Radically open DBT: Targeting emotional loneliness in Anorexia Nervosa
Abstract
This article conceptualizes Anorexia Nervosa (AN) as a prototypical overcontrolled disorder, characterized by low receptivity and openness, low flexible control, pervasive inhibited emotional expressiveness, low emotional awareness, and low social connectedness and intimacy with others. As a result, individuals with AN often report high levels of emotional loneliness. A new evidence-based treatment, Radically Open Dialectical Behavior Therapy (RO-DBT), and its underlying neuroregulatory theory, offer a novel way of understanding how self-starvation and social signaling deficits are used as maladaptive regulation strategies to reduce negative affect. RO-DBT proposes that rather than trying to be 'emotionally regulated' or achieving equanimity, long-term psychological well-being is achieved by increasing social connectedness. RO-DBT skills, including body posture, gestures, and facial expressions, activate brain regions that increase social safety responses that function to automatically enhance the open-minded and flexible social-signaling, which are crucial for establishing long-term intimate bonds with others and becoming part of a "tribe."
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Anorexia nervosa is associated with a low level of openness to unexpected events and avoidance of uncertainty.
“Anorexia nervosa (AN) is a serious psychiatric illness that is associated with a low level of openness to unexpected events and avoidance of uncertainty (Hempel, Vanderbleek, & Lynch, 2018).”
From Eating disorders in times of the <scp>COVID</scp>‐19 pandemic—Results from an online survey of patients with anorexia nervosa (2020) · cites this paper as Hempel, Vanderbleek, & Lynch, 2018
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Chapter 6. Prevalence, Sociodemographics, and Functional Impairment
Torgersen, S. O. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg06 · Cited by 1 · see citing works
Chapter 13. Dialectical Behavior Therapy
Stanley, B., Brodsky, B. S., & Gratch, I. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg13 · Cited by 2 · see citing works
Chapter 3. Articulating a Core Dimension of Personality Pathology
Morey, L. C., & Bender, D. S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg03 · Cited by 1 · see citing works
Reliability and validity of the Hindi version of the UCLA loneliness scale version 3
Giri, S. P., & Dubey, A. (2025) · Educational Gerontology · doi:10.1080/03601277.2024.2448687 · Cited by 1 · see citing works
Terapia Dialéctico Conductual Radicalmente Abierta para la Anorexia Nerviosa
Rodríguez, I. D. L. V., & Calahorra, T. M. (2020) · Revista de Psicoterapia · doi:10.33898/rdp.v31i115.314 · Cited by 1 · see citing works
Чернявский, А. М., Анатольевич, А. С., Sirota, D. A., Сергеевич, Х. Д., Mm, L., Ponomarev, D., & Kadyrbaev, D. Z. (2015) · PubMed · Cited by 1 · see citing works
Askew, A. J., Gallagher, E., Dzombak, J. W. P., & Haynos, A. F. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816384-9.00006-3
Nicholls, D., & Nagularaj, L. (2022) · doi:10.1093/med/9780198861478.003.0041
Bürger, A., & Föcker, M. (2022) · Springer eBooks · doi:10.1007/978-3-662-64627-4_10
Dialectical Behavioral Therapy
Sotsky, J., & Brodsky, B. S. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_153-1
Dialectical Behavior Therapy for Eating Disorders: Overview and Application
Anderson, L. K., & Wisniewski, L. (2023) · Springer eBooks · doi:10.1007/978-3-030-97416-9_62-1
Goetz, J. L. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95702-1.00095-6
Dialectical Behavioral Therapy
Sotsky, J., & Brodsky, B. S. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_153
Chapter 5. Manifestations, Assessment, Diagnosis, and Differential Diagnosis
Skodol, A. E. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg05
Chapter 4. The Alternative DSM-5 Model for Personality Disorders
Skodol, A. E., Bender, D. S., & Oldham, J. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg04
Chapter 22. Antisocial Personality Disorder and Other Antisocial Behavior
Black, D. W., & Blum, N. S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg22
Chapter 12. Psychodynamic Psychotherapies
Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg12
Gutheil, T. G. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg19
Chapter 20. Assessing and Managing Suicide Risk
Links, P. S., Boursiquot, P., & Links, M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg20
Choi-Kain, L. W., & Hersh, R. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg15
Chapter 14. Cognitive-Behavioral Therapy
Fowler, J. C., Orme, W. H., & Hart, J. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg14
Chapter 2. Theories of Personality and Personality Disorders
Westen, D., & Heim, A. K. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg02
Chapter 11. Therapeutic Alliance
Bender, D. S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg11
Chapter 8. Genetics and Neurobiology
Fred-Torres, S., Pérez-Rodríguez, M. M., New, A. S., Rosell, D. R., & Koenigsberg, H. W. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg08
Chapter 23. Personality Disorders in the Medical Setting
Nash, S. S., Sotsky, J., Hicks, C., & Muskin, P. R. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg23
Chapter 17. Pharmacological Management
Nelson, K. J., & Tsheringla, S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg17
Chapter 1. Personality Disorders: Recent History and New Directions
Oldham, J. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg01
Chapter 16. Group, Family, and Couples Therapies
Ogrodniczuk, J. S., Uliaszek, A. A., Lebow, J. L., & Kealy, D. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg16
Chapter 18. Collaborative Treatment
Winkeller, V., & Schlesinger, A. B. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg18
Chapter 25. Translational Research in Borderline Personality Disorder
Schmahl, C. G., & Herpertz, S. C. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg25
Chapter 21. Co-occurring Substance Use Disorders
Gorfinkel, L., Prins, S. J., Elliott, J. C., Meyers, J. L., & Hasin, D. S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg21
Chapter 9. Longitudinal Course and Outcomes
Grilo, C. M., & Skodol, A. E. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg09
Landquist, R., Öster, C., Isaksson, M., & Wolf‐Arehult, M. (2025) · Scandinavian Journal of Psychology · doi:10.1111/sjop.13089
Baudinet, J., Gledhill, L. J., Fennig, M., Gilbert, K., & Simic, M. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01440-6
Isaksson, M., Ghaderi, A., Wolf‐Arehult, M., Öster, C., & Ramklint, M. (2021) · Figshare · doi:10.6084/m9.figshare.14168368
Rowlands, K., Simic, M., Treasure, J. L., & Cardi, V. (2024) · Figshare · doi:10.6084/m9.figshare.26654254
Additional file 1 of Formulation in eating disorder focused family therapy: why, when and how?
Baudinet, J., Simic, M., & Eisler, I. (2021) · Figshare · doi:10.6084/m9.figshare.15145883
Haghshomar, M., Shobeiri, P., Brand, S., Rossell, S. L., Malayeri, A. A., & Rezaei, N. (2022) · Figshare · doi:10.6084/m9.figshare.19593998
Vuillier, L., Greville-Harris, M., Talbot, C. V., May, L., & Moseley, R. L. (2024) · Figshare · doi:10.6084/m9.figshare.26669805
Baudinet, J., Watson, C., Brothwood, P. L., Parham, R., Smith, L., Snowden, N., Konstantellou, A., Hunt, K., & Simic, M. (2022) · Figshare · doi:10.6084/m9.figshare.20317648
Measuring Trait-Level Overcontrol: Does the Measurement Fit the Theory?
Balling, C. E., Scott, S., Lang, N., & Samuel, D. B. (2026) · Assessment · doi:10.1177/10731911261479237
- Authors
- Hempel, R., Vanderbleek, E., & Lynch, T. R.
- Affiliations
- University of Southampton (GB)
- University of Notre Dame (US)
- Corresponding author
- Hempel, Roelie
- Venue
- Eating Disorders
- Publisher
- Informa UK Limited
- Published
- 2018-01-02
- Volume
- 26
- Issue
- 1
- Pages
- 92-104
- ISSN
- 1064-0266 (ISSN-L)
- 1532-530X
- OpenAlex
- W2623141687
- Cited by
- 97
- References
- 54
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 10 · 2023: 7 · 2022: 12 · 2021: 43 · 2020: 10 · 2019: 4 · 2018: 1 · 2015: 1
- FWCI
- 17.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- anorexia nervosa, emotional loneliness, social connectedness, social signaling, self-starvation, emotional awareness, flexible control
- MeSH terms
- Anorexia Nervosa, Humans, Interpersonal Relations, Loneliness, Social Isolation, Cognitive Behavioral Therapy, Behavior Control
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