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This paper addresses the relationship between severe childhood physical abuse and both perverse states of mind and frank perversion in women. The psychic necessity for the perversion in these circumstances is discussed, together with the wide range of forms it may take. Psychoanalytic psychotherapy may pose great technical difficulties in such cases. This is because of both the strains the therapist must bear in the countertransference, and also the constant pressure on the therapist to enact with the patient her perverse internal object relationships.