Emotion Regulation, Interpersonal Conflict, and DBT Skills for Eating Disorders


United States Department of Homeland Security

Key Points

  1. Since both food and substances can be used as maladaptive forms of emotion regulation, DBT skills typically used for substance abuse (such as alternate rebellion, urge surfing, and burning bridges) can also be applied to disordered eating behaviors.
  2. Take care with taste and smell when applying self-soothing skills to clients with eating disorders, since the two senses are so closely related to eating. Both senses can still be effective forms of distress tolerance, but they can also be triggering, so clinical judgment is required.
  3. When applying opposite action to clients with eating disorders, it would be easy to assume that bingeing and purging are already opposites. However, both extremes are unhealthy, non-dialectical behaviors. Even though bingeing and purging seem like opposites on the surface, they both serve the same underlying function of attempted emotion regulation.
  4. Regardless of which extreme your client is experiencing, opposite action must focus on addressing the underlying maladaptive attempt at emotion regulation rather than on the actual surface behavior.
  5. There is a vicious cycle around interpersonal conflict and disordered eating behavior. As with substance abuse addicts, it can be difficult for such clients to say no, be assertive, or set appropriate boundaries. Therefore, even though interpersonal effectiveness doesn’t seem diagnostically related to eating disorders, it’s an important part of treatment.
  6. There is also a vicious cycle between invalidation and eating disorders. It’s especially important for DBT therapists to provide appropriate validation, which includes radical genuineness.

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