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The fantasies of a group of heterosexual patients with irrational fears of being infected with AIDS are traced to an insecure masculine identity stemming from their relationships with narcissistic and neglectful fathers, who were nevertheless intrusively and vicariously involved in their sons' sexual lives. Although the fantasies are ostensibly about women, they focus on the presence of the man, who is seen as an unscrupulous seducer, while the patients consider themselves to be sensitive and nonsexist. The sexual urges driving the fantasies are ego-dystonic passive homosexual longings, while the unsuitable women these persons tend to choose are compromises between their instinctual wishes and their bondage to their fathers. The anxieties may have some resemblance to obsessive castration fears, such as of mutilation or wasting disease, that stem from oedipal prohibitions. They may also superficially resemble obsessions stemming from the defensive denial of aggressive wishes. However, according to Lewes, the core fear of this group of patients is that people will think they are homosexual, and therefore they will be subject to public ridicule as having had "passive anal intercourse with another man." Therapy may succeed via transference interpretation to enable patients to "acknowledge passive wishes as part of their sexual nature." When this occurs the panic recedes, the fear of AIDS disappears, and the heterosexuality of these patients becomes less pathological.