The observation that both oral cravings and acting out need a satisfying object, demand immediate gratification, and have urgent incorporating tendencies without regard for the object leads Altman to view oral impulses and acting out as identical. When instinctual urges of both child and parent coincide there is a summation of effect. The child is threatened from within and without and has no chance of conflict-free fulfilment. Because of the partial instinctual gratification occurring in such acting out between parent and child the only course open is an effort to master and bind the excitation through repeated acting out, which produces a specific by-passing of the ego with a reversion to oral activity with further impairment of ego function.