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What follows is based on the clinical experiences gathered by the members of the borderline psychotherapy research project at the Westchester Division of the New York Hospital-Cornell Medical Center regarding the diagnostic assessment and psychotherapeutic approach to patients with borderline personality organization and associated eating disorders. Although the focus of our project is not on eating disorders per se, most patients with severe eating disorders suffer from significant character pathology, and the experience gained in the psychodynamic treatment of borderline patients has, we believe, relevance for treating patients with these disorders. In addition, our engagement with long-term psychodynamic psychotherapy with such patients, and the availability of a cognitive-behavioral inpatient service specializing in the treatment of eating-disorder patients provides us with the opportunity to compare and relate the experiences of these patients. Finally, my own clinical experience in the psychoanalytic and psychotherapeutic treatment of such patients has permitted me to study some of the dominant dynamic features described in the literature regarding this pathology.
The two principal eating disorders, anorexia nervosa and bulimia nervosa, occur mostly in females. Anorexia nervosa is characterized by body-weight reduction of at least 15 percent of normal and the patient's active refusal to achieve normal weight; these patients are afraid of gaining weight or becoming fat; they present significant disturbances in their body image and primary or secondary amenorrhea. Bulimia nervosa signals its presence by