolerance, acceptance and mindful awareness
(also known as mindfulness). DBT is designed for the treatment of severe, chronic
and borderline personality-disordered people. Research has shown this approach
to be an effective evidenced-based modality for multi-diagnostic problems, such
as substance abuse, self-injury, spectrum mood disorders, anger/rage, impulsiv-
ity, anxiety, depression and trauma, in both adolescents and adults. DBT is more
specifically designed to:
•
Enhance a client’s capabilities
•
Improve motivational factors
•
Promote a client’s adaptability to function in new environments
•
Enhance therapist capabilities and the motivation to treat
•
Provide greater structure to the therapeutic milieu
Eating disorders have been regarded as a difficult-to-treat diagnostic category due
to the high number of characteristically significant comorbid problems, two of
which are borderline personality disorder (BPD) and parasuicidal behaviors. Eating
disorders are very serious and complex conditions with both medical and psy-
chological consequences that can take a life or destroy it. Although only approxi-
mately 30% of those with eating disorders are actually diagnosed BPD (this may be
affected by the rigorous diagnostic criteria for BPD), people with eating disorders
often have similar issues with managing overwhelming emotions as do those exhib-
iting borderline behaviors. Consequently, patients can be in therapy for many years
learning to manage their emotions. Due to its efficacy, DBT has been found to be
both a time-limited and cost-effective treatment protocol.
When it comes to unstructured eating, food avoidance (missing meals), and
food/body obsessions, DBT can be helpful in reducing symptoms, as well as self-
judgments about weight, shape, appearance, and compensatory behaviors such as
excessive exercise, purging, and the use of laxative and diet pills. The eating disor-
der often functions as a coping mechanism that suppresses difficult and negative
emotions. The emotion-governing aspects of DBT offer the client valuable replace-
ment skills to manage these dysregulated reactions (Linehan, 2004).
DBT is highly skills-based, which is one of the primary reasons it is so effec-
tive with those who are engaging in self-defeating, self-destructive behaviors. It
supports stopping the chain of events long enough to allow for healthier problem
solving and choices, while simultaneously addressing the emotions and anxiety that
so often accompany poor decisions. Instructional elements within the model help
stabilize the underlying emotional disturbance so often seen in those with eating
disorders and include the following skill sets:
1. Practicing Presence skills
address the inability to identify cognitive and
emotional cues related to hunger, satiety and “mindless eating”
Marian C. Eberly, R.N., LCSW, BCPCC, Ph.D. (candidate)
Dialectical Behavioral Therapy
and
Eating Disorders:
A Christian Perspective
