The Efficacy of Dialectical Behavior Therapy for Anorexia Nervosa in Adolescent Females: A Literature Review

Anorexia nervosa (AN) in adolescent females is associated with high mortality, significant relapse rates, and cognitive and emotional disturbances, suggesting that existing treatments may not sufficiently address core maintaining mechanisms. This literature review synthesizes current research examining the efficacy of Dialectical Behavior Therapy (DBT) and Radically Open Dialectical Behavior Therapy (RO-DBT) for adolescent females with AN, with emphasis on neurobiological vulnerability, emotional dysregulation, and maladaptive overcontrol. Neuroimaging research indicates reductions in cortical thickness and gray matter in regions associated with self-referential processing and emotional regulation, while emerging evidence suggests structural plasticity following mindfulness-based interventions. Behavioral studies demonstrate that emotional dysregulation and cognitive rigidity often persist despite improvements in weight restoration, implicating overcontrol as a central mechanism in the maintenance of restrictive eating pathology. RO-DBT, developed to target maladaptive overcontrol, and DBT skills training as an adjunct to family-based treatment show preliminary promise in improving flexibility and coping; however, much of the intervention literature relies on small, quasi-experimental designs, limiting causal inference and generalizability. Cultural considerations further complicate diagnostic and treatment frameworks, as manifestations of AN and emotional regulation may differ across populations. Collectively, the literature suggests that DBT-based approaches are theoretically aligned with identified mechanisms underlying AN, yet rigorous randomized controlled trials and longitudinal relapse-focused studies are needed to establish durability and cross-cultural applicability.