The author discusses four inter-related themes of late adolescence: birth/death throes, oblivious objects, manic defences and the potential for physical symptoms, sometimes in emergency form. These issues will be elucidated through the psychoanalysis of a late adolescent who was bulimic and binge drinking. Though her symptoms were severe, elements of her dynamics are seen as characteristic of late adolescence. The definitive separation–individuation processes of late adolescence are seen as a final death throe of childhood and a birth throe of adulthood. In these death throes, the adolescent can see objects as oblivious. The late adolescent can resort to manic leaps to negotiate passages she feels unready for. Such leaps sometimes take the form of physical symptoms, sometimes in crisis form, as late adolescents separate more definitively than in earlier developmental periods.