Wokshop Details & Abstracts

Eating disorders (EDs) are complex biological and psychiatric illnesses associated with significant morbidity and mortality (Deloitte Access Economics, 2020). While FBT and CBT approaches are considered first-line treatments, more than 50 percent of patients do not respond adequately and relapse rates remain unacceptably high (Agras, et al., 2000; Linardon et al., 2021). Individuals living with an ED who experience co-occurring suicide, self-injury, trauma, and pervasive emotional or interpersonal difficulties are considered even more difficult to treat and less likely to respond to standard evidence-based approaches (Brewerton, 2019; Cucchi et al., 2016; Racine & Wildes, 2015).

Multidiagnostic Eating Disorders-Dialectical Behaviour Therapy (MED-DBT) provides a comprehensive and multi-modal framework for managing emotion regulation difficulties and multiple high-risk behaviours in the context of an ED. With an unwavering focus on building lives worth living, MED-DBT has become a highly sought-after approach across levels of care for both adolescents and adults (Ben Porath et al., 2020; Downs, 2025; Federici, et al., 2012; McColl, Hindle, & Donkin, 2024; Wisniewski et al., 2021).

This 90-minute interactive workshop is designed for practitioners who are new to MED-DBT and seeking to gain foundational knowledge about the theories and structure of the model in order to support more advanced training. This workshop will provide an introduction to the following elements:

• Why MED-DBT?
• Assessment and Suitability
• Who is on the Team?
• The Adapted Biosocial Theory
• Targeting effectively in ED treatment

Research suggests that eating disorders (EDs) and PTSD are highly comorbid, and those who present to ED treatment with co-occurring PTSD (ED-PTSD) tend to have more severe psychopathology, poorer treatment outcomes, and higher relapse rates than those without PTSD. However, traditional evidence-based treatment models for EDs primarily focus on treating ED symptoms, with little acknowledgement of how to address co-occurring PTSD.

Growing awareness of the limitations of this approach has led to increased exploration of empirically supported methods for integrating evidence-based treatments for comorbid PTSD into ED treatment. DBT Prolonged Exposure (Harned, 2022, DBT-PE) is an empirically supported treatment for targeting PTSD in multidiagnostic populations and is therefore a promising treatment approach for the ED population.

In this workshop, we review current best-practice knowledge for utilizing the DBT PE Protocol for clients with co-morbid PTSD and high-risk multi-problem ED presentations. Objectives will include:

• Providing a brief overview of the DBT-PE model, including how it varies from other evidence-based treatment protocols for PTSD.
• Identifying modifications to DBT-PE protocol when working with ED-PTSD, including readiness criteria, contingency management of ED behaviors while in protocol, and ongoing monitoring and management of ED behaviors.
• Reviewing the use of DBT-PE for ED in different LOC settings, including outpatient and HLOC (PHP, IOP), while discussing case examples.
• Providing information on additional resources and how to undertake further training in the protocol.

Eating disorders (EDs) are complex biological and psychiatric illnesses associated with significant medical complications, morbidity, and mortality. In addition, EDs are associated with an increased risk of self-harm, suicidal ideation and attempts, non-suicidal self-injury, and suicide mortality across adolescence and adulthood. While Family Based Treatment (FBT) is the first-line treatment for adolescent EDs, over half of patients do not respond adequately and relapse rates remain high. Research has demonstrated that differential treatment approaches may be needed for individuals presenting with co-occurring suicide, self-injury, trauma, and specific bio-temperamental characteristics. While some evidence-based treatment for EDs have been adapted to address self-harm and suicidality in clinical settings (e.g., FBT, CBT), most treatments do not address multiple high-risk behaviours and do not have subsequent protocols for managing chronic suicide or self-injury. Furthermore, these treatments do not comprehensively target emotion regulation difficulties, which have been shown to be a prominent risk factor for suicidality in EDs. Dialectical Behaviour Therapy (DBT) is a comprehensive and multi-modal framework for managing emotional and interpersonal regulation difficulties, and has been shown to be effective for adolescent and adult populations. Integrating DBT and FBT provides a solid framework to help adolescents and families who struggle with multiple problem behaviours in the context of an ED.

This 90-minute clinical workshop will start by providing a comprehensive overview of the scientific evidence related to suicidality and EDs, discussing the prominent risk factors, clinical screening tools, and current ED interventions needed to address self-harm and suicide. Subsequently, the evidence base for FBT and DBT will be discussed, including the rationale for integrating these two models for adolescents with anorexia nervosa experiencing co-morbid self-harm and/or suicide. Special attention will be given to parents of children struggling with suicidal ideation and self-harm behaviours.

We now understand that there is a statistically significant comorbidity of psychiatric disorders and eating disorders, regardless of which is diagnosed initially (Momen et al., 2022). Up to 54% of patients with BPD will experience an eating disorder (Zanarini, Frankenberg, Hennen, Reich, & Silk, 2004). Furthermore, up to 10% of individuals with Anorexia Nervosa (AN; Arcelus, Mitchell, Wales, & Nielsen, 2011; American Psychiatric Association, 2013), 3.9% of those with Bulimia Nervosa (BN) and 5.2% of those with the DSM-IV diagnosis of Eating Disorder Not Otherwise Specified (EDNOS; Crow et al., 2009) will die from complications of these disorders. In the USA, 10,200 deaths per year are directly attributed to eating disorders (Deloitte Access Economics, 2020). Contributing to this premature mortality rate is a substantially increased risk of suicide. Suicide attempts are considered common, and studies report an increased risk (10 times greater) of suicide compared to the general population (Duriez et al., 2023; Goodwin et al., 2014; Cliffe et al., 2020). This combination of psychiatric comorbidity and lethality has led to DBT being a preferred choice for the treatment of multi-problem eating disorders [MED]. Stage I treatment has been explored in the literature (Ben Porath et al., 2020; Ben Porath, Wisniewski, & Warren, 2009; Federici & Wisniewski, 2013).

Clinicians who have successfully guided their MED clients through Stage I work, or have MED clients who have already achieved stage I goals (reduction of life-threatening behaviors, increased behavioral control, and skills acquisition), require guidance on Stage II treatment of MED. This has not been systematically explored in the literature. These clinicians will find themselves navigating multiple clinical issues including: When to consider starting stage II work, or alternatively when to return to Stage I work; The clinical goals of Stage II; Evidence-based treatment of common targets which may include Post-traumatic Stress Disorder, Obsessive Compulsive Disorder, perfectionism, body image concerns, emerging emotion experiencing, navigation of social pressures, and continued management of ED behaviors with a lens toward dialectical abstinence and relapse prevention. Further, this work may often occur in a private practice or solo practitioner setting which may exacerbate the experience of clinical challenges. The goal of this workshop is to review principles for Stage II treatment in DBT and engage in a conversation of how to effectively provide stage II treatment to the highly complex MED population, and to teach strategies using real-life examples of effective treatment practices.