In a patient series of 115 eating-disordered women, a secondary diagnosis of borderline personality disorder was associated with a reported history of sexual abuse. The association was specifically with childhood sexual abuse (first experience at less than 14 years), rather than with abuse later in life or with intrafamilial experiences. A model involving background features, precipitants, and immediate and long-term psychological consequences is suggested to explain this specific link to childhood abuse. The implications of this association for the treatment of anorexic and bulimic eating disorders are considered.