Binge Eating Disorders and DBT

Symptoms of Binge Eating Disorder

Binge Eating Disorder (BED) is a type of eating disorder characterized by recurrent episodes of binge eating. The American Psychiatric Association defines a binge eating episode as a discrete amount of time in which an individual feels out of control and eats significantly more than what most would eat in a similar amount of time. In order to meet the diagnostic criteria for BED, these episodes of binge eating must be associated with three of the following: 

  1. Eating more quickly than normal, 
  2. Eating far past the point of being full, eating a lot despite not feeling hungry, eating alone due to embarrassment about the amount of food consumed, and 
  3. Feeling disgusted, 
  4. Depressed or guilty after a binge.

Individuals with BED experience a great amount of distress in relation to their binge eating, and often feel a great amount of shame (APA, 2013). Individuals with Binge Eating Disorder are at higher risk of a variety of medical issues, most notably obesity. People struggling with BED are also at increased risk of diabetes, metabolic syndrome and gastrointestinal problems (Wassenaar et al., 2019). Nearly 3% of Americans experience Binge Eating Disorder at some point in their lifetime, with women meeting the criteria for BED nearly twice as often as men (Hudson et al., 2007). 

Can Binge Eating Disorder be cured or treated?

While Binge Eating Disorder cannot be “cured,” recovery/remission is possible with treatment. The first-line treatment for Binge Eating Disorder has historically been Cognitive Behavioral Therapy (CBT) (Grilo et al., 2011). Many studies have found that CBT therapy is effective at reducing episodes of binge eating in individuals with BED.

Other types of psychotherapy such as Interpersonal therapy and Psychodynamic therapy have also been proven effective at treating BED (Murphy et al., 2012; Abbate-Daga et al., 2016). Research has also found that medications including stimulants and antidepressants are effective at treating BED, especially when used in combination with psychotherapy. More recent research, however, has found that Dialectical Behavioral Therapy (DBT) is an incredibly effective treatment for Binge Eating Disorder (Iacovino et al., 2012).

What is DBT?

Dialectical Behavioral Therapy (DBT) is a type of psychotherapy created by Marsha Linehan in the late 1970s. DBT was originally developed as a treatment method for individuals struggling with suicidal and self-harming behaviors, and quickly became considered the first-line treatment for individuals diagnosed with Borderline Personality Disorder (BPD).

Today, however, DBT is used to treat a variety of psychological disorders beyond BPD, including eating disorders. DBT combines traditional behavioral therapy, which is focused primarily on change, with acceptance techniques used in traditional Zen practices. This dialectic of acceptance and change is central to DBT.

DBT was created with the intention of being used in outpatient settings and consists of four components: individual therapy, skills training, coaching calls when necessary, and clinician consultation groups. DBT skills training, which can take place individually or in a group setting, has four modules: mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation (Chapman and Dixon-Gordon, 2020). 

Is DBT effective at treating Binge Eating Disorder?

DBT has been proven to be an effective treatment for Binge Eating Disorder. There are varying opinions on the etiology of Binge Eating Disorder. While some experts conceptualize Binge Eating Disorder as a maladaptive response to intense food restriction or pattern of dysfunctional interpersonal relationships, in the context of DBT, Binge Eating Disorder is believed to be an affect regulation mechanism (Wiser and Telch, 1999).

This model theorizes that individuals engage in binge eating in an effort to manage intense, negative emotions. DBT treatment for BED, therefore, aims to help individuals gain skills such as distress tolerance and emotion regulation in order to decrease the frequency of binge eating (Telch et al., 2001). DBT was adapted to treat Binge Eating Disorder in 1999, and since then has consistently been proven to be an effective treatment method (Wiser and Telch, 1999).

A study conducted by Marsha Linehan and some Stanford researchers found group DBT to be effective at reducing binge eating and eating disorder psychopathology in individuals diagnosed with BED. Studies have also shown that DBT had higher rates of treatment completion and follow-up than other therapies (Safer et al., 2010).

In 2021, a study found that DBT was effective at improving emotion regulation, eating disorder psychopathology and BMI in individuals with BED (Rozakou-Soumalia et al., 2021). Along with being effective, DBT for BED is an efficient mode of treatment. Research has found DBT to be effective at significantly improving symptoms of Binge Eating Disorder in as few as ten sessions, with significant progress being made in as few as four sessions (Adams et al., 2021). 

Have questions or want to schedule an appointment?

How to find DBT therapy for Binge Eating Disorder in NYC?

Finding therapy in NYC, specifically eating disorder treatment, can be difficult. The first thing to consider when searching for treatment for BED in NYC is what level of treatment is appropriate for you. There are various levels of treatment for BED available, depending on the severity of your disorder: inpatient, residential, intensive outpatient or outpatient treatment.

More intensive treatment options such as inpatient, residential and intensive outpatient programs typically include a combination of individual and group therapy, medical and dietary care. Many intensive programs in NYC utilize DBT as part of their treatment approach. If you determine that outpatient therapy is the right choice for you, a good place to start is online.

There are various therapy directories, which allow you to search for therapists and filter based on primary issue, type of therapy and price. When looking at potential therapists, look for clinicians who specialize in treating eating disorders and use DBT as a part of their practice. Because of the medical issues that can arise as a result of BED, it is also a good idea to be in touch with a physician so that they can support you on your journey to recovery. Your doctor may also be able to advise which level of treatment is right for you, and connect you to therapists or treatment centers in your area.  

What techniques from DBT are used at New York Behavioral Health?

While New York Behavioral Health does not offer a fully “intensive” DBT program, many therapists at NYBH are intensively trained and multiple therapists use DBT techniques, especially when treating Binge Eating Disorder. NYBH therapists utilize a variety of DBT skills when treating BED including mindfulness skills, emotion regulation skills, interpersonal effectiveness, and distress tolerance skills.

One mindfulness skill that your therapist may utilize is mindful eating. Your therapist will help you learn mindful eating skills by guiding you through experiential exercises in your sessions. For example, your therapist may ask you to bring a few small items of food (i.e., almonds) to your session. However, instead of simply eating them, your therapist will ask you to describe the appearance, smell and texture of the almond before you eat it.

Your therapist may then ask you to eat one almond, while paying special attention to the sensations you experience. The goal of these exercises is to help you learn a new way to approach food and eating that is focused on awareness and intentionality rather than impulsivity. Your therapist may also teach you the DBT technique of “urge surfing.” Urges to engage in impulsive behaviors, such as binge eating, do not last forever, but it may feel that way to someone struggling with BED.

If you are able to endure the urge to binge, you will likely find that the urge passes rather quickly. Your therapist will teach you skills to help endure the urge, such as specific distraction or self-soothing techniques. Another aspect of DBT your therapist may utilize in treatment is chain analysis. Many individuals who struggle with binge eating lack insight into what leads them to engage in binging behavior.

The purpose of creating a chain analysis is for the client and therapist to explore what internal or external events or vulnerabilities lead to a binge, as well as brainstorm how you can interrupt that chain of events so that you are able to prevent binges from occurring. DBT skills can take time to master, but with the guidance of your therapist they can help you significantly on your journey to recovery from binge eating disorder (Wiser and Telch, 1999; Linehan, 2014).

 References

Abbate-Daga, Giovanni & Marzola, Enrica & Amianto, Federico & Fassino, Secondo. (2016). A comprehensive review of psychodynamic treatments for eating disorders. Eating and weight disorders : EWD, 21. 10.1007/s40519-016-0265-9. 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) 

Chapman, A. L., & Dixon-Gordon, K. L. (2020). Dialectical behavior therapy. American Psychological Association. https://doi-org.ezproxy.cul.columbia.edu/10.1037/0000188-000

Grilo, C. M., Masheb, R. M., Wilson, G. T., Gueorguieva, R., & White, M. A. (2011). Cognitive–behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(5), 675–685. https://doi.org/10.1037/a0025049

Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1; 61(3):348-58. PMID: 16815322

Iacovino, J.M., Gredysa, D.M., Altman, M. et al. Psychological Treatments for Binge Eating Disorder. Curr Psychiatry Rep 14, 432–446 (2012). https://doi-org.ezproxy.cul.columbia.edu/10.1007/s11920-012-0277-8

Linehan, M. M. (2014). Dbt skills training manual, second edition. Guilford Publications.

Murphy, R., Straebler, S., Basden, S., Cooper, Z., & Fairburn, C. G. (2012). Interpersonal psychotherapy for eating disorders. Clinical Psychology & Psychotherapy, 19(2), 150–158. https://doi.org/10.1002/cpp.1780

Rozakou-Soumalia, N., Dârvariu, Ş., & Sjögren, J. M. (2021). Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. Journal of personalized medicine, 11(9), 931. https://doi.org/10.3390/jpm11090931

Safer, D. L., Robinson, A. H., & Jo, B. (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behavior therapy, 41(1), 106–120. https://doi.org/10.1016/j.beth.2009.01.006

Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061–1065. https://doi-org.ezproxy.cul.columbia.edu/10.1037/0022-006X.69.6.1061

Wassenaar, E., Friedman, J., & Mehler, P. S. (2019). Medical complications of binge eating disorder. Psychiatric Clinics of North America, 42(2), 275–286. https://doi.org/10.1016/j.psc.2019.01.010 

Wilson, G. T., & Fairburn, C. G. (2002). Treatments for eating disorders. In P. E. Nathan & J. M. Gorman (Eds.), A guide to treatments that work (pp. 559–592). Oxford University Press.

Wiser, S., & Telch, C. F. (1999). Dialectical behavior therapy for binge-eating disorder. Journal of Clinical Psychology, 55(6), 755–768. https://doi.org/10.1002/(sici)1097-4679(199906)55:6<755::aid-jclp8>3.0.co;2-r 

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