Mentalization-based therapy (MBT) formulates eating disorders as disorders of the self. This article examines the meaning of self-hatred and self-directed negativity as manifestations of self-alienation and vulnerable mentalizing. Relevant concepts are examined to substantiate MBT as a clinical approach to negative self-representations and epistemic mistrust. In this context, MBT states that a clinician's not-knowing stance is crucial to help elucidate underlying states of mind. Additionally, representing the patient as possessing an agentic-self is seen as crucial to the generation of curiosity about rigidified definitions of the self. Clinical vignettes are provided, and guidelines relevant to clinical practice are proposed.