ABSTRACT
The most reliable way to identify schemas and modes is through observation, with particular attention to verbal content, countertransference reactions and non-verbal communication, such as emotional tone and gestures. Questionnaires are a useful tool for building a picture of eating symptoms, unmet emotional needs, early maladaptive schemas (EMS) and schema modes. Psychiatric comorbidity is elevated in the eating disorder (ED) population, with high levels of chronic dysthymia, depressive and anxiety disorders, substance misuse and personality disorders. Imagery for assessment can be used to connect current ED triggers with early memories, highlighting the link between ED urges and behaviours, EMS and unmet needs. A detailed assessment that elicits the way in which the ED has evolved and become perpetuated in the context of EMS facilitates the development of a refined individualised case conceptualisation – and a roadmap for future therapy.
