Addressing Schemas, Modes and Interoceptive Disconnection in Chronic Binge Eating Disorder: A Temperament-Informed Schema Therapy Case Series.

Abstract

Binge eating disorder (BED) is often chronic and accompanied by trauma, comorbidity and neurodiversity, for whom existing treatments can be less effective. This study examined a manualised, temperament-informed schema therapy protocol (ST-BED-TI) targeting early maladaptive schemas (EMS), schema modes and interoception in adults with complex BED. A prospective case series was conducted with five adult women with long-standing BED and high clinical complexity, who received between 25 and 35 sessions of ST-BED-TI in outpatient services in Australia and the United Kingdom. Individual change was evaluated with reliable change indices and clinical significance for global eating disorder (ED) symptom scores. This trial was pre-registered on the Australian New Zealand Clinical Trials Register (ID: ACTRN12623001259639). Four of five participants showed reliable and clinically significant improvement in global ED symptoms at post-treatment; three of the four measured at 6-month follow-up maintained these gains. All participants reported reductions in binge eating frequency. Most demonstrated reliable improvements in key EMS, schema modes and at least one interoceptive awareness domain, with one case showing marked interoceptive gains despite limited measurable EMS or mode change. Within the limits of a small uncontrolled case series, ST-BED-TI appears acceptable, clinically manageable and promising in this pilot context. These preliminary findings warrant larger controlled and mechanism-focused studies.