In this article we describe the use of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for people with a broad range of self-destructive behavioural problems including substance abuse, gambling, compulsive sexual activity, poor impulse control, violence, temper tantrums, self- harm, risk-taking, and the spectrum of eating disorder related symptoms. In this paper we will have a particular focus on patients with Eating Disorders (ED). We will define the different types of ED patients according to the metapsychology developed by Davanloo (1990, 2000). We will illustrate how unconscious mechanisms produce and perpetuate the self-destructive behaviours seen in these patients. Additionally, we will clarify how ISTDP may be an effective aid in working with these patients when behaviours are removed while psychopathological forces are still in operation. We will emphasise the technique as it applies to patients with severe fragile character structure/borderline organisation. We will also discuss unique treatment and therapist issues in working with behaviourally disordered patients.