The narcissistic defences and a lack of emotional awareness (alexithymia) are both salient features of eating disorder pathology, as well as being linked to each other. As each of these characteristics impacts independently on treatment, it is important to understand how they interact within an eating-disordered population. The present study assessed the associations between the three core elements of alexithymia and the core and defensive elements of narcissism in this clinical group. Seventy eating-disordered patients completed standardised measures of alexithymia and narcissism, and multiple regression analyses were conducted in order to examine the relationship between these variables. Core narcissism (e.g. grandiosity, entitlement) was associated with difficulties in describing feelings to others, whereas the narcissistic defences were associated with difficulties in identifying feelings and distinguishing them from somatic experiences. These patterns of association suggest that different aspects of alexithymia are associated with different aspects of narcissism. Clinical suggestions are made for how these characteristics might require modifications of standard treatment approaches for the eating disorders.