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The present study investigates the relationship among intrapsychic processes and aggressive-defiance behaviors (e.g., oppositionality, bullying and destructive tendencies) as influenced by biological sex. This study seeks to gain insight into the nature of the relationship between aspects of object relations (operationalized as the proportion of human movement responses on the Rorschach Inkblot test) and Defiance/Aggression (measured by youth self-report [SR]), by examining the moderating effect of sex. Results are based on a sample of youth (N = 62, 55% male, 45% female, 27% White, 34% Black, 21% Latine, 17% other, 68% below median income) ages 7-17, receiving mental health services at a community-based clinic in an underresourced urban population. Outcomes from the present study support the hypothesis that a child's sex may influence the relationship between aspects of object relations and aggressive-defiance behaviors; specifically, for females but not for males, higher levels of internalized images (an aspect of object relations) predicted less self-reported Defiance/Aggression. Broadly, these results suggest differences in the interaction of unconscious processes and aggressive-defiance behaviors for male and female youth. Furthermore, this study offers an integration of psychoanalytic theory with test data and demonstrates the applicability of personality assessment to treatment conceptualization.