Antisuicide Therapy May Help Bulimics Cope With Disease
After 20 weeks, four women in the DBT group had stopped binging and purging completely, while several others reported significant reductions in the frequency of binge/purse episodes. There was no improvement in the waiting group.
Other types of therapy for bulimia tend to focus on dieting and distorted body image. But in DBT, "emotions are primary," says Safer. "We don't even talk about food. For some reason, whether biological or environmental, [bulimics] don't have skills for dealing with their emotions. Food is used to create walls because they don't have a way to let what's going on outside be outside, while remaining calm inside.
Because binging and purging suppresses emotional distress so well, "the pattern is ... reinforced and hard to break," Safer continues. "The first important skill to learn is stepping back from whatever is so overwhelming and just looking at it without engaging in compulsive behaviors to avoid it."
Not everyone with bulimia responds to DBT, says Safer.
"This is not a panacea," she says. "It doesn't work well for those who insist on maintaining a very low body weight or who purge 10 times a day and more. It seems to be most effective for those whose eating is very emotionally driven."
DBT is geared toward people with personality disorders, says Katherine Halmi, MD, professor of psychiatry at Weill Cornell Medical College and director of the eating disorders program at New York Presbyterian Hospital. "I don't think it is worthwhile to study this therapy in bulimics per se," she tells WebMD.
"DBT targets specific interpersonal problems and a way of relating to people," says Halmi. "Some people with bulimia don't have that problem. They may have anxiety problems, for example, and DBT does nothing for that."
Even in patients who do respond to DBT, it doesn't happen overnight.
"It's an ongoing process; it takes practice," says Safer. "But once you feel less ashamed, angry, or fearful, life does change. It becomes much more positive."