Dialectical Behavior Therapy for Bulimia: Challenge Your Thoughts and Emotions

Dialectical behavior therapy (DBT) is a form of psychotherapy being investigated for treatment of bulimia nervosa. At its core, DBT is designed to help with regulation of emotions: It was first created for work with people with borderline personality disorder (BPD), a disorder that involves powerful mood changes. DBT has been shown to be very effective with BPD, and it has also shown promise in treating binge-eating disorder. If DBT can help with binge eating, can it also help with binging and purging?

Why DBT May Be Appropriate for Treating Bulimia Nervosa

Many believe that binge eating is a way to regulate emotions. In bulimia, as in binge-eating disorder, binging is a repetitive and impulsive behavior. If you struggle with bulimia, you may find purging to be beyond your control as well. In fact, you may find that purging provides a big sense of relief - temporarily. Often, the relief later melts into shame.

Impulsive behavior is a hallmark of those with borderline personality disorder. Those with BPD seem to use this kind of behavior to manage emotions. If DBT can address the emotions underlying the behavior of those with BPD, it may have promise in doing the same for the emotions underlying binging and purging in bulimia.

How DBT Can Help to Change Binging and Purging Behaviors in Bulimia

In addition to individual sessions, DBT therapy includes a group therapy component. The DBT group teaches interpersonal effectiveness, distress tolerance, emotion regulation and mindfulness skills. The core goal of DBT is to help clients to build skills for regulating emotions. In particular:

• It teaches the ability to recognize what triggers emotions and how to keep them from leading to unhealthy behaviors. For example, those in DBT learn to breathe while focusing on the diaphragm, encouraging relaxation that eases emotional stress.
• It gives practice in mindful eating, with a focus on awareness of emotional responses to food while eating. This is a big contrast with the sense of emotional "numbness" that many report during and after binge eating.
• DBT normalizes emotions, helping each person to understand that having "negative" emotions (like anger and sadness) doesn't mean that there's something wrong with you. So these emotions don't lead to shame and guilt.
• When you run into unavoidable stress, DBT helps by teaching self-soothing as an alternative to binging and purging.

Initial Research Investigating DBT for Bulimia Nervosa

A trial comparing DBT to a group receiving no treatment showed that DBT significantly reduced the frequency of binging and purging. Of the 14 participants receiving DBT, four had completely stopped binging and purging after 20 weeks. Another five had reduced both binging and purging by nearly 90%. The remaining five continued to have symptoms consistent with the diagnosis of bulimia.

A separate study employed six months of DBT for eight participants who met the criteria for BPD as well as either bulimia (3) or binge-eating disorder (5). Though very small, this study also showed promising reductions in disordered eating behaviors, although two participants dropped out and several wished that the treatment would go longer than six months.

Is DBT a Good Choice for Treating Your Bulimia?

It's possible that DBT would be helpful for you if you struggle with bulimia. It is one of several options, and is not yet widely practiced for this purpose. Consider these points if you would like to try DBT:

• You must be willing to work in the context of a group. Though the group process is a distinct strength of DBT, in my opinion, you may find speaking in a group context daunting.
• You must be willing to do homework outside of the scheduled meeting times. This is how you will move the skills you learn in therapy to your everyday life, where you need them most.

What I like about DBT is that it addresses both current behaviors and underlying emotional problems, rather than one or the other. It's a powerful method for dealing with difficult emotions, as proven by its success in working with the difficult challenges of borderline personality disorder. As you consider therapists in your area, you can ask whether they offer DBT as a treatment option. If a therapist doesn't, ask him or her to direct you to others who do.