"When Standard Treatments Are Not Enough" - Showcasing Schema Therapy for the Treatment of Anorexia Nervosa and Borderline Personality Disorder

Whilst standard cognitive and behavioural treatments lead to clinical improvement for approximately half of the people with eating disorders, preliminary evidence indicates that complex comorbidity, including personality difficulties, insecure attachment patterns and Posttraumatic stress disorder, may hinder treatment engagement and outcomes. Such comorbidities tend to be associated with increased emotional dysregulation, rigidity of beliefs, and dissociation. Schema Therapy is a transdiagnostic approach that interweaves the treatment of current eating disorder symptomatology and comorbid presentations through addressing early maladaptive schemas linked to unmet attachment needs and traumas. The goals are to promote integration, coherence, and resilience of self, whilst reducing reliance on the eating disorder as a means of self-regulation and substitute identity. In this case example, we follow a 27-year-old woman with an eating disorder (Anorexia Nervosa) and comorbid personality disorder (Borderline Personality Disorder), illustrating how Schema Therapy can effectively treat both conditions by healing the underlying schemas. This case study highlights the ways in which the therapeutic 'limited reparenting' approach is used to interweave cognitive, experiential, and behavioural techniques that address clients' chronically unmet emotional needs, and the importance of enhancing the individual's Healthy Adult mode to facilitate self-regulation and the client's capacity to effectively manage their own psychological needs in the future.