Cognitive-behavioural case formulation in complex eating disorders

The treatment of people with eating disorders (ED) continues to be a major challenge for clinicians. Patients present with a bewildering array of cognitive, emotional and physical symptoms, resulting from starvation and/or other problematic weight control behaviours (Zipfel et al. 2003). Comorbid difficulties are common, including depressive, socially anxious and obsessivecompulsive symptoms, self-harm and other impulsive behaviours, and cluster II or III personality traits or organisation (Bulik 2002; Wilson 2002; Wonderlich 2002). Additionally, these patients may not be motivated to engage in treatment or share others’ views about the need to change (Treasure and Schmidt 2001). An individual case formulation approach may offer clinicians an enhanced means of understanding, and guidance in treating, these patients.