Written by James Downs @jamesldowns https://www.jamesdowns.co.uk
For too long, eating disorders have been met with treatments that don’t always account for their complexity. As someone who has personally experienced a longstanding and severe eating disorder, I’ve witnessed how traditional approaches often fall short of addressing the many dimensions involved – be they emotional, social, medical, or even existential in nature. Thankfully, innovative therapies like Dialectical Behaviour Therapy (DBT), and more specifically adaptations like Multi-Diagnostic DBT (MED-DBT), are changing that narrative by taking a more expansive approach.
DBT was initially developed for borderline personality disorder but has shown immense potential in addressing eating disorders. The approach centres on building skills in mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness – elements that are often key to recovery. For me, the focus on practical, life-changing skills was transformative. Recovery didn’t just mean reducing symptoms; it meant starting to learn how to live fully and authentically again – on my own terms.
Beyond symptom reduction
One of the most innovative aspects of approaches like MED-DBT is their shift from simply targeting symptoms to enhancing quality of life. Recovery isn’t just about stopping harmful behaviours but building a “life worth living.” This phrase, borrowed from DBT’s philosophy, has been profoundly motivating for me in reframing my recovery as something more meaningful than “not suffering”. I wasn’t just fighting an eating disorder; I was creating a future aligned with my values and goals.
This perspective resonates with many who have struggled with longstanding and severe eating disorders. It’s not uncommon for patients to feel overwhelmed by the sheer effort of recovery, particularly when treatments focus narrowly on symptom management without addressing the broader aspects of life that make recovery worthwhile. Importantly, focussing on quality of life in DBT doesn’t come as an alternative to more conventionally-defined measures of recovery, such as improving physical health and safety. Instead, an integrated approach sees the work of recovery as inseparable from the why.
Validation as a gateway to compassion
Another hallmark of DBT-based approaches is their emphasis on validation. For many of us, eating disorder behaviours can be entrenched by their effectiveness as ways of coping with distress or other co-occurring symptoms. Reframing these behaviours not as failures but as attempts to survive has been deeply healing. Instead of being met with judgment, I was met with compassion – a powerful motivator to work towards change.
This compassionate framework can be especially beneficial for individuals who may have been told they are “hard to treat”, or have faced repeated setbacks. By balancing acceptance of the present with the possibility of change, DBT creates a foundation for progress even in the most challenging of moments.
Challenges lie ahead
While approaches like MED-DBT show promise, they are not without their challenges. One key issue is accessibility. Eating disorder treatments often lack inclusivity, with marginalised groups facing significant barriers to care. Cultural biases, stigma, and systemic inequities mean that many people don’t receive the treatment they need. Future research and programme development must prioritise diversity and equity to ensure these therapies reach everyone who needs them.
Another challenge lies in sustaining progress after treatment. For me, the transition from structured therapy to self-management was daunting. What helped most were the practical skills I’d learned, which became tools I could rely on in daily life. However, more robust aftercare plans – like peer support networks or booster sessions – could further bridge this gap, helping individuals maintain their progress and prevent relapse.
Hope for the future
Innovation in eating disorder treatment isn’t just about advances in therapies; it’s about rethinking their aims, and recovery itself. It’s also about challenging the nature of the world that people re-engage when they feel more free of their eating disorder. Is it sufficient enough to reduce suffering so that people can better cope with unhelpful ways of being in environments that need to fundamentally change? Or do we need to be more ambitious and radical, aiming to create lives that are full of wellbeing and meaning? Maybe we need to move beyond individualistic models and recognise how individual healing doesn’t happen in a vacuum, but within a context that might need to heal, too. The task and the potential is huge, but frameworks like MED-DBT are leading the way in creating more compassionate, inclusive, and effective approaches to care.
This Eating Disorders Awareness Week, I want to celebrate these innovations and the possibilities they can bring. I never thought I would know anything other than unbearable suffering, but other ways of being were opened up to me by DBT. With continued research, co-produced treatment frameworks, and a commitment to inclusivity, we can ensure that everyone affected by eating disorders has access to the support they need to build their own “life worth living.”