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Some borderline, narcissistic, and psychotic patients come into treatment acting out their anxieties of primitive loss, sadistic guilt, and persecution. These feelings and phantasies comprise the internal annihilation threat that Melanie Klein (1955) felt was at the core of human experience. This intrapsychic panic state emerges from the simultaneous fears of losing that which is necessary for survival (the object) and of being destroyed by that object. Often, the dread of attack and persecution comes first, followed by a phantasy of being abandoned or shunned. This is the result of internalization of traumatic object relations as well as the projection of aggression and envy. Through projective identification, a hypervigilant state escalates internally until the self and object are constantly embattled.
The life instincts and the death instincts normally exist in a state of balance. When the external world and the internal world create demands on or threats to the ego, the life instinct can become more powerful and actively challenge the threat. Or the death instinct can deny, erase, or neutralize the threat by shutting down the life instinct. By cutting off the link between the ego and the threat, the death instinct creates a defense, a magical sense of safety and omnipotence. Clinically, this may appear as masochism, martyrdom, and denial. Often, there is a seeming indifference to the cruelty of others because sadism exists as a part of splitting. Therefore, there is a denial of any important self-to-object link.