The trend in contemporary psychiatry toward nosographic overkill must be met with skepticism by psychoanalytic clinicians. It is often said that as an analysis proceeds, the diagnosis of the patient becomes less and less clear. Seemingly pure diagnostic entities often evaporate when they are placed under the lens of psychoanalytic scrutiny. It is the exceptional patient who does not present a complex array of features stemming from various developmental crises and reflecting a myriad of defensive operations.

Nowhere is the wisdom of this axiom more apparent than in the psychoanalytic treatment of borderline patients. Obsessional, hysterical, and phobic symptoms may coexist with paranoid episodes in which reality testing is clearly lost. Diagnostic diversity of such proportions led Hoch and Polatin in 19491 to view such patients as