Treating Eating Disorders with RO-DBT: Understanding Emotional Over-Control
Many approaches to eating disorder treatment focus on building coping skills such as emotional regulation, grounding techniques, and distress tolerance. But what about the people who already excel at self-control? Many individuals with eating disorders are highly disciplined, emotionally restrained, and exceptionally capable of regulating impulses, sometimes too well.
This is where Radically Open Dialectical Behavior Therapy (RO-DBT) can make a life-changing difference.
RO-DBT vs. Traditional DBT
While standard DBT is designed for individuals who experience emotional under-control (intense feelings, impulsivity, difficulty pausing), RO-DBT is specifically geared toward those with emotional over-control. RO-DBT isn’t diagnosis-based, it focuses on personality traits and social signaling patterns that often go overlooked in treatment.
People with emotional over-control often:
Hold back their feelings
Appear composed, even when struggling inside
Have high standards for themselves (and sometimes others)
May be perfectionistic or detail-oriented
Can be rigid in thinking or routines
They may not lack relationships. In fact, they often have many people in their lives. However, they may still feel deeply lonely, because emotional expression and vulnerability don’t come naturally. The loneliness stems not from a personal flaw, but from unintentional social signaling that makes closeness harder to access.
RO-DBT helps individuals reconnect, express authenticity, and build meaningful emotional bonds, key components in sustainable eating disorder recovery.
A Quick Self-Reflection Exercise
Below is a simplified tool adapted from The Radically Open DBT Workbook for Eating Disorders (Hall, 2022). Consider which column feels more familiar:
Traits of emotional under-control Traits of emotional over-control
Bossy Accommodating
Risk-taking Cautious
Often late Punctual
Chaotic Organized
Laid back Hard-working
Extreme Orderly
Fearless Think before acting
Misbehaving Disciplined
Careless Precise
Wild Proper
Impatient Patient
Slacker Perfectionist
Untidy Tidy
Rebellious Obedient
Playful Formal
Stubborn Compliant
Aggressive Submissive
Most of us have traits from both sides. What matters is whether some of these patterns have become rigid or costly in your life.
Additional Signs of Emotional Over-Control
Ask yourself:
Threat Sensitivity:
Do new social situations feel exciting or overwhelming?
Novelty & Flexibility:
Do you enjoy spontaneous plans or prefer routines and predictability?
Joy & Social Connection:
Do social activities feel energizing or more like obligations?
Emotional Expression:
Do others know how you feel, or do you keep emotions internal and controlled?
Attention to Detail:
Do small errors or imperfections bother you more than they seem to bother others?
There is nothing wrong with being organized, thoughtful, patient, or composed. These are strengths. RO-DBT simply aims to support greater flexibility, so that control works for you, not against you.
When RO-DBT Helps in Eating Disorder Recovery
RO-DBT is especially effective for individuals with:
Anorexia Nervosa
Orthorexia / restrictive eating patterns
Perfectionism-driven disordered eating
High-functioning anxiety
OCD and rigid routines
Difficulty connecting emotionally with others
By increasing emotional openness, social connection, and flexibility, RO-DBT can help reduce shame, isolation, and the internal pressure to perform or appear “perfect.”
Ready to Explore RO-DBT?
If you see yourself in these patterns and are seeking support, you’re not alone.
Transformation Counseling and Wellness offers compassionate, evidence-based therapy for:
Eating Disorders and Disordered Eating
Body Image Concerns
OCD and Anxiety
Perfectionism and High-Achievement Stress
Licensed therapists are available for virtual therapy in Wisconsin and Florida.
Reach out today to schedule a free consultation.
You deserve connection, support, and a relationship with food, and yourself, that feels peaceful.
