AbstractThis paper describes an inpatient treatment programme specifically designed for normal weight bulimia nervosa patients who have a co‐morbidity marked by alcohol and drug abuse, ‘cutting’, repeated overdosing or stealing, or sexual disinhibition (multiimpulsive bulimia). The programme uses a rigorous ward regime and simple behavioural counselling, under the direction of a nurse‐counsellor to bring control to the many addictive and self‐damaging behaviours. The underlying emotional and personality issues are addressed by focal‐interpretive (psychodynamic) and cognitive techniques in both group and individual sessions. Major use is made of creative therapies and reality‐orientated therapies. General psychodynamic groups are mixed with focal groups using cognitive techniques. Patients respond well and the improvement in symptomatology is maintained during follow‐up. Those patients who describe poor peer relationships in adolescence and who find engagement in psychotherapy diffi