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In classical considerations, hysteria has often been viewed from the standpoint of secondary identifications and erotic drives. Clinical experience, however, shows that it is aggressive impulses which make for difficulty in the analytic relationship and determine its outcome. Moreover, the hysteric struggles not with ambivalence from the anal stage, but with oral aggression. The oral aggression is to be distinguished from the sexual aggression of sadism. It is a nonsexual hate, derived from a 'primary hostility' which is nonlibidinal in character and has the sole aim of destroying the object which threatens the hedonism of the narcissistic ego.
The author notes Dora's subsequent history and deep identification with her mother which was manifested in her contact with F. Deutsch. Dora's analysis with Freud gave little indication of such a pathological identification with her mother. The concept of negative identification would explain this problem. The hysteric confronted with an invading and all-powerful maternal imago resorts to the oral defense of negative identification. By this means, the hysteric inwardly conforms to mother but opposes her externally. This mechanism may seem to resemble Anna Freud's concept of identification with the aggressor, but there is neither a dominant role for projection nor the reversal of roles characteristic of identification