I have attempted a new description of the salient clinical phenomenology of the primitive personality disorders (borderline, narcissistic, paranoid and schizoid), focusing in particular on absence of personality integration, sensorimotor-affective thinking, and an inability to recognize and to own significant emotional predispositions and institute appropriate behavioral adaptations. I conclude that these phenomena cannot adequately be comprehended either from the classical intrapsychic perspective and the cognitive and affective capabilities assumed to exist in normal and neurotic individuals, or from the perspective of self psychology. I propose an alternative model in which pathology of cognition and affect is postulated to be both the contemporary cause and the historical result of pathological adaptation. For these individuals, analysis of cognition and affect must occupy the central position that analysis of conflict and defence occupies in the treatment of the neurotic.