Methods: This article explains how problems formerly viewed as related to aggressive or sexual impulses can now only be envisaged dialectically alongside the issues of identity, limits, and fears of engulfment or of abandonment by persons of trust. Narcissistic injury, and the impact of insecure relationships in early life occupy a central position in the understanding of these pathologies.
Conclusions: The capacity for self-awareness has led human beings towards an exponentially increased creative potential, but also towards boundless destructiveness. Both appear as a form of reaction in the face of a threatened territory and humiliated narcissism. Rather than the person's impulses, it is the biological emotional particularities of each person, and the quality of his or her internal security and narcissistic foundation that will determine that person's ability for containment, and the balance of his personality, in a process of constant exchange and co-construction with those around him. Adolescence is a particularly crucial period for the expression of these issues. The weight of constraints, whether biological or social, make the self and the familial and environmental setting central in their management. The person's ability to cope, or conversely his or her liability to be engulfed by trauma, are essential determinants of the prognosis.