The author discusses the treatment of severe anorexic patients in the environment of a hospital. The patients he describes are typically older and have had unsuccessful treatment in the past. Story stresses the need to view these individuals with empathic psychodynamic understanding which in turn dictates the therapeutic approach. He cautions against the tendency to see them as simply anorexic and to aim for mere symptom alleviation. Focusing on the underlying conflicts and personalities of the patients he has treated, he likens them to schizophrenic, schizoid, and borderline individuals. Case material is used to illustrate dynamics, family interaction, and the rationale behind the therapeutic approach. Particular emphasis is placed on how the therapist and staff deal with the starving patient. The author emphasizes the need for examining and working through the pre-anorexic period, and for understanding and dealing with the countertransference phenomena, which can be very taxing in these cases.