Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders

Eating disorders such as anorexia nervosa and bulimia nervosa are characterized by significant disturbances in the frequency and duration of eating activities that are aberrant from traditional views of nutritional well-being (American Psychiatric Association [APA], 2000). The National Eating Disorders Association (2005) estimated that approximately 10 million women and 1 million men in the United States experience the symptoms associated with an eating disorder. Although eating disorders are more prevalent among women than men (APA, 2000; Striegel-Moore & Bulik, 2007), there does not appear to be significant differences between the age groups that are at risk for developing these disorders (Hudson, Hiripi, Pope, & Kessler, 2007). This lack of a target population is a concern for both clients and counselors given that eating disorders are among the top 10 causes of disability among women (Striegel-Moore & Bulik, 2007) and that anorexia nervosa is associated with the highest lethality rate for any mental disorder (Crow et al., 2009). When comparing individuals with eating disorders and those without, researchers detected a number of deleterious and pervasive psychosocial trends, including strained interpersonal relationships (Ringer & Crittenden, 2007), difficulty regulating emotions (Whiteside et al., 2007), higher incidence of despondency and anxiety (Doyle, le Grange, Goldschmidt, & Wilfley, 2007), and decreases in occupational functioning (McElroy et al., 2011). Given the prevalence and associated consequences of eating disorders, a prudent task for counseling professionals is to evaluate what interventions are associated with desirable treatment outcomes. One target outcome for many counselors treating individuals diagnosed with eating disorders is the frequency of eating disorder episodes (Bankoff, Karpel, Forbes, & Pantalone, 2012; Safer, Lock, & Couturier, 2007; Safer, Telch, & Algras, 2001b). Across diagnostic categories, disordered eating is evidenced by client behaviors such as severe restriction (e.g., dieting, fasting, excessive exercise), binging/purging (e.g., self-induced vomiting or misuse of laxatives), or a combination of both in an effort to avoid weight gain (APA, 2000). Kaplan and Noble (2007) noted that the frequency of eating disorder episodes is positively associated with several medical consequences, including bone density loss, gastrointestinal complications, cardiovascular impairment, and chronic pain. Additionally, individuals experiencing health complications related to eating disorders reported frequent hospitalization and requisite outpatient care (Kaplan & Noble, 2007). As a consequence, clients with an eating disorder are often vulnerable to developing co-occurring psychiatric conditions, including anxiety disorders such as social phobia and obsessive-compulsive disorder (Kaye et al., 2004) and major depressive disorder (O'Brien & Vincent, 2003). Several researchers have indicated that among all co-occurring psychiatric disorders, major depressive disorder not only is the most prevalent with eating disorder but also is highly associated with suicidal gestures and attempts (Arcelus, Mitchell, Wales, & Nielsen, 2011; Godart et al., 2007; Mischoulon et al., 2011; O'Brien & Vincent, 2003). Counselors providing interventions to individuals with co-occurring depression and an eating disorder stated that the interrelation of symptomatology may provide a noteworthy challenge for promoting desired therapeutic change across treatment settings (Mischoulon et al., 2011; O'Brien & Vincent, 2003). As severity of depressive symptoms among individuals with eating disorders decreases, so too does the degree of lethality and potential for related self-injurious behaviors. When one considers the findings that traditional antidepressant medication may be only marginally effective for treating depressive symptoms among individuals with eating disorders (Romano, Halmi, Sarkar, Koke, & Lee, 2002; Walsh et al. …