Dialectical behavioral therapy for the treatment of adolescent eating disorders: a review of existing work and proposed future directions

Abstract

Over the past several decades, Dialectical Behavior Therapy (DBT) has been adapted for a range of presenting problems related to emotion dysregulation. Considerable enthusiasm exists regarding the use of DBT for treating eating disorders; however, to date, there have been no reviews summarizing empirical efforts to adapt DBT for eating disorders in youth. Accordingly, in the present narrative review, we provide a comprehensive summary of existing work testing DBT for adolescent eating disorders. First, we briefly review existing work applying DBT to eating disorders in adults and general adolescent samples. We then review research focused specifically on the use of DBT for adolescent eating disorders, including both those studies applying DBT as the primary treatment and investigations of DBT as an adjunctive treatment. Overall, initial results for DBT-based approaches are promising. However, rigorous empirical work testing DBT for treating adolescent eating disorders remains limited; the majority of existing research is comprised of case series and small-scale studies. Therefore, we close with specific recommendations for future research testing this approach.

Emotion regulation in adolescents with anorexia and bulimia nervosa: Differential use of adaptive and maladaptive strategies compared to healthy adolescents

“…Our results underline that ER difficulties constitute a trans- (Reilly et al, 2020). Given that adolescents with BN exhibit higher levels of maladaptive ER than AN, they might specifically benefit from interventions aimed at increasing negative affect tolerance to decrease impulsive engagement in maladaptive ER.…”

Emotion Dysregulation and Eating Disorder Symptoms: Examining Distinct Associations and Interactions in Adolescents

“…Firstly, the current study suggests that in addition to the well-established disorderspecific risk factor of weight and shape concerns, emotion dysregulation may play an important part in both the probability of engaging in and the frequency of certain eating disorder behaviors. As such, treatments for eating disorders may benefit from integrating emotion regulation-based approaches, such as dialectic behavioral therapy (see Reilly et al, 2020 for review), especially when treating adolescents who engage in binge eating and/or fasting. Similarly, prevention programs may benefit from teaching adolescents emotion regulation skills more broadly.…”

Emotion dysregulation across the span of eating disorder symptoms: Findings from a community sample of adolescents

“…Findings from the current study suggest that there are few differences between diagnostic groups in emotion dysregulation among adolescents, but that those who engage in fasting may be particularly affected by emotion dysregulation. These findings have important implications for clinical practice, where treatment approaches that directly target emotion dysregulation are increasingly implemented (Reilly et al, 2020). While dialectic behavioral therapy has been increasingly used to treat BN and BED (Linardon, Fairburn, Fitzsimmons‐Craft, Wilfley, & Brennan, 2017), our findings highlight the potential utility of considering emotion dysregulation when high levels of fasting are present, independent of diagnostic group.…”