Dialectical Behavioural Theory

Currently, DBT (Dialectical Behavioural Therapy) is the emotional regulation intervention with the greatest empirical support in the treatment of patients with borderline personality disorder (APA, 2001). It is considered the gold standard for addressing this disorder, but it has also been applied to other diagnoses in patients who are difficult to treat, such as those with eating disorders presenting on Axis I and II, whose symptoms often include suicidal ideation and self-harm behaviours.

This theoretical model suggests that the core issue for individuals with bulimia nervosa and binge eating disorder is a dysfunction in emotional regulation. This dysfunction is a result of emotional vulnerability and inadequate skills to achieve healthy emotional regulation. Thus, this model argues that the central and primary problem for these subjects involves difficulties in identifying, monitoring, changing and accepting emotions. Together with poor emotional regulation skills, this intervention model is also based on the premise that individuals with binge eating disorder and bulimia nervosa also have an increased emotional vulnerability.

The use of the DBT model of intervention for eating disorders includes the same intervention strategies as classical DBT, such as dialectical strategies (balance between validation and change, modelling of dialectical thinking), strategies for problem solving and analysis of solutions (chain analysis), strategies for compromise (weighing pros and cons, playing the role of "devil's advocate", "foot in the door", freedom of choice...), structural and support strategies (weekly sessions of group therapy or individual therapy with the therapist). 

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