A psychoanalytic formulation of bulimia, based on the work of Balint and Kohut, is presented. Its central thesis is that severe bulimics demonstrate a "basic fault" in their ego, specifically an impairment in functions which regulate tension. Because of this deficiency they are subjected to intolerable internal tension which enfeebles their sense of self. The typical bulimic sequence of dieting, binging, vomiting, relaxation, and repudiation is seen as a defensive reparative device which attempts to alleviate internal tension and to bridge the underlying fault. Illustrative case material is included.