The application of dialectical behavior therapy to the treatment of eating disorders

Transdiagnostic Applications of DBT for Adolescents and Adults

“…Studies suggest that 15% to 40% of clients with BN attempt suicide (Dulit, Fyer, Leon, Brodsky, & Frances, 1994); similarly, there is a strong association between AN and completed suicide (Wisniewski, Safer, & Chen, 2007). Empirically-supported treatments such as cognitive behavior therapy (CBT) are estimated to be effective for only about half of individuals who seek treatment for BN (Whittal, Agras, & Gould, 1999) and for an even smaller percentage of clients with AN (Fairburn & Harrison, 2003).…”

“…To improve understanding about the etiology of eating disorders, Wisniewski and Kelly (2003) adapted the biosocial theory of DBT. They posited that in addition to having a biological susceptibility to emotion dysregulation, clients with EDs are also susceptible to a nutrition-related vulnerability that affects the body's ability to regulate hunger cues.…”

“…These vulnerabilities are thought to transact with an invalidating environment to create maladaptive behaviors, such as restricting, binge eating, and/or purging. The invalidating environment may take the form of teasing about weight from family members and peers, cultural pressures that promote an "ideal" weight and size, and media attention on dieting and losing weight (Wisniewski, Safer, & Chen, 2007).…”

“…As Wisniewski, Safer, and Chen (2007) highlight, ED behaviors are considered to be life threatening when they pose an imminent risk of threat either to the patient or another person. Examples of life-threatening behaviors include vomiting in the context of severe electrolyte imbalance or restriction in a low-weight patient with bradycardia.…”

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why

“…FBT for eating disorders in younger cases  Patient is usually weighed, and the patient's weight is discussed with them and with the family  Exceptionally, if the clinician concludes that this should not be done initially, this issue is treated as part of the dynamic of therapy  Later in therapy, the regularity and scheduling of weighing is negotiated as appropriate to tolerating uncertainty (Eisler, personal communication) Dialectical behavior therapies Wisniewski & Kelly (2003) DBT for eating disorders  Weighing is a core part of therapy (refusal to be weighed seen as a therapy interfering behavior)  Weight communicated to patient in all cases bar those when the patient declines to be told, in which case they are told about direction of weight change (Wisniewski, personal communication (Zipfel, personal communication) Key: CBT -cognitive behavioral therapy; CBT-E -enhanced cognitive behavioral therapy; CT -cognitive therapy; DBT -dialectical behavior therapy; FBT -family based therapy; FPT -focal psychodynamic therapy; IPT -interpersonal psychotherapy; MANTRAMaudsley model of anorexia nervosa treatment for adults; SSCM -specialist supportive clinical management…”