In our practice as psychoanalysts we frequently meet the perverse, and this may incorporate a range of pathologies. For example, borderline or psychotic structures are often associated with a sexualized and perverse use of the body. We discuss in the following clinical case study how sadistic sexual fantasies mingled with primal scene representation gave rise to persecutory anxieties, and how this blocked progress towards a resolution of the oedipal stage. It was at the point of intense psychic pain with a consequent fear of psychotic breakdown that the patient sought psychoanalytic help. We conclude that psychoanalytic treatment in such cases is likely to involve a deep regression, and that communication between the patient and the psychoanalyst will rely primarily upon a sharing of feelings and emotions.