In this case review we will describe a female patient with borderline personality disorder, who has developed severe conversive symptomatology, highlighting in particular the psychodynamic point of view.

In the patient's history essential was the absence of both parents from her earliest infancy period (her mother suffered from postpartum depression, and her father abandoned the family) and then the childhood full of traumatic events, including physical abuse. The patient has established a disorganized system of attachment with intense separation difficulties. Luckily, there was an older stepbrother as a good replacement object. During her life the pattern of establishing unstable interpersonal relationships and taking risk was apparent, with a dramatic recent emotional relationship that lead to the repetition of earlier sadistic experiences.

During the in-patient treatment of the patient, positive transfer has been established with her therapist. Constant was the idealization-devaluation pattern, the fundamental unclear notion of self and very poor regulation of affect. With dominant immature defense mechanisms, internal disorganization of the patient was frequently solved by splitting, which, in situations of increased psychological distress, was manifested in the form of severe conversive attacks.

The goal of the treatment, which continues as outdoor-patient treatment, is to strengthen, through psychotherapy and supportive medical therapy, mature defense mechanisms, reduce her symptoms and provide a better quality of life and level of functioning. What is further encouraging is the unfinished psychological development and greater effectiveness of psychotherapeutic interventions in this age.