Integrated enhanced cognitive behaviour therapy (I-CBTE) for the treatment of severe and long-standing eating disorders (SEED). Paper 2: From chrysalis to butterfly – a detailed case study

Background: This case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, long-standing anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk.Case Presentation: The patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation, proved effective.Methods: This paper details the personalised application of the I-CBTE model, illustrating the process through a comprehensive case report. The model integrates multidisciplinary treatment to effectively address EDs and comorbid conditions, highlighting the adaptability and potential of I-CBTE for managing severe and long-standing cases.Outcomes: The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the effectiveness of the I-CBTE approach in patients with complex, long-standing eating disorder histories. Successful treatment also saved in excess of £360k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs.Conclusion: This case study provides a detailed description of the practical application of I-CBTE for patients with severe and long-standing eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to adopt a similar comprehensive treatment approach, potentially transforming the trajectory of those traditionally deemed treatment resistant. Recommendations: We advocate the broader integration of the I-CBTE model into clinical services to improve outcomes for patients with complex eating disorders, and recommend systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach.