Unravel the knot: Exploring Treatment Process and Outcome in a Binge Eating Disorder Case Study

Introduction: Binge eating disorder (BED) is characterized by recurrent binge eating behaviors involving the consumption of a large amount of food and a profound feeling of loss of control during the overeating episodes (Kittel et al., 2015). Patients with BED experience difficulty regulating affects and emotions, identity diffusion, immature defense mechanisms, and impairments in distinguishing between mental and somatic states. Aim of the study: The study aims to discuss the clinical case of a 25-year-old patient diagnosed with BED admitted to a specialized residential treatment, according to DSM-5-TR criteria. Methods: Personality patterns and defense mechanisms were assessed using the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Defense Mechanism Rating Scale Q-sort (DMRS-Q), applied to the Clinical Diagnostic Interview (CDI) transcript at intake and discharge. At both time points, the Psychodynamic Diagnostic Chart (PDC-2) was used for comprehensive diagnostic assessment. The patient completed the Eating Disorder Inventory (EDI-3), the Identity and Eating Disorders (IDEA), the Multidimensional Assessment of Interoceptive Awareness (MAIA) and the Outcome Questionnaire-45.2. The therapeutic process was evaluated by assessing the quality of the therapeutic alliance through the Working Alliance Inventory fulfilled both by the patient (WAI-P) and the therapist (WAI-T) after the first month of treatment and at treatment termination. Therapist countertransference reactions were explored using the Therapist Response Questionnaire (TRQ). The patient provided informed consent to participate in the study. Results: Changes were observed in personality patterns, defensive functioning and symptomatic impairment before and after treatment. Overinvolved/worried and parental countertransference patterns were identified together with changes in the therapeutic alliance throughout treatment. Discussion: The findings highlight the clinical value of a multidimensional and psychodynamically informed approach, providing key insights into subjective experience of BED patients. Conclusion: This approach offers implications for assessment and therapeutic interventions in treating BED. Declaration of conflict of interest: The authors declare no conflicts of interest.