Abstract
This paper details some different manifestations of inaccessibility encountered in working with eating disorders. Using clinical material relating to anorexia and bulimia, the destructive and defensive measures that make it so difficult to reach, understand and change such pathologies are explored. The main hypothesis is that the degree of inaccessibility is a salient prognostic indicator and marker of the severity of the eating disorder. The role and meaning of extreme, pervasive and rigid inaccessibility is considered along with psychic positions of greater porosity that offer more hope, optimism and ‘movement towards life’. Finally, the therapeutic implications are examined in attempts to work with these difficult to engage and often refractory conditions, both at the individual and institutional level.
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