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The discussion of Wooldridge’s paper (this issue) offers two theoretical ideas to conceptualize the psychodynamics and treatment of individuals with severe eating disorders. Multiple self-states posited by Philip Bromberg and others allows for an understanding of the often contradictory nature of eating disorder symptomatology. Pathological organizations and primitive anxieties, elaborated by Paul Williams, suggests that the deep psychotic layer of the personality must be reckoned with in order to help the patient. Wooldridge’s patient Sara is discussed from these two perspectives, and technical considerations are offered.