Eating disorders are about so much more than just food. Eating behaviors in eating disorders are the tip of the iceberg, the visible part of a mental health struggle that is often rooted in family dysfunction, rejection, and bullying, impossible/unhealthy social expectations, and co-occuring mental health disorders like anxiety, depression, OCD, BPD, and PTSD.
Eating disorders serve as a way to fit in, especially in social settings where abuse and dysfunction are considered the norm. They also serve as a source of control in out-of-control environments, where eating behaviors are used to soothe mental health symptoms. This intersection of extreme social rejection and mental health struggles is where emotional regulation comes into play for eating disorders.
What does emotional regulation have to do with eating disorders?
It’s common for girls, women, and gender-diverse people with eating disorders to struggle to cope with emotional overwhelm. Often, their environment is overwhelming and emotionally difficult, and it’s also common for mental health symptoms to amplify emotional experiences. It’s also common for people with eating disorders to have a loud inner critic, constantly and harshly accusing and demanding. That critic is compelling, and for someone at risk for an eating disorder, it becomes all too easy to fall into disordered behavior patterns to try to soothe overwhelming emotions.
Through dialectical behavior therapy (DBT), learning emotional regulation skills makes it easier to manage and even stop disordered eating behaviors. These helpful skills give people the opportunity to regulate emotions without relying on disordered eating practices. With time and practice, these skills can ease mental health symptoms and also provide an inner source of emotional stability in complex, chaotic home, school, and work environments.
What emotional regulation DBT skills work as coping strategies for eating disorder treatment?
DBT Skill: Identify and Describe
It’s common when we have experiences that we don’t fully understand immediately, we will provide our own interpretation of them (e.g. we might think our friend is mad at us if we don’t get a text back right away). Our interpretations often generate emotions, and when we struggle with issues like an eating disorder, negative interpretations, and difficult emotions can be common. We feel those emotions in our body first, and then that feeling can lead us to want to act.
When you step back and observe your interpretation, the emotion, how it feels in your body, what it makes you want to do, and what you end up doing, you get a much better understanding of your emotions, your thought patterns, and you give yourself a better opportunity to decide what you want to do in response to your emotions.
DBT Skill: Opposite Action
When you’re experiencing a tough emotion like anger, you might want to scream or make wild accusations, or with an eating disorder, harm yourself through restricting, bingeing, or purging. Taking the opposite action to what you want to do, like slowly eating a nourishing meal or taking a walk instead of starting a binge, diffuses your emotion instead of playing into it. It gives you space to make choices instead of being driven to disordered eating by your emotions.
What actions work best for you will be very personal, and you can brainstorm with your therapist on the best choices for you. Your therapist can also help you decide when emotions are worth listening to,vs. taking opposite action, so you don’t ignore dangerous situations,or your personal values, hile applying this skill.
DBT Skill: Increasing Positive Emotions
This is a DBT skill that you use to create a life worth living. This can reduce the impacts of difficult emotions, helping you long-term with emotional regulation. Seek out, and create opportunities for, ositive experiences that make you feel good. These can be small-scale things like sharing a laugh with a friend, r large-scale things like working toward a life goal; both are part of a life worth living.
It’s easiest to increase positive emotions by being deliberate about it. Create a list of experiences you’d enjoy, and make it a priority to pursue these experiences. Some examples include:
- Enjoying time in nature
- Set aside time to enjoy your favorite show
- Spend time with friends
- Watch a sunset
- Learn a new skill
- Start new relationships (friend, romantic, work colleagues)
- Make a major life change to meet a goal (new job, buy a car/house, get a pet)
DBT Skill: Cope Ahead
When you know you’re going to be in an emotionally difficult situation, having a plan ahead of time can help you navigate the emotions that come up for you. Instead of leaning on a binge or restriction for soothing, you can choose healthier steps that help you feel stable even in difficult situations.
The steps for this skill are:
- Describe the situation, sticking to the facts. Describe what emotions you’ll probably experience.
- Decide what DBT skills and coping mechanisms you want to use, in detail, for the situations that may arise.
- Imagine yourself in the situation, and rehearse your coping skills. Allow yourself to succeed in your mental rehearsal, even when thinking of coping with your worst-case-scenario
- Spend time relaxing and calming yourself after this rehearsal.
DBT Skill: ABC PLEASE
ABC PLEASE pulls together a whole group of emotional regulation skills in a handy acronym to help you reduce your vulnerability to emotional overwhelm. It asks you to take good care of your physical body and your mind by balancing food, exercise, and slep, and avoiding mood-altering drugs (like alcohol or street drugs, this does not refer to prescribed psychiatric medication) to ensure you feel your est, and can respond to emotions with your own best interests in mind.
ABC PLEASE includes:
- Accumulate positive emotions: see above
- Build mastery: in a skill that makes you proud of yourself
- Cope Ahead: see above
- treat Physical iLlnesses: it’s easier to regulate emotions when your physical body is running as smoothly as possible.
- balance Eating: make sure to do this with the guidance of your care team, but just as emotional regulation can help with eating disorders, treating your eating disorder can improve your emotional regulation.
- Avoid mood-altering drugs
- balance Sleep
- get balanced Exercise: “balanced” is a keyword here. Make sure to do this with the guidance of your care team, as excessive exercise can be a symptom of eating disorders.
How else can DBT therapy help with eating disorder treatment?
The structure of DBT offers girls, women, and gender-diverse people with eating disorders a broad base of support for shifting eating behavior while also addressing underlying mental health concerns. DBT’s group therapy to practice skills and develop a healthier understanding of what social groups should feel like. Individual therapy helps you process the roots of trauma and dysfunction that led to an eating disorder, and helps you choose where and how to apply DBT skills to cope effectively. Finally, DBT is designed to help you live a fulfilling life. By becoming your own agent of change in life, you learn to trust yourself, and you learn that bullying, peer pressure, and abuse can hurt, but they don’t have to shake your own love and trust for yourself.
THIRA Health offers an inpatient mental health treatment program that incorporates DBT to help those with eating disorders to find a new, healthy approach to both eating, and other behaviors in their life that tie into their disordered eating. If you’re ready to get started on living a life worth living, connect with us today to learn more.
