From Crisis to Coping: How DBT Can Support Eating Disorder Recovery
When someone is struggling with an eating disorder, it can impact the whole family. The journey through treatment can feel confusing and emotionally charged, but there are tools that can help. Dialectical Behavior Therapy (DBT), originally developed for the treatment of borderline personality disorder, has become a valuable approach used in many eating disorder treatment settings. It offers concrete, teachable skills to manage overwhelming emotions, reduce urges, and build a more compassionate relationship with self and body. Let’s take a closer look at how DBT fits into eating disorder treatment and how its core skills can support lasting recovery.
Eating Disorders and Emotion Dysregulation
Eating disorders often co-occur with challenges like anxiety, depression, perfectionism, trauma, or just general difficulty managing emotions. Those who struggle in these ways can feel emotionally flooded, stuck in rigid thinking patterns, and desperate for relief. The eating disorder may become a way to numb, distract, or to express something they struggle to verbalize.
Focusing on nutrition and weight restoration are critical aspects of treatment, however recovery also depends on helping people understand why they turn to these behaviors and giving them healthier, more sustainable tools to manage what’s underneath.
What is DBT? A Quick Overview
At its core, DBT helps people learn to understand and manage their emotions without letting those emotions take over.
DBT teaches four key sets of skills:
Mindfulness: Noticing what’s happening in the moment without judgment. (E.g., “What am I feeling right now?”)
Distress Tolerance: How to survive a crisis without making things worse. (E.g., “What can I do instead of binging or purging when I feel overwhelmed?”)
Emotion Regulation: Understanding emotions and learning how to reduce their intensity in healthy ways. (E.g., “How can I calm myself down when I feel out of control?”)
Interpersonal Effectiveness: Navigating relationships and asking for what you need without hurting others or yourself. (E.g., “How can I ask for meal support in a clear and respectful way?”)
Why is DBT Helpful in Eating Disorder Treatment?
Eating disordered behaviors are often fueled, or followed, by a storm of painful emotions, like shame, anxiety, and fear to name a few. Without tools to manage those emotions, the eating disorder can become the go-to strategy for relief. That’s where DBT comes in. It doesn’t just tell someone to “stop the behavior,” it teaches them how to sit with discomfort, how to tolerate distress without acting on it, and how to find words for what they feel instead of turning to unhealthy coping strategies.
One of DBT’s biggest contributions to eating disorder treatment is its emphasis on urges. Whether it’s the urge to restrict, binge, purge, or obsess over weight, DBT treats these as behaviors that can be observed rather than acted on. Individuals learn to notice urges as temporary emotional waves rather than commands to follow. Through distress tolerance skills, they begin to ride those waves and survive the moment without engaging in harmful behaviors.
DBT also addresses black-and-white thinking, which is so common in eating disorders. Someone might believe, “If I eat one 'bad' food, I’ve ruined everything.” DBT challenges that mindset by teaching dialectics. This is the idea that two seemingly opposite things can be true at the same time. For example: “I want to recover, and I feel afraid of gaining weight.” This kind of flexible thinking is essential for long-term recovery.
In many eating disorder programs, DBT is used alongside other evidence-based approaches like Family-Based Treatment (FBT) or Enhanced Cognitive Behavioral Therapy (CBT-E). And in my clinical experience, it has been essential in the outpatient treatment setting. What makes DBT especially powerful is that it meets people where they are emotionally and validates their pain while helping them build a life worth living beyond the eating disorder.
Specific DBT Skills Learned in Eating Disorder Treatment
One of the strengths of DBT is that its skills are not just for the individual in treatment, but they can also support families in building a more validating, connected environment. Here are a few foundational DBT skills that are especially helpful for parents and teens:
Validation
One foundational skill taught in DBT is validation of self and others, which can be especially helpful for parents supporting their teen. In eating disorder treatment, this doesn’t mean agreeing with the eating disorder thoughts, it means recognizing the feeling underneath and showing your child that their experience makes sense, even if you don’t agree with their behavior. For example, saying: “It makes sense that eating that food feels scary right now. You’ve been under a lot of pressure.” This is very different from: “It’s just food, you need to eat.”
Co-Regulation
Another key element for parents is learning to stay regulated when your teen is not. DBT teaches co-regulation, which recognizes that one person’s nervous system influences another’s. Maintaining a calm presence can help anchor your teen through emotional storms. That’s not always easy, but having a shared framework makes a huge difference.
Practice “Wise Mind” Moments
“Wise Mind” is DBT’s way of describing the calm, grounded inner voice that blends emotion and logic. Helping teens identify their Wise Mind supports more grounded decision-making, especially when facing food-related anxiety or urges. You might say: “I can tell your emotion mind is really loud right now. Let’s take a few breaths and see if we can hear your Wise Mind, too.”
Even using the phrase “Wise Mind” regularly creates shared language for reflection, rather than reactivity.
TIPP Skills (for crisis moments)
When anxiety or distress feels overwhelming, such as before a challenging meal, TIPP skills offer fast-acting physiological relief. These are part of the distress tolerance skills mentioned previously and can help people regulate their bodies enough to move forward with a difficult task, like completing a meal.
Temperature (cold pack or ice on face)
Intense exercise (a quick burst of movement)
Paced breathing and progressive muscle relaxation
Final Thoughts
Eating disorder recovery can feel complex and treatment often requires addressing multiple components. DBT offers practical, evidence-based tools to help individuals manage overwhelming emotions, build healthier relationships with themselves and others, and stay grounded during moments of distress. Whether you’re navigating recovery yourself or supporting a loved one in doing so, DBT provides a structure for meaningful change.
Looking for treatment or further consultation regarding eating disorders and/or DBT? Get started with Dr. Rogers.
Eating Disorder Resources
The Academy of Eating Disorders (AED) offers continuing education, research updates, and treatment guidelines.
The National Eating Disorders Association (NEDA) offers free screening tools and helps you find local ED resources.
A clinician-focused but highly readable book on adapting DBT for eating disorder treatment: Dialectical Behavior Therapy for Binge Eating and Bulimia
A self-help book for individuals in recovery: The Dialectical Behavior Therapy Skills Workbook for Bulimia: Using DBT to Break the Cycle and Regain Control of Your Life
DBT Resources
While traditional DBT helps individuals regulate extreme emotions, Radically Open Dialectical Behavior Therapy (RO DBT), has been shown to be effective for treating Anorexia and other disorders characterized by overcontrol or emotional inhibition: The Radically Open DBT Workbook for Eating Disorders
Learn about the origins of DBT and find trained therapists and programs at Behavioral Tech: behavioraltech.org