The patient, a young-looking man of twenty-nine with congenital absence of his right ear, complained of obsessions which had 'dominated' his life for thirteen years. He was concerned about whether he infected people with his germs, whether he cheated if he did not read every word of an assignment, and he had a fear of hurting bugs. The idea of the bugs' suffering filled him with guilt, but if he believed the bugs had been killed, he felt no guilt. He was particularly concerned with bugs that might have been on his body.

These ideas about bugs were shown by analysis to be his defense against a dual wish,—to be violated (feminine) and to violate (masculine); both wishes were attended by fear. He also gained satisfaction in these fantasies. In his masturbation the moment of excitement was achieved when he did not know if he were a male or a female. During incest fantasies he could almost hear a voice say, 'You'll get your penis cut off'. Anxiety disappeared if he felt a bug on his body.