DBT for Eating Disorders
Has your relationship with food and your body taken over your life?
You're not vain or weak—you're using food and body control to manage emotions you don't know how to handle another way
Maybe you restrict food, count every calorie, and panic when you have to eat something unplanned. Or perhaps you binge eat—consuming large amounts of food rapidly, feeling out of control, then drowning in shame afterward. You might purge through vomiting, laxatives, or excessive exercise to undo what you've eaten. Or maybe you do all of these things in different combinations, trapped in cycles you can't break.
Your eating disorder started as a solution. Maybe it helped you feel in control when everything else felt chaotic. Maybe it numbed emotions that felt unbearable. Maybe it gave you a sense of accomplishment, made you feel safe, or helped you cope with trauma or anxiety. But now it's destroying your health, consuming your thoughts, damaging your relationships, and stealing your life.
You might have tried treatment before—therapy that didn't understand eating disorders, nutritionists who just told you what to eat, or even residential programs that helped temporarily but didn't give you skills to sustain recovery. Standard eating disorder treatment often focuses on weight restoration and meal plans but misses a critical piece: teaching you how to manage the emotions that drive disordered eating. That's where DBT for eating disorders is different.
Are you using food restriction, binging, or purging to cope with emotions?
Food and eating have become your primary way of managing feelings. When you're anxious, you might restrict—the control over food feels like control over the anxiety, and the emptiness provides a temporary calm or sense of accomplishment. When you're overwhelmed, sad, lonely, or numb, you might binge—food provides comfort, distraction, or a way to feel something when you're disconnected from your emotions.
These behaviors work in the moment—they provide temporary relief from unbearable emotions—but the relief never lasts, and the behaviors create more problems.
Your eating disorder has its own logic, its own rules that feel absolute: foods that are "safe" versus "forbidden," numbers on the scale that determine whether you're acceptable, rituals around eating that you can't violate without intense anxiety. Breaking these rules feels impossible because they're tied to your sense of safety, control, and worth. You might know intellectually that the rules are arbitrary and destructive, but emotionally they feel like survival.
The eating disorder has become your identity. You might not know who you are without it. The thought of recovery is terrifying not just because it means changing behaviors, but because it means losing the coping mechanism that's gotten you through every difficult emotion and challenging situation. You're not choosing the eating disorder over health—you're choosing the only way you know to manage unbearable emotions and maintain a sense of control.
Is your eating disorder damaging your relationships?
Your relationships may suffer - family members are worried, frustrated, or walking on eggshells around food. Friends don't understand why you won't eat with them or why you disappear to the bathroom after meals. Your partner might feel helpless, shut out, or exhausted from trying to help. Social situations revolve around food, making them unbearable—you avoid restaurants, parties, holidays, or anything involving eating with others.
Your life has become smaller. You might have stopped activities you loved because they interfere with exercise routines or eating rituals. You've declined opportunities—jobs, travel, relationships—because they would threaten your ability to maintain your eating disorder. You spend hours thinking about food, planning meals, calculating calories, checking your body, or engaging in eating disorder behaviors. The mental space the eating disorder occupies leaves room for little else.
You feel hopeless about recovery. Maybe you've been in treatment multiple times. Maybe you've gained weight in treatment only to relapse immediately after. Maybe you've been told you're not "sick enough" for help, or that you'll always struggle with this, or that recovery means accepting a body you hate. Previous treatment might have focused only on changing eating behaviors without addressing the emotional dysregulation driving them, which is why it didn't work.
Do you struggle with body image and self-worth tied to appearance?
You might check your body constantly—weighing yourself multiple times daily, measuring body parts, pinching fat, or checking in mirrors. Or you might avoid seeing your body entirely—no mirrors, no tight clothing, no photos. Either way, your body dominates your thoughts and determines how you feel about yourself. A number on the scale or the size of your clothes determines whether you have value as a person.
Body dissatisfaction might have started small but has become all-consuming. You see flaws no one else sees. You believe you're disgusting, unacceptable, unworthy of love at your current size. The judgmental thoughts feel absolutely true—you don't recognize them as harsh judgments. Every social interaction is filtered through anxiety about how your body looks. You assume others are judging your appearance when they might not even be thinking about it.
You might engage in body checking or avoidance rituals that maintain the distress: repeatedly checking specific body parts, comparing yourself to others, seeking reassurance about your appearance (which never helps for long), or avoiding situations where your body might be seen. These behaviors feed body dissatisfaction by keeping your attention focused on perceived flaws and preventing you from learning that your worth isn't determined by appearance.
The eating disorder promises that thinness will bring happiness, acceptance, love, success—all the things you're seeking. But people who achieve their goal weight discover the emptiness remains, the anxiety persists, and the eating disorder demands more. The promise is a lie, but it's a lie you can't stop believing because giving up the pursuit feels like giving up hope.
We understand that eating disorders aren't about vanity or control—they're about managing overwhelming emotions you don't have other tools to handle.
We specialize in DBT for eating disorders, using approaches like the MED-DBT model (for Multi-diagostic Eating Disorders) specifically designed to address the emotion dysregulation and disordered eating behaviors.
We can help you develop healthier ways to cope with emotions while addressing the eating disorder behaviors and thoughts keeping you trapped.
How DBT helps you recover from eating disorders
DBT for eating disorders recognizes that disordered eating is fundamentally an emotion regulation problem. You're using food, restriction, binging, purging, or exercise to manage feelings you don't know how to tolerate any other way. Recovery requires learning skills to regulate emotions without using eating disorder behaviors, while also addressing body image, interpersonal patterns, and building a life worth living that competes with the eating disorder.
When you're ready to get started, treatment includes individual therapy where you work on your specific patterns and goals, skills training groups where you learn mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness skills, and phone coaching to help support you when you’re in the moment, to use skills instead of acting on urges. This comprehensive approach addresses both the behaviors and the underlying emotional struggles.
How DBT treatment for eating disorders works
We begin by understanding your unique eating disorder patterns and what maintains them. We identify your specific behaviors, your rules and rituals around food and body, what triggers eating disorder behaviors, and what emotions you're trying to manage through disordered eating. We also assess co-occurring conditions (depression, anxiety, trauma, substance use), and previous treatment attempts. We conduct behavioral chain analyses to understand the function of your eating disorder behaviors—what problem does it solve, what emotions does it regulate? This understanding is crucial for identifying what needs to change. You work with an individual therapist weekly throughout treatment, to target your specific behaviors and challenges.
We also teach you skills to replace eating disorder behaviors. The core of DBT for eating disorders is learning to manage emotions without using food, restriction, or body control. You'll learn to identify and label emotions accurately (eating disorders often develop partly because you struggle to understand what you're feeling), and understand what prompts your emotions and what makes them worse or better. You'll also learn to validate your own emotions instead of judging yourself for feeling, which reduces emotional intensity. These skills give you alternatives to the eating disorder behaviors when you’re having unwanted emotions or faced with stressors.
We teach distress tolerance skills to help you manage urges without acting on them. Urges to restrict, binge, purge, or engage in body checking feel overwhelming and impossible to resist. DBT teaches you that urges are temporary experiences—they rise, peak, and fall even if you don't act on them. We teach you specific skills to ride out urges: distraction techniques, self-soothing using the five senses, improving the moment through imagery or encouragement, and radical acceptance of discomfort. You'll learn to tolerate the anxiety of eating without compensatory behaviors, the discomfort of not checking your weight, or the fear of eating avoided foods. These skills break the automatic link between urge and behavior, giving you choice and control over your actions even when emotions are intense.
We teach skills to help with interpersonal relationships. Interpersonal effectiveness skills help you communicate needs directly instead of through eating disorder behaviors, assert limits in relationships, and build connections that aren't based on being sick or being the "perfect" thin person. We also work on identity—helping you discover who you are beyond the eating disorder, what you value, and what kind of life you want to build. Recovery requires having something to recover for.
We teach mindfulness skills. Eating disorders are characterized by disconnection from hunger, fullness, and pleasure in eating—you eat (or don't eat) based on rules, emotions, or compulsions, not based on your body's signals. We introduce mindfulness skills for general moments in life, and then work up to using mindfulness skills to help you reconnect with internal cues: what does hunger feel like, what does satisfaction feel like, what do you actually enjoy eating? We work toward mechanical eating initially (eating regular meals at regular times regardless of hunger or fullness because your body's signals are disrupted), then gradually toward more intuitive and mindful eating as your relationship with food normalizes. We also address food rigidity, expanding the variety of foods you can eat and situations where you can eat, which reduces the eating disorder's control over your life.
Frequently Asked Questions
Who do you treat?
DBT Center of Tacoma treats adolescents (13+) and adults with eating disorders who live in Washington state. We provide in-person services in Ruston, WA and telehealth across Washington state.
How is DBT for eating disorders different from traditional eating disorder treatment?
Traditional eating disorder treatment often focuses heavily on meal plans, weight restoration, and behavioral compliance with eating goals, but may not adequately address the emotion dysregulation driving the eating disorder. People often gain weight in treatment then immediately relapse because they never learned how to manage emotions without the eating disorder. DBT for eating disorders explicitly treats the emotion regulation problems underlying disordered eating—you learn skills to tolerate distress, manage intense emotions, and cope with life stress without using food, restriction, or body control. We address eating and weight, but we prioritize teaching you emotional and interpersonal skills that create sustainable recovery. The focus is on building a life worth living, not just on eliminating symptoms. DBT is highly collaborative, and balances acceptance and change to help you take steps that feel tolerable and sustainable.
Do I have to gain weight or reach a certain weight in DBT treatment?
This depends on your medical status and diagnosis. If you're at a lower weight than your expected weight based on your individual growth history, weight restoration is necessary for safety and for your brain to function well enough to learn skills. However, DBT for eating disorders doesn't have rigid weight requirements for treatment to begin, and we work with people across the weight spectrum. The focus is on developing a healthier relationship with food and your body, reducing eating disorder behaviors, and improving quality of life—not on achieving a specific number on the scale. We work collaboratively with you and medical providers to determine appropriate weight goals if needed, and we use a weight-neutral, Health at Every Size-informed approach that doesn't perpetuate weight stigma or diet culture.
Can DBT help with binge eating disorder, or is it just for anorexia and bulimia?
Absolutely. DBT is highly effective for binge eating disorder. Binge eating is fundamentally an emotion regulation problem—people binge to cope with negative emotions, stress, or emptiness. DBT teaches you to identify emotions triggering binges, use skills to manage those emotions without eating, tolerate distress without turning to food, and build a more balanced relationship with eating. Research shows DBT significantly reduces binge eating frequency and improves emotional regulation. We don't use restrictive diets or "food plans" that often backfire—we help you develop sustainable ways to relate to food and emotions that don't involve binging or restricting.
What if I'm not ready to give up my eating disorder? Can I still start treatment?
Many people begin eating disorder treatment with ambivalence—part of them wants recovery, part of them is terrified of letting go of the eating disorder. This is normal and doesn't mean you can't benefit from treatment. DBT doesn't require you to be fully committed or ready to change on day one. We work with your ambivalence, helping you understand what the eating disorder does for you while also exploring the costs and whether there might be other ways to meet your needs. We build motivation through the process rather than requiring it upfront. That said, we do ask that you commit to showing up to treatment and learning skills, even if you're not sure you're ready to use them to change eating behaviors yet. The willingness often develops as you acquire skills and begin to see that life without the eating disorder might be possible.