The use of psychotropic medications in eating disorder patients with personality disorders (PDs) is a complex topic. In this overview, we do not focus on individual studies, but rather on the philosophical issues and broader management principles of medications in this comorbid population. We review a general construct of personality and PD development, the theories that underlie how medications might work in PDs, and the target-symptom approach to treatment. We also discuss the essential elements of the prescribing context, an approach to psychotropic medication selection in the borderline personality population, and general caveats for medication use in those with eating disorders. Despite available data, significantly more research is needed in this area.