Filling the Emptiness: An Empirically Supported and Psychodynamic-Oriented Single Case Study on Structural Change in Binge-Eating Disorder Treatment

Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating involving the consumption of large amounts of food accompanied by a marked loss of control. Individuals with BED tend to exhibit affect dysregulation, identity diffusion, use of immature defense mechanisms, and difficulties distinguishing between mental and somatic states. The present study examined the clinical case of a 25-yearold patient with a Diagnostic and Statistical Manual of Mental Disorders-5-TR diagnosis of BED, who was receiving treatment at a specialized residential treatment center. Upon intake, the patient presented with an insecure-preoccupied attachment style, avoidant personality disorder with dependent and schizoid traits, low defensive functioning, and marked symptom impairment. A comprehensive psychodynamic-oriented treatment, incorporating a multimethod and multi-informant approach, resulted in meaningful structural and symptomatic improvements, particularly in personality organization, defensive patterns, and symptom severity. The findings underscore the clinical importance of the structural reorganization of core areas of functioning in patients with BED, necessitating an individual approach to treatment.