Efficacy of Dialectical Behavior Therapy (DBT) and DBT-Informed Interventions for Binge Eating in Adolescents: A Systematic Review

Standard treatments for adolescent eating disorders, such as family-based treatment (FBT), may be insufficient for patients presenting with severe emotion dysregulation and co-occurring pathologies. Dialectical behavior therapy (DBT) targets affect regulation and may therefore offer a viable alternative or adjunctive intervention. This study aimed to evaluate the efficacy of DBT and DBT-informed interventions, including those integrated with FBT, for adolescents with eating disorders characterized by binge eating episodes. A systematic literature search was conducted across four databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they involved adolescents with eating disorders characterized by binge eating who received DBT-based interventions. The primary outcome was change in objective binge episodes (OBEs), while secondary outcomes included body mass index (BMI), purging frequency, and Eating Disorder Examination (EDE) measures. Data were analyzed using random-effects meta-analysis. Six studies comprising 102 adolescents were included. Pooled analysis demonstrated a statistically significant reduction in OBEs from pre- to post-treatment (mean difference MD = -2.15, 95% confidence interval CI: -3.93 to -0.38, p = 0.018). Significant improvements were also observed in vomiting episodes (MD = -2.04, 95% CI: -2.72 to -1.35, p < 0.001), as well as EDE Questionnaire (EDE-Q) global scores (p < 0.001) and EDE purging subscale scores (p = 0.008). In contrast, no statistically significant change was observed in BMI (p = 0.064). Subgroup analyses indicated that interventions integrating DBT with FBT (MD = -2.60, p = 0.044) and those delivered in partial hospital settings were associated with significant reductions in binge eating, whereas outpatient settings did not reach statistical significance in pooled estimates. Overall, DBT and DBT-informed interventions are associated with significant reductions in binge eating and purging behaviors in adolescents with eating disorders, without producing significant changes in BMI. The integration of DBT with FBT appears particularly promising for complex clinical presentations; however, larger randomized controlled trials are needed to confirm these findings and evaluate long-term efficacy.