The treatment plan and efficacy for a person with Intellectual Disability and Intentional Imaginary Companions, a Gender Identity and Depersonalization Disorder including a Koro-Like Symptom, Trauma/abuse, and Sex Offenses is presented. A complex set of co-morbid disorders was targeted for treatment. Treatment targets included addressing sexual knowledge deficits, the banishing of all Imaginary Companions, managing his gender identity and depersonalization disorders along with trauma/abuse, and continuing with Old Me New Me Sex Offender Treatment for Persons with Intellectual Disability. The Old Me New Me Treatment model would be the core treatment paradigm with other specialized treatments incorporated into the core treatment phases. Pictorial displays for his Old Me and New Me as well as the treatment plan would be presented to enhance his understanding of the complex and prioritized set of treatment targets and procedures. The “treatment package” involved 60 sessions over a 5-month period and was effective in stabilizing all of his clinical symptoms, establishing a New Me identity, and decreased his dynamic risk level.