Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…

The author describes a sub-group of anorexic patients who present themselves clinically as "invisible" and "insubstantial". The concept of "invisibility" is understood in terms of primitive object relations. The underpinning of this dynamic is a lack of separation and differentiation from mother and a consequent effort to live inside her skin. The…

This paper presents a detailed theoretical discussion of destructive narcissism in relation to Freud and Rosenfeld and later theorists. In destructive narcissism, the destructiveness is itself idealised and overrides "the vital functions which serve the purpose of self-preservation" (Freud, S., 1914, "On narcissism" S.E. 14: 87)--a feature which…